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Polymicrobial Late-Onset Knee Prosthetic Joint Infection Involving Parvimonas micra: A Case Report and Genomic

Mauro Jose Salles1,2,3, Daniel Litardi Pereira2, Ícaro Santos Oliveira2,3

  • 1Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Universidade Federal de São Paulo-UNIFESP, São Paulo CEP 04025-010, Brazil.

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Summary

This case study details a rare polymicrobial prosthetic joint infection in a knee replacement caused by Parvimonas micra and Staphylococcus aureus. Whole-genome sequencing revealed P. micra

Keywords:
Parvimonas micraanaerobic infectiondiagnosisprosthetic joint infectionwhole genome sequencing

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Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Microbiology
  • Genomics

Background:

  • Late-onset prosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
  • Polymicrobial infections are less common but can complicate treatment strategies.
  • Parvimonas micra is an emerging pathogen in chronic infections, often overlooked.

Purpose of the Study:

  • To report a rare case of polymicrobial late-onset knee PJI.
  • To characterize the virulence and resistance genes of the involved pathogens, particularly P. micra.
  • To highlight the role of P. micra in chronic biofilm-related PJIs.

Main Methods:

  • Case presentation of an 80-year-old female with a five-year-old total knee arthroplasty.
  • Synovial fluid analysis and intraoperative tissue and sonication fluid cultures.
  • Pathogen identification using MALDI-TOF MS and whole-genome sequencing (WGS).
  • Analysis of virulence and antibiotic resistance genes in P. micra.

Main Results:

  • Polymicrobial infection identified: Parvimonas micra and Staphylococcus aureus.
  • P. micra strain possessed virulence genes (groEL, tufA, clpP, ctrD, srtC4, gaIE) and vanW, vanT, vanY resistance genes.
  • Successful treatment with two-stage revision surgery and targeted antimicrobial therapy.
  • No recurrence observed at 12-month follow-up.

Conclusions:

  • Parvimonas micra can be a significant pathogen in chronic, polymicrobial prosthetic joint infections.
  • Whole-genome sequencing provides crucial insights into the genetic basis of virulence and resistance in rare PJI pathogens.
  • Early identification and targeted therapy are essential for successful management of complex PJIs.