Legionella micdadei, a New Cause of Prosthetic Joint Infection

Marı́n, Mercedes; Corral, Laura Castelo; Usubillaga, Rafael; Martín‐Rabadán, Pablo; Bouza, Emilio

doi:10.1128/jcm.00770-11

Cited by 22 publications

(14 citation statements)

References 15 publications

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“…Similar to L. pneumophila and other Legionella species, L. micdadei usually causes infection of the respiratory tract, most commonly manifested as lobar pneumonia, while lung abscesses or lung nodules have also been described . A few extrapulmonary cases have been reported, including cutaneous infection , brain abscess , prosthetic valve endocarditis , and prosthetic joint infection . Most cases of L. micdadei infection, including a nosocomial outbreak , involved immunocompromised patients.…”

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confidence: 99%

Mistaken identity: Legionella micdadei appearing as acid‐fast bacilli on lung biopsy of a hematopoietic stem cell transplant patient

Waldron

Martin

2015

Transplant Infectious Dis

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Legionella micdadei is a potential cause of invasive lung infections in immunocompromised hosts. On biopsy specimens, it can appear as an acid-fast bacillus (AFB) and can be mistaken for a member of genus Mycobacterium. As Legionella requires selective media to grow in culture, and a commonly used, commercially available urine antigen test for Legionella only detects Legionella pneumophila serogroup 1 but not L. micdadei, it is important to consider this organism in the differential diagnosis for AFB in immunocompromised hosts. We report a case of Legionella micdadei infection, which was initially treated empirically for non-tuberculous mycobacteria based on acid fast staining of biopsy tissue before the final diagnosis was made.

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confidence: 99%

Mistaken identity: Legionella micdadei appearing as acid‐fast bacilli on lung biopsy of a hematopoietic stem cell transplant patient

Waldron

Martin

2015

Transplant Infectious Dis

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“…4 Extrapulmonary manifestations appear mostly in immunocompromised patients such as petechial and macular or maculopapular skin lesions, 5 neurological abnormalities following Legionella pneumonia such as cerebellar disorders, 6 and prosthetic valve infection. Furthermore, 3 cases of native valve infection 7-10 as well as 6 cases of septic arthritis [11][12][13][14][15][16] are described due to different Legionella species. Here we report the first case of septic arthritis with supposed endocarditis caused by L. pneumophila serogroup 1.…”

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confidence: 99%

“…Legionella pneumophila (2 cases), L. longbeachae, L. bozemanii, L. micdadei, and L. dumoffii (1 case each) could be detected either by PCR or by culture. [11][12][13][14][15][16] Native valve endocarditis has been described in 2 cases in immunocompromised patients due to L. pneumophila serogroup 1 7 and Legionella cardiaca sp. nov. 8,9 The strains were detected either by blood culture or by PCR on aortic valve tissue.…”

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Legionella pneumophila Serogroup 1 Septic Arthritis With Probable Endocarditis in an Immunodeficient Patient

Thurneysen

Boggian²

2014

JCR: Journal of Clinical Rheumatology

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“…may also cause primary extrapulmonary disease, and septic arthritis has been reported. Four cases of septic arthritis (2,3,7,12), two cases of reactive arthritis (1, 13), and one case of a prosthetic joint infection (6) have been reported in the past. These pathogens were L. pneumophila (four cases), Legionella longbeachae (one case), Legionella dumoffii (one case), and Legionella micdadei in a prosthetic joint infection.…”

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confidence: 99%

“…Also, the 16S PCR assay has been used successfully to detect Legionella spp. in joint infections (6,7).…”

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Detection of Legionella bozemanae, a New Cause of Septic Arthritis, by PCR Followed by Specific Culture

et al. 2012

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Legionella bozemanae is a rare isolate in clinical specimens. We describe a case of joint infection due to L. bozemanae in an immunocompromised patient with dermatomyositis. Without the use of PCR screening or culture on specialized medium, the organism would not have been detected. CASE REPORTA 71-year-old woman with amyopathic dermatomyositis presented to the department of rheumatology with septic arthritis of the left knee. Her medical history included several admissions to the department during 2011, where she underwent a comprehensive diagnostic workup for dermatomyositis with underlying malignancy.During the investigation, three skin biopsy specimens were obtained, one close to the interphalangeal joint of her right thumb, one from the anterior aspect of the chest, and one from the right thigh. All of the skin lesions appeared as erythematous-toviolaceous papules and plaques.Unfortunately, the biopsy specimen from the thumb was complicated by septic arthritis due to Streptococcus agalactiae, followed by Staphylococcus aureus wound and bloodstream infections. However, the patient gradually recovered and the diagnostic program found no signs of malignancy. During the entire diagnostic workup, the patient had normocytic, normochromic anemia with hemoglobin levels of 5.0 to 7.0 mmol/liter.The patient was diagnosed with amyopathic dermatomyositis and started on immunosuppressive treatment with methotrexate (20 mg weekly), prednisolone (20 mg daily), and hydroxychloroquine (250 mg daily) and then discharged to a rehabilitation stay at a rheumatologic hospital. At discharge, both her white blood cell (WBC) count and her C-reactive protein (CRP) level were within normal the ranges.During this stay, the patient developed intermittent pain in her left thigh, with a concomitant rise in the CRP level to 24 mg/liter. During the next months, the pain in the thigh worsened and she experienced malaise and weight loss. Examination at our hospital revealed a swelling of her left knee. Ultrasound showed a large intracavital joint fluid effusion. Five milliliters of purulent aspirate was obtained from the left knee joint cavity (WBC count not available). Gram staining with carbol fuchsin as a counterstain showed numerous neutrophilic granulocytes but no bacteria or fungi. No crystals were detected. Cultures grown under standard conditions were negative (agar plates with 10% horse blood and thioglycolate broth [Statens Serum Institute, SSI Diagnostica, Hilleroed, Denmark] incubated for 48 h at 35°C with 5% CO 2 ). Blood samples showed anemia (5.4 mmol/liter), leukocytosis (WBC count of 13.9 ϫ 10 9 /liter with the following differential analysis: neutrophils, 12.4 ϫ 10 9 /liter; eosinophils, 0.0 ϫ 10 9 /liter; basophils, 0.0 ϫ 10 9 /liter; lymphocytes, 0.7 ϫ 10 9 /liter; monocytes, 0.8 ϫ 10 9 /liter), and an increased CRP level (54 mg/liter). X-rays of the left knee and chest were unremarkable. Blood and urine cultures were negative.Methotrexate treatment was withdrawn, and intravenous cefuroxime (1,500 mg three times daily) wa...

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Legionella micdadei, a New Cause of Prosthetic Joint Infection

Cited by 22 publications

References 15 publications

Mistaken identity: Legionella micdadei appearing as acid‐fast bacilli on lung biopsy of a hematopoietic stem cell transplant patient

Mistaken identity: Legionella micdadei appearing as acid‐fast bacilli on lung biopsy of a hematopoietic stem cell transplant patient

Legionella pneumophila Serogroup 1 Septic Arthritis With Probable Endocarditis in an Immunodeficient Patient

Detection of Legionella bozemanae, a New Cause of Septic Arthritis, by PCR Followed by Specific Culture

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