Near-fatal Periprosthetic Infection with Streptobacillus moniliformis: Case and Review

Smallbones, Matthew; Monem, Mohammed; Baganeanu, Marina; Okocha, M; Sofat, Rajesh

doi:10.7150/jbji.40635

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…Nonetheless, we expect that, in the future, the databases of the analyzers will be extended with new bacterial profiles and identification of S. moniliformis can become possible. Until then, the 16S rRNA sequencing remains the fundamental method for the identification of S. moniliformis [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Smallbones et al . (2020) described a case of TKA with S. moniliformis infection, who was unsuccessfully treated by arthroscopy and hence in need of two-stage revision surgery [ 11 ]. It remains debatable whether patients could be treated purely with antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…While arthralgia, pyogenic infection of the joint, antibiotic treatment of prosthesis infection and even arthroscopic treatment of an infected knee prosthesis have been reported before. We hereby present, to the best of our knowledge, the first case of a PJI caused by S. moniliformis in a patient who received a total knee arthroplasty (TKA) and was managed by surgical Debridement, Antibiotics and Implant Retention (DAIR) [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Rat bite fever in a total knee arthroplasty: an unusual case of periprosthetic joint infection

et al. 2022

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Background Periprosthetic joint infection (PJI) is a serious complication of orthopedic arthroplasty surgery. Rat bite fever is a rare infection with Streptobacillus moniliformis (S. moniliformis). Rat bite fever can lead to serious complications such as pyogenic infection of joints, bacteremia, endocarditis and even death. We hereby present the first case of a patient with a total knee arthroplasty, infected with S. moniliformis, successfully treated by surgical debridement, antibiotics and implant retention (DAIR). Case presentation The patient was a 64-year-old female. S. moniliformis was isolated from blood cultures and an aspirate of the left knee by 16S rRNA gene polymerase chain reaction technique. It was assumed that the S. moniliformis had a systemic origin and secondarily infected the knee due to fever nine days before the onset of symptoms of the knee. The patient was successfully managed with DAIR and intravenous administration of ceftriaxone for six weeks and oral doxycycline for another six weeks. Conclusions S. moniliformis is a rare pathogen and is difficult to culture. The 16S rRNA sequencing is helpful in the determination of a causative microorganism in the case of a culture-negative PJI. A DAIR procedure in combination with 12 weeks of antibiotics could successfully treat S. moniliformis prosthetic joint infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rat bite fever in a total knee arthroplasty: an unusual case of periprosthetic joint infection

et al. 2022

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“…Periprosthetic bone infection caused by Streptobacillus moniliformis was rst reported in 2020 by Smallbones et al, describing a case of infection in a knee replacement [10]. Therefore this publication is the second reported case with a periprosthetic focus in the worldwide literature.…”

Section: Discussionmentioning

confidence: 75%

A Rare Case of Periprosthetic Streptobacillosis - Rapid Identification via Nanopore Sequencing After Inconclusive VITEK MS Results

Spott

Schleenvoigt

Edel

et al. 2022

Preprint

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BackgroundStreptobacillus moniliformis is the main cause of human streptobacillosis, also known as rat-bite or Haverhill fever. Generally transferred by bites or scratches of rats and other rodents or by rat-excrement polluted water, symptoms commonly start to appear after < 10 days and are highly variable. Due to scarcity, non-specific symptoms, and difficulties in cultivating this fastidious organism, the correct diagnosis is frequently delayed.CaseHere, we report an 85-year old male with a left-sided prosthetic hip joint hospitalized because of immobilizing left hip pain. The patient denied fever, chills, and night sweats. There was no swelling or erythema. Via sonography an echo-free round mass was detected at the left hip. Punctuation of the hip joint revealed putrid secretion. From the synovial fluid and from concomitantly drawn blood cultures grew a pleomorphic, gram-negative rod after 48 h and 35 h, respectively. The microorganism formed small, grey, round, and convex colonies. VITEK and VITEK MS (MALDI-TOF) analysis brought no results. Therefore the unknown isolate was sent to the Institute for Infectious Diseases and Infection Control for sequencing. Following isolation, the DNA was sequenced using Nanopore Third-Generation Sequencing. After one hour enough data were generated to identify the microorganism as Streptobacillus moniliformis.ConclusionTo date, this is the second published case of a periprosthetic bone infection caused by Streptobacillus moniliformis. Although streptobacillosis has a mortality rate of around 10% in humans, it is rarely diagnosed and published. In this context, nanopore sequencing enables fast and reliable diagnostic results for identifying microorganisms and their properties.

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“…There were 87 cases identified from review of the literature over the period 2005 to 2020 1,3–77 . Children (aged <18 years) accounted for 28 (32%) of 87 patients, including 4 infants.…”

Section: Resultsmentioning

confidence: 99%

Rat-Bite Fever Due to Streptobacillus moniliformis

Croker

Prudence

Wilson

et al. 2021

Infect Dis Clin Pract

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Introduction: Rat-bite fever due to Streptobacillus moniliformis is an uncommon infection, which seems to have been increasingly diagnosed in the Hunter New England-Central Coast area of New South Wales, Australia, in recent years.Method: A case series was presented and a review of the literature since 2007 was performed.Results: Our case series includes 11 patients with a median age of 27 years (range, 8-61 years), all of whom were diagnosed with bacteremia. All patients reported rat exposure, although only 4 of 11 were bitten. Common features included fever, rash, joint pains, headache, and vomiting. Patients were mostly treated with 2 to 4 weeks of antibiotic therapy; complications were rare with resolution of symptoms at last follow-up in most cases. There have been 87 patients with rat-bite fever described in the literature since 2007. Clinical findings were similar to our case series although complications, particularly endocarditis and septic arthritis, occurred in approximately a third of cases. Conclusions:The case series and literature review of rat-bite fever describe a characteristic clinical picture with fever, arthritis, and rash; a history of rat exposure is supportive, and blood cultures with current laboratory techniques are usually diagnostic.

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Near-fatal Periprosthetic Infection with Streptobacillus moniliformis: Case and Review

Cited by 7 publications

References 17 publications

Rat bite fever in a total knee arthroplasty: an unusual case of periprosthetic joint infection

Rat bite fever in a total knee arthroplasty: an unusual case of periprosthetic joint infection

A Rare Case of Periprosthetic Streptobacillosis - Rapid Identification via Nanopore Sequencing After Inconclusive VITEK MS Results

Rat-Bite Fever Due to Streptobacillus moniliformis

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