Listeria Monocytogenes Prosthetic Joint Infection, Case Report and Review of the Literature

Abstract

Background: Listeria monocytogenes causes bacteraemia in elderly and immunocompromised patients and rarely also in immunocompetent patients. In sporadic setting it can be challenging to diagnose. We present the first case of Listeria monocytogenes infection presenting as an acute infection of a prosthetic joint in an immunocompetent patient. Case summary: An immunocompetent patient presented with acute onset of right hip pain lasting for 3 days. The day before admission the patient had fever of 38.5°C and chills. The patient admitted having eaten raw meat some days prior to onset of symptoms. He had a prosthetic right hip implanted due to secondary arthritis 9 months prior to onset of hip symptoms. He was treated successfully with removal of mobile parts and appropriate antibiotic treatment. Conclusion: Sporadic focal infections with Listeria monocytogenes occur rarely and are often not diagnosed until the arrival of final culture results. Dietary history is also important when clinical history of patients is taken. Food consumption advice is important in immunocompromised, but also immunocompetent patients can get infected when eating raw food. Accurate diagnosis for orthopaedic samples is crucial. In order to successfully treat patients with a prosthetic joint infection, a tight collaboration between several specialists is needed.

Treatment of Prosthetic Joint Infection due to Listeria Monocytogenes. A Comprehensive Literature Review and a Case of Total Hip Arthroplasty Infection

“…In a recent study of 294 hips and knees, infection caused by LM was reported at a rate of 0.7%. We have found 67 cases with PJI caused by LM in English Literature (from 1987 until 2020) [ 2 , 3 , 5 , 20 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] ] ( Table 1 ). The mid-time from initial surgery to the onset of infection caused by LM in the prior literature was 6.8 years (range, 2 mo-21 y) whereas in this case was 9 years postoperatively ( Table 1 , Table 2 ).…”

“…Kleemann et al reported a recurrent infection 2 years after initial conservative treatment [ 9 ]. Of 9 patients (13.2%) treated with debridement 7 were reported to have good results over a 3-month to 20-month follow-up period, but 2 patients had implants removed later [ 5 , 6 , 14 , 20 , 24 , 32 , 33 , 36 ]. All were acute cases.…”

“…Search results were limited to articles written in the English-language. There were 33 publications; 31 were found in PubMed and 2 in Google Scholar where 67 cases were reported (the first one was reported in 1987 and the last one was reported in 2020) ( Table 1 ) [ 2 , 3 , 5 , 20 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] ]. The median age of the patients was 65 y (range, 29-87 y), there were ∼60% males and ∼40% females, 20 patients (30%) had TKA infection whereas 47 patients (70%) had THA infection including our case.…”

“…E.) Two-stage revision Iv Amp for 4 days; po Amp for 3 mo Asymptomatic 2y later 26) 2012 [ 2 ] 34 [59] 34/43 (1992-2010 FNRCL) Age was 72 (range, 16–89)/61% M 79% (NS particularly for Arth/sty) 79% (NS particularly for Arth/sty) Hip 26 Knee 8 9y median time 12 one-stage revision 2two-stage revision 5 removal 13 no surgery 2 NS Primarily Amox 80% with Ami 48% for median duration 15w Asymptomatic 5 mo later 27) 2015 [ 5 ] 1 [60] 72/F Polymyalgia rheumatic Prednisone Knee 2y Debridement Iv Amp 6w; po Amox 6 mo Asymptomatic mo later 28) 2016 [ 6 ] 1 [61] 61/M DM; Cushing syndrome Prednisolonemg Fludrocortisone Knee 2y Debridement Iv Amp/ TMP/SMX 6w; po Amox/ TMP/S MX for 7 w Asymptomatic several months later 29) 2018 [ 13 ] 1 [62] 78/F Rectal cancer None Hip 21y One-stage revision with the diagnosis of aseptic loosening Van prophylaxis (Implant microbiological analysis LM) Asymptomatic 6 mo later 30) 2018 [ 3 ] 1[63] 69/M DM. Anemia, Hypertension None Knee 3w Debridement, mobile parts were replaced Iv Amox/2w folloed by TMP/SMX/10w Asymptomatic 1y later 31) 2019 [ 20 ] 1 [64] 50/M None None Hip 9 mo Debridement, mobile parts were replaced Iv Amp/Rif 13 d; po Lev/Fif for 3 mo Asymptomatic 20 mo later 32) 2019 [ ...…”

“…It accounts for approximately 2% of prosthetic hip and knee infections [ 4 , 17 , 18 ]. However, in recent years, PJI shows an increasing tendency because of an aging population and the increased number of immunocompromised patients undergoing joint replacement surgery [ 7 , 9 , 19 , 20 ]. We reviewed the published studies in the English language and present a case of a patient with total hip arthroplasty who had been affected by Listeria monocytogenes (LM).…”