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Prosthetic Knee Joint Infection with Haemophilus influenzae 1 Year After Total Knee Arthroplasty: A Case Report and
Ahmed AlSharakhat1, Safiya AlMusawi2, Ahmed Husain3
1Department of Histopathology, Salmaniya Medical Complex, Manama, Bahrain.
Abstract:
BACKGROUND Haemophilus influenzae is a gram-negative bacterium that normally inhabits the mucosal surfaces of the upper-respiratory tract system of many healthy individuals. The capsular types of H. influenzae are found to be responsible of invasive infections such as meningitis, epiglottitis, orbital cellulitis, and bacteremia. H. influenzae is rarely described as a causative agent of periprosthetic joint infection (PJI). Here, we report a case of H. influenzae causing prosthetic knee joint infection 1 year after total knee arthroplasty. CASE REPORT A 59-year-old woman was admitted with a 1-day history of a painful right knee and inability to bear weight. She had undergone a unilateral total knee arthroplasty 1 year ago. She reported a history of recurrent upper-respiratory tract infections, with the most recent episode occurring 3 months prior to the current presentation. H. influenzae grew on 2 knee aspirate specimens and a peripheral blood culture. The isolated H. influenzae strain was beta-lactamase-negative and identified as a non-type B by the public health laboratory. The patient was successfully treated with intravenous ceftriaxone for a total of 30 days followed by oral cefuroxime for 14 days. She underwent a first-stage revision of the right total knee arthroplasty, debridement, irrigation, and spacer placement; subsequently, second-stage revision was performed. CONCLUSIONS The findings of this case report, coupled with a thorough review of the literature, demonstrate the pathogenic potential of H. influenzae in periprosthetic joint infection (PJI). The diagnosis of PJI can be difficult and the management needs a multidisciplinary team.
Insights
Haemophilus influenzae, a bacterium usually causing respiratory infections, can also cause prosthetic joint infections (PJI). This case highlights its pathogenic potential in knee replacement infections, emphasizing the need for multidisciplinary management.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Haemophilus influenzae is a common bacterium inhabiting human mucosal surfaces, typically causing respiratory infections.
- While known for invasive diseases like meningitis, H. influenzae is an infrequent cause of periprosthetic joint infection (PJI).
- This report details a rare instance of H. influenzae-induced prosthetic knee joint infection.
Purpose of the Study:
- To report a case of prosthetic knee joint infection caused by Haemophilus influenzae.
- To discuss the pathogenic potential of H. influenzae in periprosthetic joint infections.
- To highlight diagnostic and management challenges in PJI cases.
Main Methods:
- Case report of a 59-year-old woman with a painful prosthetic knee 1 year after total knee arthroplasty.
- Diagnosis confirmed by positive knee aspirate and blood cultures for H. influenzae.
- Treatment involved intravenous and oral antibiotics (ceftriaxone and cefuroxime) and staged surgical revision.
Main Results:
- Haemophilus influenzae was identified as the causative agent of the prosthetic knee joint infection.
- The isolated strain was beta-lactamase-negative and non-typeable.
- The patient successfully responded to a 44-day antibiotic course and surgical intervention.
Conclusions:
- Haemophilus influenzae possesses pathogenic potential for causing periprosthetic joint infections.
- PJI diagnosis can be challenging, requiring a high index of suspicion for unusual pathogens.
- Effective management necessitates a multidisciplinary approach involving infectious disease specialists and orthopedic surgeons.
