Related Experiment Videos
[Streptococcus equisimilis associated septic arthritis/prosthetic joint infection]
Oğuz Reşat Sipahi1, Sebnem Ozkören Calik, Hüsnü Pullukçu
1Ege Universitesi Tip Fakültesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Izmir. oguz.resat.sipahi@ege.edu.tr
Abstract:
Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary systems. They are rare causes of human pharyngitis, arthritis, pneumonia, meningitis and bacteremia. In this report, a 71-years old male patient with Streptococcus equisimilis arthritis/prosthetic joint infection has been presented. The patient was admitted to the emergency service with the complaints of erythema, swelling and tenderness on right knee which had total knee prosthesis. Examination of synovial fluid punction sample yielded abundant amount of leukocytes (> 1000 cells/mm3). Empirical ampicillin-sulbactam (1 g q6h, parenterally) therapy was initiated. Bacteria which have been cultivated from synovial fluid specimen were identified as S. equisimilis. The isolate was found to be susceptible to penicilin, erythromycin and teicoplanin, and resistant to chloramphenicol and tetracycline. Although clinical presentation improved during the first ten days, symptoms recurred after the 10th day and the therapy was switched to teicoplanin. The recurrence was thought to be the result of antibiotic tolerence. The patient was treated successfully with teicoplanin, and no relapse or reinfection was observed during one year of follow-up. To our knowledge this is the first case of S. equisimilis arthritis reported from Turkey and first case of S. equisimilis associated prosthetic joint infection.
Insights
This case report details a rare instance of Streptococcus equisimilis prosthetic joint infection in a 71-year-old male. Successful treatment with teicoplanin highlights its efficacy in managing this challenging infection.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Group C streptococci, including Streptococcus equisimilis, are typically commensal flora but can cause invasive infections.
- Prosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery, often requiring complex management.
- Arthritis caused by S. equisimilis is uncommon, and PJIs specifically linked to this pathogen are exceedingly rare.
Observation:
- A 71-year-old male presented with symptoms of erythema, swelling, and tenderness in a right knee with a total knee prosthesis.
- Synovial fluid analysis revealed a high leukocyte count, indicative of infection.
- Empirical ampicillin-sulbactam therapy was initiated, followed by a switch to teicoplanin due to symptom recurrence.
Findings:
- Synovial fluid culture identified Streptococcus equisimilis as the causative agent.
- The S. equisimilis isolate demonstrated susceptibility to penicillin, erythromycin, and teicoplanin, but resistance to chloramphenicol and tetracycline.
- Recurrence of symptoms after initial improvement was attributed to antibiotic tolerance, necessitating a change in treatment.
Implications:
- This case represents the first reported instance of S. equisimilis arthritis in Turkey.
- It is also the first documented case of a prosthetic joint infection caused by S. equisimilis.
- The successful management with teicoplanin underscores its potential role in treating resistant or recurrent S. equisimilis PJIs.
Related Concept Videos
Endocarditis I: Introduction
Streptococcal Pharyngitis
Endocarditis II: Clinical Features of Infective Endocarditis
Endocarditis III: Medical Management
Rheumatic Heart Disease I: Introduction
Staphylococcal Skin Infections