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Thompson JC, Goldman AH, Tande AJ, Osmon DR, Sierra RJ. Streptococcus bovis Hip and Knee Periprosthetic Joint Infections: A Series of 9 Cases. J Bone Jt Infect 2020; 5:1-6. [PMID: 32117683 PMCID: PMC7045526 DOI: 10.7150/jbji.36923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/15/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction: Prosthetic joint infection (PJI) due to Streptococcus bovis group (SBG), specifically S. bovis biotype I (S. gallolyticus), is rare and associated with colorectal carcinoma. Little has been published regarding SBG PJI. We analyzed nine cases of SBG PJI at our institution, the largest series to date. Methods: The medical records of patients diagnosed with SBG PJI between 2000-2017 were reviewed. Patients were followed until death, failure, or loss to follow-up. Mean follow-up was 37 months (range 0.5-74 months). Results: Nine PJI in 8 patients with mean prosthesis age at diagnosis of 8 years (range 4 weeks-17 years) were identified. The median duration between symptom onset and treatment was 38 weeks (range 0.3 weeks-175 weeks). 8/9 had their PJI eradicated with treatment based on acuity of symptoms. Acute PJI (2) was treated with DAIR, and chronic PJI (7) was treated with 2-stage revision arthroplasty. 1 PJI with chronic PJI developed recurrent infection after initial treatment. All patients received post-operative IV antibiotics. 7/8 patients received Ceftriaxone. Three patients received lifelong oral antibiotics. 7/8 patients underwent colonoscopy. 5/7 patients were found to have polyps following PJI diagnosis with one carcinoma and two dysplastic polyps. The two patients without polyps had identifiable gastrointestinal (GI) mucosal abnormality: tooth extraction prior to symptom onset and diverticulosis on chronic anticoagulation. Conclusion: SBG PJI is typically due to hematologic seeding. Colonoscopy should be pursued for patients with SBG PJI. Surgical treatment dictated by infection acuity and 6-week course of Ceftriaxone seems sufficient to control infection.
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Affiliation(s)
| | | | - Aaron J Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Douglas R Osmon
- Department of Orthopedic Surgery.,Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Tanwar YS, Debnath A, Mehndiratta L, Kharbanda Y, Sardana R. Streptococcus gallolyticus infection after knee arthroplasty: A case report. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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McLawhorn AS, Nawabi DH, Ranawat AS. Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty. Open Orthop J 2016; 10:615-632. [PMID: 28503214 PMCID: PMC5408484 DOI: 10.2174/1874325001610010615] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/19/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a devastating complication following lower extremity total joint arthroplasty (TJA). It is a leading cause of morbidity and revision following TJA. As such, PJI is a significant driver of healthcare costs. The prevalence of PJI related to resistant and atypical organisms is increasing, and approximately 10-30% of PJIs are culture-negative. The purpose of this review is to summarize the current epidemiology, diagnostics, and management of PJI associated with resistant and atypical pathogens and of culture-negative PJIs. METHODS The published literature related to the epidemiology, diagnosis, and management of atypical, drug-resistant, and culture-negative PJI is reviewed. RESULTS The clinical diagnosis of PJI is often challenging, particularly when pathogens are fastidious or when antibiotics have been administered empirically. Molecular diagnostic studies, such as synovial α-defensin, may provide rapid, accurate identification of PJI, even in the setting of concurrent antibiotics administration or systemic inflammatory disease. Once PJI is diagnosed, two-stage exchange arthroplasty remains the gold standard for treating PJI with resistant microorganisms, since there is a high rate of treatment failure with irrigation and debridement and with one-stage exchange arthroplasty. CONCLUSION Additional research is needed to define the optimal treatment of PJIs associated with rare pathogens, such as fungi and mycobacteria. There is a need for inexpensive, reliable tests that rapidly detect specific microbial species and antimicrobial susceptibilities. Additional research is also required to define the specific organisms, clinical scenarios, surgical techniques, and antimicrobial regimens that allow for reproducible treatment success with prosthetic retention strategies.
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Affiliation(s)
- Alexander S McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
| | - Danyal H Nawabi
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
| | - Amar S Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA
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García-País MJ, Rabuñal R, Armesto V, López-Reboiro M, García-Garrote F, Coira A, Pita J, Rodríguez-Macías AIB, López-Álvarez MJ, Alonso MP, Corredoira J. Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review. Semin Arthritis Rheum 2016; 45:738-46. [PMID: 26992635 DOI: 10.1016/j.semarthrit.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.
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Affiliation(s)
| | - Ramón Rabuñal
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Victor Armesto
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - Amparo Coira
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Julia Pita
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - María Pilar Alonso
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Corredoira
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
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Jans C, Meile L, Lacroix C, Stevens MJA. Genomics, evolution, and molecular epidemiology of the Streptococcus bovis/Streptococcus equinus complex (SBSEC). INFECTION GENETICS AND EVOLUTION 2014; 33:419-36. [PMID: 25233845 DOI: 10.1016/j.meegid.2014.09.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 02/07/2023]
Abstract
The Streptococcus bovis/Streptococcus equinus complex (SBSEC) is a group of human and animal derived streptococci that are commensals (rumen and gastrointestinal tract), opportunistic pathogens or food fermentation associates. The classification of SBSEC has undergone massive changes and currently comprises 7 (sub)species grouped into four branches based on sequences identities: the Streptococcus gallolyticus, the Streptococcus equinus, the Streptococcus infantarius and the Streptococcus alactolyticus branch. In animals, SBSEC are causative agents for ruminal acidosis, potentially laminitis and infective endocarditis (IE). In humans, a strong association was established between bacteraemia, IE and colorectal cancer. Especially the SBSEC-species S. gallolyticus subsp. gallolyticus is an emerging pathogen for IE and prosthetic joint infections. S. gallolyticus subsp. pasteurianus and the S. infantarius branch are further associated with biliary and urinary tract infections. Knowledge on pathogenic mechanisms is so far limited to colonization factors such as pili and biofilm formation. Certain strain variants of S. gallolyticus subsp. macedonicus and S. infantarius subsp. infantarius are associated with traditional dairy and plant-based food fermentations and display traits suggesting safety. However, due to their close relationship to virulent strains, their use in food fermentation has to be critically assessed. Additionally, implementing accurate and up-to-date taxonomy is critical to enable appropriate treatment of patients and risk assessment of species and strains via recently developed multilocus sequence typing schemes to enable comparative global epidemiology. Comparative genomics revealed that SBSEC strains harbour genomics islands (GI) that seem acquired from other streptococci by horizontal gene transfer. In case of virulent strains these GI frequently encode putative virulence factors, in strains from food fermentation the GI encode functions that are pivotal for strain performance during fermentation. Comparative genomics is a powerful tool to identify acquired pathogenic functions, but there is still an urgent need for more physiological and epidemiological data to understand SBSEC-specific traits.
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Affiliation(s)
- Christoph Jans
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, 8092 Zurich, Switzerland
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, 8092 Zurich, Switzerland
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, 8092 Zurich, Switzerland
| | - Marc J A Stevens
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, 8092 Zurich, Switzerland.
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Abstract
Streptococcus pasteurianus is part of the normal flora of the intestine. It has also been isolated from various infection sites. However, to date it has not been reported as a cause of fulminant septicemia and death. We report the post-mortem findings in a splenectomized hemophiliac patient with cirrhosis and concurrent human immunodeficiency virus (HIV), hepatitis B and hepatitis C infections.
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Affiliation(s)
- D Alex
- Department of Pathology and Laboratory Medicine, Georgetown University Hospital/MedStar Health, Washington, USA
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Nagy MT, Hla SM, Keys GW. Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers. BMJ Case Rep 2013; 2013:bcr-2013-008709. [PMID: 23744853 DOI: 10.1136/bcr-2013-008709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immunecompetent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient's ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery.
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Affiliation(s)
- Mathias Thomas Nagy
- Department of Trauma and Orthopaedic Surgery, Macclesfield District General Hospital, Macclesfield, UK.
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The Role of Bacteria in Cancer Development. Infect Agent Cancer 2013. [DOI: 10.1007/978-94-007-5955-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liddle AD, Abram S, Iyer S, Andrade AJMD. Streptococcus gallolyticus prosthetic joint infection associated with undiagnosed colonic malignancy. Knee Surg Sports Traumatol Arthrosc 2012; 20:1069-70. [PMID: 21863307 DOI: 10.1007/s00167-011-1646-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Streptococcus gallolyticus is a group D streptococcus which was previously classified as part of the S. bovis/S. equinus complex. It is a rare pathogen in prosthetic joint infection but has been demonstrated to have a strong association with colorectal carcinoma. In this case, a patient with no symptomatology suggestive of colorectal carcinoma presented with a S. gallolyticus prosthetic joint infection. Awareness of the association prompted investigation and subsequent diagnosis of colorectal carcinoma which was successfully treated prior to two-stage revision knee replacement. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Alexander D Liddle
- Combined Orthopaedic and Medical Microbiology Service, Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK.
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Abstract
AIM An association between colonic carcinoma and Streptococcus bovis endocarditis/bacteraemia was first suggested in 1951. This knowledge has great clinical implications, yet we found scant awareness amongst general surgical trainees. The aim of this article was to review the evidence available in the literature and explore the pathophysiology behind this association. METHOD The literature was reviewed, between 1950 and 2008, using Pubmed, Embase and Ovid database searches. We utilized different combinations of the keywords: Streptococcus bovis, endocarditis, septicaemia and colon cancer/carcinoma. Quality assessment was determined using the Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001). Studies were selected based on their relevance to the aims to be addressed. RESULTS We included nine case reports and found 24 studies demonstrating an association between S. bovis bacteraemia/endocarditis and colon cancer; the reported incidence in studies was variable (6-67%). The majority of studies (20) were retrospective analysis of data; only four studies were prospective. A total of 12 of 24 studies also reported an association with extra-colonic malignancy (1-22%) and 12 with liver disease (3-57%). Eight studies relevant to the pathophysiology of this association were identified. CONCLUSION Streptococcus bovis endocarditis and/or bacteraemia is an early clue to the likely presence of colorectal cancer. Whilst further studies are required to determine the precise pathophysiology, clinicians should be aware of this association. It is advisable to investigate rigorously for colon cancer in all patients presenting with S. bovis endocarditis/bacteraemia; such patients may also present with liver disease or, occasionally, extra-colonic malignancy.
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