Actinomyces neuii subsp. neuii Associated with Periprosthetic Infection in Total Hip Arthroplasty as Causative Agent

Abstract

Actinomyces neuii has until now not been described as a pathogen associated with periprosthetic infection in total joint replacement. The case presented here suggests that A. neuii subsp. neuii is a causative pathogen. The discussion and review of the literature indicate the impact that detection of Actinomyces species could have.

Anaerobic prosthetic joint infection

“…Actinomyces PJI is associated with signs of local inflammation, including pain, erythema, swelling and limited range of motion of the joint, as well as joint instability [24e27,39e41,96]. A number of cases also reported systemic symptoms, including fevers, leukocytosis and tachycardia [26,27,41]. Inflammatory markers, including sedimentation rate and C-reactive protein, were almost always elevated in the reported cases [24e27,39e41].…”

Prosthetic Joint Infection

“…In contrast to other anaerobic infections, which may exist as part of a polymicrobial infection (170,186), infections due to Actinomyces species are nearly uniformly monomicrobial (191)(192)(193)(194)(195). The clinical presentation is typically indolent, as in other Actinomyces infections.…”

Actinomyces and Related Organisms in Human Infections

“…According to recent reports, A. neuii, especially A. neuii subsp. neuii, seems to be the most frequently detected Actinomyces species in infected tissues around different types of prostheses, including mammary prostheses (225), penile prostheses (226), prosthetic valves (227), and hip prostheses (228), but also in connection to medical devices such as ventriculoperitoneal shunts (229,230) and peritoneal dialysis catheters (231). In addition, A. israelii and A. naeslundii have been identified as causative agents of periprosthetic infections of the hip or knee joints (232)(233)(234).…”