A 75-year-old man was diagnosed with probable Campylobacter jejuni prosthetic knee infection after a diarrheal illness. Joint aspirate and operative cultures were negative, but PCR of prosthesis sonicate fluid was positive, as was stool culture. Nineteen additional cases of Campylobacter prosthetic joint infection reported in the literature are reviewed.
CASE REPORTA 75-year-old man from Minnesota presented with a 6-day history of right knee pain and swelling. He had a history of bilateral knee arthroplasties performed 4 years prior, hypertension, and papillary thyroid cancer. Two years prior, he developed culture-negative right prosthetic knee joint infection (PJI), which was managed at another facility with two-stage resection-reimplantation of his right knee prosthesis. He had been doing well since then. One day before his current onset of knee pain, he developed acute, nonbloody diarrhea. He worked on a cattle farm but had no direct contact with animals, had no recent travel, did not recall consuming undercooked meats, and had no ill contacts. He was evaluated by his local doctors 3 days into his diarrheal illness. Stool was positive for Campylobacter antigen (ImmunoCard STAT! CAMPY; Meridian Bioscience, Cincinnati, OH). He was treated with oral azithromycin for 3 days. His diarrhea improved, but knee pain persisted and was associated with subjective fevers and chills. On the fifth day of illness, he presented to his local orthopedic surgeon and underwent right knee aspiration, which showed 27,900 leukocytes/l (88% neutrophils).The following day, he presented to our facility with a warm and tender right knee and a large effusion. Right knee aspiration yielded 127 ml of "brown murky" fluid with 42,681 leukocytes/l (92% neutrophils). The C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were 239 mg/liter and 47 mm/h, respectively. Gram stain of the aspirated fluid was negative, as were bacterial cultures (aerobic cultures on sheep blood and chocolate agar, anaerobic cultures in thioglycolate broth and on CDC sheep blood agar, and Campylobacter cultures under microaerophilic conditions on cefoperazone-vancomycin-amphotericin B [CVA] and buffered charcoal yeast extract [BCYE] agar) at 42°C and fungal and mycobacterial cultures, along with blood cultures. The patient underwent resection arthroplasty with placement of a vancomycin-and gentamicin-impregnated antibiotic spacer. Acute inflammation was present in periprosthetic tissue. Aerobic, anaerobic, and microaerophilic cultures (at 42°C) performed on two periprosthetic tissues and prosthesis sonicate fluid (1) were negative. A previously described Campylobacter jejuni/Campylobacter coli real-time PCR assay targeting cadF and designed for testing stool (2) was performed on sonicate fluid. The PCR assay was positive, with a crossing point value of 37.6 cycles (positivecontrol crossing point, 32.0 cycles). He was treated with intravenous meropenem (1 g every 8 h) and oral azithromycin (500 mg daily) for 6 weeks. The Campylobacter antigen-posit...
