An unusual case of Erysipelothrix rhusiopathiae prosthetic joint infection from the Canadian Arctic: whole genome sequencing unable to identify a zoonotic source

Abstract

BackgroundErysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipeloid and is most frequently associated with exposure to domestic swine. Infection of native and prosthetic joints is a rarely reported manifestation.Case presentationWe describe a case of E. rhusiopathiae prosthetic joint infection in a woman with a history of exposure to wild animals in the Canadian Arctic. Patient management involved a 1-stage surgical revision exchange with an antibiotic impregnated cement spacer and 6 weeks of intravenous penicillin G followed by 6 weeks of oral amoxicillin. Ten previously reported cases of E. rhusiopathiae joint infection are reviewed. Recent increases in mortality due to infection with this organism among host animal populations in the Canadian Arctic have generated concern regarding a potential increase in human infections. However, whole genome sequencing (WGS) of the organism was unable to identify a zoonotic origin for this case.ConclusionsConsideration should be given to E. rhusiopathiae as a cause of joint infections if the appropriate epidemiologic and host risk factors exist. Expanded use of WGS in other potential animal hosts and environmental sources may provide important epidemiologic information in determining the source of human infections.

A recurrent prosthetic joint infection caused by Erysipelothrix rhusiopathiae: case report and literature review

“…Infection with E. rhusiopathiae has probably been underestimated so far and its identification may now be easier to achieve [19]. 16S rRNA gene sequencing has shown its usefulness in many clinical cases, particularly in cases of blood culture-negative endocarditis [20,21]. The use of a specific PCR has been reported in animal samples, especially for species serotyping [22], but seems to be of little use in human samples, due to the low prevalence of Erysipelothrix infection, and thus 16S PCR is plainly more relevant [21].…”

Osteoarticular Infections Caused by Erysipelothrix rhusiopathiae: Case Report and Literature Review

“…Erysipelothrix rhusiopathiae equally caused acute (evolving for 1–14 days) and chronic (evolving for 1–24 months) OAIs with 8 cases each, although previous reports mainly described them as a chronic process [ 6 , 15 ]. All 10 E rhusiopathiae –related cases of arthritis involved a single big joint, either native (n = 6) or prosthetic (n = 5), mainly the knee (n = 7).…”

Polyarticular septic arthritis caused by Erysipelothrix rhusiopathiae infection

“…Inoculation of the bacterial agent after a cutaneous lesion such as a wound or surgical procedures might be suspected. Indeed, five patients had infection of their prosthetic joints, [7][8][9]12,13 and our patient had undergone osteotomy of the knee. Thus, infection with E. rhusiopathiae might occur secondarily to under-recognised skin involvement.…”

“…1 However, isolation of the E. rhusiopathiae bacterium in synovial fluid is rare. Including the present case, only 12 cases of septic arthritis related to E. rhusiopathiae infection [4][5][6][7][8][9][10][11][12][13][14] have been reported (Table 1). The clinical presentation is mainly chronic monoarthritis of a large joint, notably the knee.…”