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Ureaplasma parvum prosthetic joint infection detected by PCR
John J Farrell1, Joshua A Larson2, Jeffrey W Akeson3
1University of Illinois School of Medicine, Department of Medicine, Peoria, Illinois, USA jjf@uic.edu.
Abstract:
We describe the first reported case of Ureaplasma parvum prosthetic joint infection (PJI) detected by PCR. Ureaplasma species do not possess a cell wall and are usually associated with colonization and infection of mucosal surfaces (not prosthetic material). U. parvum is a relatively new species name for certain serovars of Ureaplasma urealyticum, and PCR is useful for species determination. Our patient presented with late infection of his right total knee arthroplasty. Intraoperative fluid and tissue cultures and pre- and postoperative synovial fluid cultures were all negative. To discern the pathogen, we employed PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Our patient's failure to respond to empirical antimicrobial treatment and our previous experience with PCR/ESI-MS in culture-negative cases of infection prompted us to use this approach over other diagnostic modalities. PCR/ESI-MS detected U. parvum in all samples. U. parvum-specific PCR testing was performed on all synovial fluid samples to confirm the U. parvum detection.
Insights
This study reports the first case of prosthetic joint infection caused by Ureaplasma parvum, identified using polymerase chain reaction (PCR). This finding is significant as Ureaplasma typically infects mucosal surfaces, not artificial joints.
Area of Science:
- Microbiology
- Infectious Diseases
- Orthopedics
Background:
- Ureaplasma species, lacking a cell wall, are commonly linked to mucosal infections.
- Prosthetic joint infections (PJIs) typically involve bacteria with cell walls.
- Ureaplasma parvum is a recently defined species within the Ureaplasma genus.
Observation:
- A patient presented with a late-onset infection of a total knee arthroplasty.
- Standard cultures of intraoperative and synovial fluid samples were negative.
- The patient did not respond to empirical antimicrobial therapy.
Findings:
- Polymerase chain reaction coupled with electrospray ionization mass spectrometry (PCR/ESI-MS) detected Ureaplasma parvum in all tested samples.
- PCR/ESI-MS was crucial for identifying the pathogen in this culture-negative case.
- Confirmatory Ureaplasma parvum-specific PCR validated the findings.
Implications:
- This case highlights Ureaplasma parvum as a potential, albeit rare, causative agent of prosthetic joint infections.
- PCR-based methods are essential for diagnosing challenging, culture-negative infections.
- Understanding Ureaplasma's role in PJIs may refine diagnostic and treatment strategies.
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