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Published on: February 25, 2022
An elderly male with septic arthritis and bacteremia
Jui Athavale1, Nandini Sethuraman2, Ram Gopalakrishnan3
1Institute of Infectious Diseases, Apollo Hospital, Chennai, India.
Abstract:
Rhodococcus hoagii is a gram positive actinomycete found in horses and cattle. Humans can be infected by ingestion or inhalation through contaminated food or soil. The organism usually infects immunosuppressed hosts with pneumonia being the common presentation. We present a case of an 89 years old, apparently immunocompetent host presenting with fever, encephalopathy and arthritis who grew Rhodococcus hoagii in blood and synovial fluid, The patient responded well to a combination of vancomycin, azithromycin and imipenem-cilastatin. Our case demonstrates that extra-pulmonary manifestations such as septic arthritis and bacteremia can be seen in immune competent hosts.
Insights
Rhodococcus hoagii infections, typically seen in immunocompromised individuals, can manifest as severe extra-pulmonary disease, including septic arthritis, even in immunocompetent hosts. This case highlights the importance of considering Rhodococcus hoagii in diverse clinical presentations.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Rhodococcus hoagii is a Gram-positive actinomycete commonly found in animals like horses and cattle.
- Human infections typically occur via ingestion or inhalation of contaminated food or soil.
- The organism predominantly affects immunosuppressed individuals, often presenting as pneumonia.
Observation:
- A case study of an 89-year-old, seemingly immunocompetent patient presenting with fever, encephalopathy, and arthritis.
- Rhodococcus hoagii was identified in blood and synovial fluid cultures from the patient.
- The patient showed a positive response to a combination antibiotic therapy.
Findings:
- This case demonstrates that Rhodococcus hoagii can cause severe extra-pulmonary infections, such as septic arthritis and bacteremia.
- Such manifestations can occur in immunocompetent hosts, challenging the typical presentation patterns.
- Successful treatment involved a combination of vancomycin, azithromycin, and imipenem-cilastatin.
Implications:
- Clinicians should consider Rhodococcus hoagii in the differential diagnosis of severe infections, even in immunocompetent patients.
- The findings expand the understanding of Rhodococcus hoagii's clinical spectrum beyond pneumonia in immunocompromised individuals.
- This case underscores the potential for diverse extra-pulmonary manifestations of Rhodococcus hoagii infections.
