Bacteroides fragilis infection of a knee prosthesis after haemorrhoidectomy

Anaerobic prosthetic joint infection

“…The majority of the published cases have been associated with Bacteroides fragilis [20e23]. The cases presented in the literature have similar features, including signs of both local (swelling, redness, pain, foul smelling purulence) and systemic (fevers, leukocytosis, sepsis) inflammation, as well as concurrent bloodstream infection [20,21,23]. All of the published cases were monomicrobial.…”

“…Three cases were associated with rheumatoid arthritis [20e22], and one occurred in a patient with Still's disease in which the patient was on prednisone, indomethacin and gold therapy [23]. Three cases were associated with concomitant gastrointestinal or genitourinary pathology (squamous cell carcinoma of the cervix treated with external radiotherapy [22], hemorrhoidectomy [21], and diverticulitis [20]). …”

“…The placement of semi-constrained prostheses has also been suggested to be a possible risk factor [21]. Table 1 summarizes the recommended treatment and duration for Bacteroides PJI.…”

“…Despite presenting as a late acute infection, the prosthesis was resected in published cases [20,23]. Two cases were treated with repeated joint aspirations and antimicrobial therapy; at 6 months one case showed no evidence of ongoing infection, in the second case, persistent warmth and swelling remained [21,22].…”

Septic complications after treatment of haemorrhoids

“…In these studies there were no clinically adverse events other than transient fever, but bacteraemic complications have been reported elsewhere following haemorrhoid treatment. Bacteroides fragilis infection of a 6-year-old knee prosthesis has been reported 3 months after haemorrhoidectomy, presumably secondary to bacteraemia, although the delay seems rather lengthy 16 . Two separate cases of meningitis have also been reported following haemorrhoid treatment.…”