UnusualSalmonella typhiperiprosthetic joint infection involving bilateral knees: management options and literature review

Abstract

A 70-year-old Indian woman, who had undergone primary bilateral total knee arthroplasty (TKA) for rheumatoid arthritis 10 months prior, presented with 10 days history of pain, swelling and erythema over both knees with pus discharging from the right knee. She had type 2 diabetes mellitus and was on long-term steroid, leflunomide and antitumour necrosis factor therapy for rheumatoid arthritis. Her clinical and laboratory features were suggestive of a haematogenous periprosthetic joint infection (PJI). The final diagnosis of bilateral PJI was made based on culture reports. Considering her underlying immunosuppression, a bilateral two-stage revision TKA was done with complete remission of symptoms and good functional recovery at last follow-up after 18 months. infection of prosthetic joint has not been reported in the literature. Patients presenting with gastrointestinal complaints and PJI should alert the clinician to the possibility of infection with such atypical organisms endemic to the region.

Salmonella sp. as the Cause of Periprosthetic Joint Infection of the Hip: Report of a Rare Case and Review of Past 10-year Literatures

“…as the cause of PJI has been reported by several previous authors during the past 10-years period [2], [3], [4], [5], [6], [7], [8], [9], [10]. It can occur after total knee arthroplasty (TKA) [2], [3], [5], [6], [9], [10] or THA [4], [5], [6], [7], [8]. In a series reported by Gupta et al [6], during 44 years study period (1969-2013) at Mayo Clinic (Rochester, USA), they only found six cases of Salmonella PJI.…”

Early Infection of Bilateral Total Knee Arthroplasty with Salmonella typhi: Case Report and Review of Literature

“…A PubMed search reveals 44 published cases of salmonella species infections out of which 32 were in the Hip and 12 were in the Knee. Majority (43/44) of these were caused by Non-Typhoid Salmonella (NTS) and only one was caused by S. Typhi [8]. The higher incidence seen with NTS is because these bacteria have a wider distribution and can manifest with bacteremia and extra intestinal manifestations [9,10].…”

“…The usual presentation in patients without knee replacement is Reactive arthritis after Enteric fever and in very rare cases septic arthritis [11,12]. All the infections by Salmonella reported till date had presented between 4 months to 9 years s after post surgery9 [8,13,14] but none had an Early presentation with S typhi. In previously reported cases with Salmonella 50 percent had an underlying immunosuppressive condition [7,15]-Sa typhi is mainly acquired through orofecal contamination with Gastrointestinal tract being primary focus and then via hematogenous spread it can go to the joints [16,17].…”

“…Also, patient did not have Sickle cell trait or any other immunocompromised state [19]. The only other case of bilateral simultaneous infection with Salmonella Typhi was delayed presentation at 10 months post-surgery and patient had underlying immunocompromised state and was on treatment with Immunomodulators [8] Treatment was directed based on culture sensitivity and as directed by infectious diseases consultations [17,20,21]. In absence of defined protocols infection was treated with 6 weeks of antibiotics [17,20,21].…”

“…Other species of salmonella-like enteritis and typhimurium have been reported in such patients [7]. There have been 4 prior instances of PJI [8] with Salmonella typhi in the English Literature but none of them had an acute presentation. We present a rare case of early periprosthetic joint infection of bilateral total knee arthroplasty with Salmonella typhi.…”