Septic Arthritis Caused by Mycobacterium fortuitum and Mycobacterium abscessus in a Prosthetic Knee Joint: Case Report and Review of Literature

Abstract

Nontuberculous mycobacterium (NTM) is an infrequent cause of prosthetic knee joint infections. Simultaneous infection with different NTM species in a prosthetic knee joint has not been previously reported. A case of prosthetic knee joint infection caused by Mycobacterium abscessus and M. fortuitum is described in this report. The patient was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of prosthetic knee joint infection caused by NTM are reviewed.

Prosthetic knee joint infection due to Mycobacterium abscessus

“…Literature describes total of 25 cases of PJI, including 16 cases of knee-PJI, by RGM species including Mycobacterium chelonae , Mycobacterium smegmatis , Mycobacterium fortuitum , Mycobacterium wolinskyi , and M. abscessus ,123456789 of which only four were associated with M. abscessus 1489 [Table 1]. Diagnosis is frequently delayed due to similar clinical and laboratory presentation to a bacterial abscess and lack of its growth in routine culture adding to morbidity 7.…”

“…Many authors recommend removal of implants,3891718 especially in case of M. abscessus which is considered as one of the most resistant organisms to chemotherapeutic agents 118. Nevertheless, there is no common consensus on removal of well fixed prosthesis as there are few reports documenting complete eradication of infection with ATT only with retention of well fixed implants 12.…”

“…The American Thoracic Society guidelines suggest 6 months of multidrug therapy including clarithromycin/azithromycin with one parenteral antibiotic (amikacin/cefoxitin/imipenem, of which amikacin is considered most effective) 17. Wang et al 9. reported no relapse in 10 months after more than 9 months of ATT.…”

Bug or no bug: challenges in diagnosing cutaneous mycobacterial infections

“…However, NTM infections continue to occur in healthy individuals without any known immune dysfunction (e. g. recipients of prosthetic knees, fish tank granuloma patients, tattooed patients). These patients develop mostly primary cutaneous infections at the site of inoculation .…”

Keim oder kein Keim: Herausforderungen bei der Diagnose mykobakterieller Infektionen der Haut

“…Allerdings können NTM‐Infektionen auch bei gesunden Personen ohne bekannte Störungen des Immunsystems (wie Empfänger von Knieprothesen, Schwimmbadgranulom‐Patienten, tätowierte Patienten) auftreten. Diese Patienten entwickeln meist primäre kutane Infektionen an der Eintrittsstelle .…”