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

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Periprosthetic joint infections (PJIs) pose a significant challenge in orthopedic surgery.
• Late-onset PJIs often require complex management strategies.
• Penicillin hypersensitivity can limit treatment options for bacterial infections.

Observation:

• A 66-year-old female with a history of penicillin hypersensitivity developed a late acute periprosthetic infection of her total knee replacement.
• The patient underwent emergency surgery and intensive care admission.
• The causative agent was identified as Streptobacillus moniliformis.

Findings:

• This is the first reported case of prosthetic joint infection caused by Streptobacillus moniliformis.
• Standard culture methods have a low detection rate for this organism.
• 16S PCR is recommended as the primary diagnostic tool for Streptobacillus moniliformis detection.
• Rodent exposure history is a key factor in suspecting this infection.

Implications:

• Highlights the importance of considering rare pathogens in PJIs, especially with relevant patient history.
• Emphasizes the utility of molecular diagnostic methods like 16S PCR for challenging microbial identification.
• Suggests carbapenems as a viable treatment option for penicillin-hypersensitive patients with Streptobacillus moniliformis infections.