Septic arthritis due to Legionella cincinnatiensis: case report and review of the literature

被引:0
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作者
Florian Banderet
Annette Blaich
Evelin Soleman
Valeria Gaia
Michael Osthoff
机构
[1] University Hospital Basel,Division of Infectious Diseases and Hospital Epidemiology
[2] University Hospital Basel,Division of Clinical Microbiology
[3] University Hospital Basel,Department of Plastic, Reconstructive, Aesthetic and Hand Surgery
[4] Ente Ospedaliero Cantonale,Swiss National Reference Centre for Legionella, Servizio di microbiologia EOLAB
[5] University Hospital Basel,Department of Clinical Research
来源
Infection | 2017年 / 45卷
关键词
Septic arthritis; Polymerase-chain reaction;
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摘要
Legionella spp. are an important cause of pulmonary and rarely extrapulmonary infections. L. cincinnatiensis has only been implicated in five cases to date. We herein report the first case of L. cincinnatiensis septic arthritis in a 90-year old lady with a past medical history of chronic kidney disease. She developed septic arthritis of her left wrist after having received intraarticular corticosteroid injections and oral corticosteroids administered for presumed chondrocalcinosis. Appropriate antimicrobial treatment of L. cincinnatiensis septic arthritis was delayed until identification of this organism in joint biopsies by broad-range bacterial PCR targeting the 16S rRNA gene with subsequent rDNA sequence analysis and by culture on special media. Reviewing all reported cases of septic arthritis caused by Legionella spp. other than L. cincinnatiensis it is notable that diagnosis was established by PCR in the majority of cases and only subsequently confirmed by special culture. Although most patients were immunosuppressed, outcome was favourable. Treatment consisted of a fluoroquinolone alone or in combination with rifampicin or a macrolide. Our case highlights the need for a high index of suspicion for infections with unusual/fastidious organisms when symptoms are suggestive of septic arthritis but conventional methods fail to identify a causative organism.
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页码:551 / 555
页数:4
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