Leuconostoc mesenteroides periprosthetic knee infection, an unusual fastidious Gram-positive bacteria: a case report

Abstract

BackgroundPeriprosthetic joint infections are mainly caused by Gram-positive cocci. Leuconostoc mesenteroides is a rare microorganism mainly causing bloodstream infections. At times, it might be confused with another type of cocci and give rise to misdiagnosed infections. Molecular diagnosis and biofilm production comprise important techniques to guide antibiotic treatment.Case presentationA 68-year-old Hispanic female with a previous history of bilateral knee arthroplasty presented with acute right-knee inflammation and gait impairment. Blood tests showed inflammatory response and knee x-ray revealed no prosthesis loosening. Irrigation and debridement was performed. Gram-positive cocci were obtained from cultures, and then biochemical and molecular identification revealed L. mesenteroides. Susceptibility and biofilm production were performed. The patient was treated with IntraVenous (IV) Ceftriaxone for ten days and was then switched to Amoxicillin-Clavulanate for 3 months with clinical and laboratory success.ConclusionsMicrobiology diagnosis of fastidious microorganisms is mandatory to treat periprosthetic joint infections adequately. L. mesenteroides may infect non-immunocompromised persons; however, treatment guidelines are lacking.

Leuconostoc mesenteroides bacteremia, a rare cause of septic shock

“…Son cocos gram (+) hemolíticos o alfa-hemolíticos (-) que crecen sobre agar de sangre de oveja y se confunden generalmente con Enterococcus o Streptococcus. En este caso en particular se pensó en una nueva infección por EVR posterior ( 4,5) al choque séptico .…”

“…Se consideran factores de riesgo para bacteriemia a Leuconostoc mesenteroides: catéter venoso central, administración de nutrición parenteral, cirugía gastrointestinal, tratamiento previo con vancomicina y diarrea crónica. Se acepta como principal probable puerta de (4,5) entrada la gastrointestinal pero también se plantea la piel como puerta de entrada . El presente caso cumple con varios factores de riesgo.…”

Acute Endophthalmitis Caused by Leuconostoc spp. following Intravitreal Bevacizumab Injection

“…Since the first reported human infection in 1985 [ 13 ], several cases and outbreaks of Leuconostoc infection have been reported, mostly in hospital settings and in immunocompromised patients [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Rare cases of Leuconostoc infection in immunocompetent hosts have been reported, including periprosthetic knee infection [ 14 ], and in a healthy infant [ 15 ]. To our knowledge, only 3 cases of endophthalmitis caused by Leuconostoc spp.…”

Multilocus Sequence Typing of Leuconostoc mesenteroides Strains From the Qinghai-Tibet Plateau

“…The demand for producing high quality dextran and their derivatives continues increasing all over the world ( Naessens et al, 2005 ). Compared to the immense applications in pharmaceutical, food and biotechnology industries, that in public health and food safety should be paid more attention and further investigations need to cover the origin of L. mesenteroides because of its frequent detection in different foods and its interaction to some gastrointestinal problem in humans ( Franco-Cendejas et al, 2017 ; Menegueti et al, 2018 ). In our study, Qula (a kind of fermented dairy food) is very popular in the Qinghai-Tibet Plateau region, but there are few reports about the microorganisms and food safety in Qula which poses some potential threats to diet health.…”