We describe a case of shoulder hemiarthroplasty infection with Desulfovibrio legallii. Antimicrobial susceptibilities of 36 Desulfovibrio isolates are presented. Metronidazole and carbapenems exhibited reliable activity, although piperacillin-tazobactam did not. Eleven previous cases of Desulfovibrio infection are reviewed; most arose from a gastrointestinal tract-related source.
CASE REPORT
In July 2013, a 70-year-old woman with a 10-year history of palmoplantar psoriasis presented to our institution with a 6-month history of intermittent fever, chills, and left-shoulder pain. This had worsened over the preceding 2 weeks, and she had developed a diminished range of movement of her left shoulder. She had sustained a closed proximal humerus fracture which had been treated with a humeral endoprosthesis implanted 18 years prior to presentation. For about 8 years through August 2012, she had received treatment for psoriasis with twice-yearly intramuscular injections of 80 mg triamcinolone. In August 2012, she was placed on topical treatment and phototherapy. In attempt to improve her psoriasis, the patient reported soaking her hands and feet, which had many fissures and cracks, in Lake Superior and in the Pacific Ocean. Physical examination revealed a well-healed surgical scar over her left shoulder and a scant amount of swelling in the lower axilla. She had an elevated white cell count of 16 ϫ 10 9 /liter, an erythrocyte sedimentation rate of 35 mm/h (normal, 0 to 29 mm/h), and a C-reactive protein level of 204.3 mg/liter (normal, Յ8 mg/liter). An indium 111 bone scan showed asymmetric uptake around her left shoulder suggestive of periprosthetic infection. The cell count in the aspirated shoulder joint fluid was 25,075 white blood cells/l, with 99% neutrophils. Cultures of the aspirated joint fluid yielded moderate growth of small, pinpoint, clear colonies on CDC anaerobic sheep blood agar after 6 days of anaerobic incubation at 35°C (Fig. 1A); broth cultures were negative. The colonies measured about 1 mm in diameter and were graygreen and convex after 10 days of incubation (Fig. 1B). Gram stain showed spiral-shaped Gram-negative bacilli (Fig. 1C) which were motile, indole negative, and catalase positive with 15% H 2 O 2 . PrepMan Ultra (Life Technologies, Grand Island, NY) was used to prepare DNA for partial 16S rRNA gene PCR using primers 5=-T GGAGAGTTTGATCCTGGCTCAG-3= and 5=-TACCGCGGCT GCTGGCAC-3= with bidirectional amplification product sequencing performed using the same primers. A 496-bp sequence was generated, revealing 100% identity to Desulfovibrio legallii (strain H 1 ) (base pairs 4 to 499 of GenBank accession number FJ225426) (1, 2). Per our laboratory protocol, for species identification, a Ն99% agreement with a database strain with Ͼ0.8% separation from other species is required. The next-best matches were Desulfovibrio sp. canine oral taxon 070 clone 1P043 (GenBank accession number JQ295257) (96% match) and Desulfovibrio sp. canine oral taxon 070 clone 1J008 (GenBank accession number JQ294906) (95% ...