Hair of the Dog? Periprosthetic Joint Infection with Streptococcus canis

Abstract

A 61-year-old man underwent elective primary total hip arthroplasty at an academic center and presented to the emergency department 2 weeks later with a periprosthetic infection. Intraoperative cultures were positive for Streptococcus canis. He was successfully treated with one-stage revision and 6 weeks of intravenous cefazolin. It was later determined that the patient has a pet dog who frequently licks his legs. We hypothesize that patients with pets are more likely to carry this pathogen as part of their skin microbiome, and further research is required to establish whether S. canis poses an infectious risk beyond that of normal group B Streptococcus skin flora and if preoperative decolonization strategies are warranted.

Streptococcus canis, the underdog of the genus

“…Sporadic cases of human infection were described in the literature as case reports, with clinical manifestations such as purulent skin infection (Bert and Lambert-Zechovsky, 1997;Whatmore et al, 2001;Lam et al, 2007), cellulitis (Takeda et al, 2001;Lam et al, 2007), septicaemia (Bert and Lambert-Zechovsky, 1997;Takeda et al, 2001;Whatmore et al, 2001;Ohtaki et al, 2013;Taniyama et al, 2017), endocarditis (Amsallem et al, 2014;Lacave et al, 2016;Mališová et al, 2019), arthritis and bone infection (Tarabichi et al, 2018;McGuire et al, 2021). The majority of case reports of S. canis infection involve patients above 60 years of age, with various comorbidities or previous trauma.…”

“…Notably, a proportion of cases describe prior interactions with dogs (Takeda et al, 2001;Lam et al, 2007;Ohtaki et al, 2013;Amsallem et al, 2014;Lacave et al, 2016;Taniyama et al, 2017;Tarabichi et al, 2018;Mališová et al, 2019;McGuire et al, 2021), in particular dog bites or scratches (Takeda et al, 2001;Taniyama et al, 2017;Tarabichi et al, 2018). However, more direct evidence to support the hypothesis that dogs may be a source of S. canis zoonotic infection was presented in only one report, which described a woman developing S. canis septicaemia two weeks after a dog bite (Takeda et al, 2001).…”

“…This may be explained by the low prevalence of infection in humans and production animals together with the fact that it is broadly sensitive to commonly used antibiotics, which may contribute to it being given a low priority (Galpérine et al, 2007;Pinho et al, 2013). However, the health threat represented by S. canis should not be underestimated, particularly in light of the severe disease cases reported in humans and the documented acquisition of AMR (Takeda et al, 2001;Galpérine et al, 2007;Lam et al, 2007;Lacave et al, 2016;Tan et al, 2016;Fukushima et al, 2020b;McGuire et al, 2021). Potential virulence determinants of S. canis are summarized in Table 5.…”

“…The ability of S. canis to colonise and cause disease in a variety of mammals is well documented (Richards et al, 2012). Human infections are understood to be rare, although there has recently been an increase in reported cases (Takeda et al, 2001;Galpérine et al, 2007;Lam et al, 2007;Lacave et al, 2016;Tan et al, 2016;McGuire et al, 2021), and little is known about epidemiology in humans. Since dogs and cats are recognised as the main host species of S. canis, it is likely that human infection can result from direct 'pet-to-people' transmission, making S. canis a potentially zoonotic pathogen (Richards et al, 2012).…”

Genetic organization of an M protein trans-acting positive regulator (Mga) orthologue and its adjacent M-like protein (SCM) alleles in Streptococcus canis

“…This species was recovered from two Japanese patients with bacteremia who were in deep contact with or bitten by pet dogs [ 8 , 9 ]. Periprosthetic joint infection with S. canis has been described in a man undergoing elective primary total hip arthroplasty [ 10 ]; a pet dog had frequently licked his legs. Many Japanese individuals keep dogs or cats in their homes.…”