Chronic prosthetic joint infection caused by Listeria monocytogenes

Abstract

We report what is to the best of our knowledge the first case of persistent human listeriosis. A housewife underwent excision of a leiomyosarcoma and implantation of a prosthetic knee device. Infection of the device with Listeria monocytogenes occurred and persisted for 2 years. Despite having an allergy to ampicillin, the patient was cured solely by antibiotics and without surgery.

The arsenal of virulence factors deployed byListeria monocytogenesto promote its cell infection cycle

“…Perinatal listeriosis increases the probability of abortion, stillbirth or birth of a baby with generalized infection, sepsis or meningitis. 9 L. monocytogenes is also able to induce a broad variety of uncommon focal infections; cases of endocarditis, 10 cutaneous infection, 11 joint infection, 12 myocarditis and necrotizing fasciitis 13 have been described. Among the L. monocytogenes strains, those of serovars 1/2a, 1/2b and 4b are responsible for 95% of human infection cases.…”

Late Hip Arthroplasty Infection Caused byListeria monocytogenesin a Non-Immunocompromised Patient

“…A remarkable feature of prosthetic joint infection with L. monocytogenes is the long period between implantation of the prosthetic device and manifestation of the infection. The late occurrence of the infection in prosthetic joints suggests a transient bacteremia and hematogenous route of infection and most likely is not associated with the surgical operation itself [1][2][3][4]7,12,[14][15][16]18,20,21]. As in the present patient, the disease expresses as severe joint pain and fever.…”

“…Nieman et al, were the first to report in 1980, on L. monogytogenes arthritis [11]. Meningitis and sepsis in neonatal infants, bacteremia, endocarditis, prosthetic valve endocarditis, and endophthalmitis are the infections reported most frequently; osteomyelitis, septic arthritis, and prosthetic joint infections are rare [1][2][3][4][5]7,[12][13][14][15][16][17][18][19][20][21].…”

“…In approximately one-half of the cases reported in the literature, such infections were treated successfully by a combination of two-stage revision surgery and antibiotic therapy [5,7,[14][15][16]21,24]. In the remaining cases, treatment by intravenous administration of ampicillin and gentamicin followed by prolonged oral administration of trimethoprim/ sulfamethoxazole or ampicillin [15,20] was efficacious. In immunocompromised patients, prolonged antimicrobial treatment certainly is necessary [6,15,20,25].…”

“…In immunocompromised patients, prolonged antimicrobial treatment certainly is necessary [6,15,20,25]. In all cases, the infection appears to be more insidious and indolent than similar infections with S. aureus, and in view of the frequent recurrence because of the inoculation of the prosthesis and the intracellular growth of the organism, a six-week period of intravenous antibiotic therapy followed by at least three months of oral therapy is indicated [1,3,4,7,12,[14][15][16]18,20,21]; lifelong antibiotic therapy does not seem to be necessary [18].…”