Listeria monocytogenes infection in a prosthetic knee joint in rheumatoid arthritis.

Abstract

The prosthetic knee joint of a 64 year old woman with severe rheumatoid arthritis was found to be infected with Listeria monocytogenes. After treatment with intravenous antibiotics, symptoms gradually resolved. She subsequently received prolonged treatment with oral co-trimoxazole and 18 months later remained well.Listeriosis is an uncommon cause of joint infection in rheumatology despite its predilection for the immunocompromised host. Listeria monocytogenes causes neonatal infections, septicaemia (resulting in a flu-like illness in pregnancy), and meningoencephalitis. There have been reports of listeria septic arthritis1-3 and two cases of infected prosthetic joints.4 5 No cases of listeria joint infection were found in a previous survey of non-prosthetic bacterial arthritis from this hospital.6Rheumatology Unit,

Antimicrobial chemotherapy of human infection due toListeria monocytogenes

“…Listerial septic arthritis has been described both in normal and prosthetic joints (2,(96)(97)(98)(99). Normal joints infected with Listeria monocytogenes have been successfully treated with ampicillin plus gentamicin for two weeks when combined with drainage plus irrigation (2).…”

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

“…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].…”

“…Prosthetic joint infections usually occur in patients with malignant disease, diabetes mellitus, chronic kidney disease, or liver disease, or in elderly or immunocompromised patients [3][4][5][6]. Listeria monocytogenes infections have become a topic of interest recently because of the increase in prosthetic joint replacement operations in patients receiving immunosuppressive therapy, such as for rheumatoid arthritis [1,[6][7][8].…”

Listeria monocytogenes infection in prosthetic joints

“…A review of the literature by Louthrenoo and Schuhmacher [14], published in 1990, revealed only four cases of prosthetic joint infection by L. monocytogenes in three hips and one knee. By 1991 ten cases had been reported, including the two patients presented in this paper, with six in the hip and four in the knee [ 1,5,9,10,11,15,25,27]. It is possible that the actual incidence of listeria prosthetic joint infections has not increased but that further awareness of this possibility has led to a more thorough laboratory examination of gram positive bacilli.…”

“…Regular consumption of unpasteurized milk was recorded for patient B, and the literature supports a role for raw milk consumption in at least two listeria epidemics [2,23]. Booth et al recently reported a patient with a prosthetic knee joint infection secondary to L. monocytogenes who also regularly consumed unpasteurized milk [9]. Epidemiological and laboratory studies have implicated processed meats as a cause for listeriosis [22].…”