Artritis séptica por Listeria monocytogenes sobre rodilla protésica en una paciente con artritis reumatoide y macroglobulinemia de Waldenström

Abstract

CASO APORTADOMujer de 76 años con antecedentes de cardiopatía isquémica, diagnosticada de artritis reumatoide seronegativa en 1992 por una [0212-7199 (2006) RESUMENListeria es un bacilo grampositivo que puede aislarse del suelo y de las heces de la mayoría de los mamíferos. Rara vez es patógena en la población sana, pero, en pacientes inmunocomprometidos, puede provocar diversas infecciones focales y, sobre todo, meningoencefalitis y sepsis. No obstante, las artritis sépticas son complicaciones excepcionales. Aportamos un nuevo caso de artritis séptica por L. monocytogenes sobre una prótesis de rodilla en una paciente con artritis reumatoide seropositiva y macroglobulinemia de Waldenström. Adicionalmente se revisa la literatura acerca de las infecciones articulares por Listeria.

Unusual Listeria monocytogenes hematogenous infection in total knee replacement treated with one-stage revision surgery

“…Most LM infections are asymptomatic in immunocompetent people or rarely cause a flu-like syndrome or a gastrointestinal disease [11], [12]. There have been a few reported cases of septic arthritis caused by LM and the majority of patients were immunocompromised or had an underlying disease [6], [15], [17], [18], [25]. Concomitant underlying diseases and/or their therapeutic management can lead to alterations of the immune system which makes individuals more susceptible to infection [26].…”

“…Meningitis and bacteremia are the most common clinical syndromes described in the literature. Endocarditis, prosthetic valve endocarditis, and endophthalmitis are frequent too, but septic arthritis and PJIs are extremely rare [4], [5], [6], [15], [16], [17], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]. PJIs are rare, but can lead to severe complications, including permanent joint removal.…”

“…LM infections have been more frequent recently because of the increase in prosthetic joint replacement in patients receiving immunosuppressive therapy, such as for rheumatoid arthritis [7], [15], [17], [18]. In this paper, we describe a previously healthy patient, without immunological compromise, with a late total knee arthroplasty (TKA) hematogenous infection caused by LM treated with one-stage revision surgery.…”

Successful Debridement of a Knee Joint Prosthesis Infected with Listeria Monocytogenes. Case Report and Review of Current Literature

“…To our knowledge there are a few described cases of Listeria monocytogenes infected patients who were successfully treated with joint lavage, although in each case the maximum follow up duration was six months. 9 - 11 Chougle et al only used AB in an infected elderly patient after hip joint replacement with a good outcome 18 months follow up. 14 Since Morchon et al reviewed the literature on prosthetic joint infection with Listeria monocytogenes up to 2007, 7 we also summarized all literature published from a later date.…”

“… 1 , 3 - 8 Only 3 case reports have described joint lavage as a treatment in case of such an infection, each with positive outcomes but all with a rather short follow-up. 9 - 11 We report the rare case of a Listeria monocytogenes infection of a prosthetic knee joint with a good outcome one year after treatment with antibiotics, surgical debridement, lavage and implant retention. We also present an overview of recent literature on this topic.…”