Isolated Septic Arthritis of the Hip Due to Fusobacterium nucleatum in An Immunocompetent Adult: A Case Report and Review of the Literature

Abstract

Introduction: Hip septic arthritis is more common in children than in adults. Staphylococcus aureus and Streptococcus spp. are commonly found in association with septic joints. In contrast, Fusobacterium nucleatum septic arthritis in adults is extremely rare. To the best of our knowledge, only five cases have been reported in the literature in English, and three of them were cases of periprosthetic joint infection. We report a rare case of hip septic arthritis due to F. nucleatum in an immunocompetent adult. Case Presentation: A 56-year-old Asian man with a history of bilateral Perthes’ disease and mild alcoholic liver disease presented to our hospital complaining of worsening right hip pain and difficulty in walking for the previous 3 weeks. On presentation, his temperature was 38.7°C, and laboratory results showed a white blood cell count of 19 200 cells/µL and a C-reactive protein level of 43.56 mg/dL. Hip movements were limited due to pain. Contrast-enhanced computed tomography and magnetic resonance imaging showed fluid retention, suggesting infection. F. nucleatum was detected in the culture test from joint aspirate. Surgical drainage was performed 3 times in combination with antibiotherapy. Finally, we performed two-stage total hip arthroplasty, and the post-operative course was uneventful without implant loosening or infection relapse. Conclusion: The patient had a history of Perthes’ disease and had hip osteoarthritis, which may have contributed to the development of hip septic arthritis. We treated this rare case of hip septic arthritis due to F. nucleatum with two-stage revision surgery and antibiotherapy. Clinicians should be aware that F. nucleatum could be the etiologic agent of hip septic arthritis in an immunocompetent patient. Keywords: Septic Arthritis, Hip joint, Fusobacterium nucleatum, Adult

The hypotheses of oral disease‐associated perioprosthetic joint infections to understand the role of oral health for endoprostheses ‐ a narrative review

“…Another finding in literature, that is, the occurrence of Porphyromonas gingivalis in synovial joint fluids arthritis 8 appear rather a consequence of the inflammation (favorable conditions for Porphyromonas gingivalis ) than a cause. This might be similar for other microbiota including Fusobacterium nucleatum and Parvimonas micra , which were frequently found in native infected joints of patients, who were not treated by an EP 42–46 . The logical consequence appears to be the presumption, that the microorganisms favor inflammatory conditions, resulting to their colonization of inflamed tissues and areas.…”

“…This might be similar for other microbiota including Fusobacterium nucleatum and Parvimonas micra, which were frequently found in native infected joints of patients, who were not treated by an EP. [42][43][44][45][46] The logical consequence appears to be the presumption, that the microorganisms favor inflammatory conditions, resulting to their colonization of inflamed tissues and areas. Nevertheless, it must be recognized that especially potentially periodontal pathogenic bacteria have various mechanisms to interfere with the host immune mechanisms; the ability of certain species to evade the immune system, their virulence factors, and pathogenic potential must be considered.…”

Quantitative Proteomic Analysis of Outer Membrane Vesicles from Fusobacterium nucleatum Cultivated in the Mimic Cancer Environment

“…It is isolated most frequently from both healthy and diseased sites in the oral cavity and is commonly known as a key pathogen in gingivitis and periodontitis ( 1 – 3 ). It has also been isolated in several inflammatory processes at distinct body sites, such as endocarditis ( 4 , 5 ), septic arthritis ( 6 , 7 ), liver ( 8 , 9 ) and brain ( 10 , 11 ) abscesses and has been implicated in adverse pregnancy outcomes ( 12 , 13 ). F. nucleatum was first reported in colorectal cancer (CRC) tissue in 2011, suggesting that a higher abundance of F. nucleatum was significantly associated with CRC ( 14 , 15 ).…”