Early Onset Prosthetic Knee Joint Infection by Mycobacterium Fortuitum: A Case Report and Literature Review
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Published:
Aug 17, 2019
Keywords:
Knee arthroplasty Non-tuberculous mycobacteria Rapidly growing mycobacteria Prosthetic joint infection Mycobacterium fortuitum
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Abstract
Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Non-tuberculous mycobacteria (NTM) are considered a very rare cause of knee prosthetic joint infection with only a few of such cases reported in the literatures. Mycobacterium fortuitum is one of the NTM defined as rapidly growing mycobacteria (RGM).
In this case report, we present an infected TKA case by M. fortuitum with an early onset of symptoms only 3 weeks from the index operation. Although the literature suggests two-stage exchange arthroplasty for surgical treatment in this group of patients, we could successfully treat this patient with debridement and prosthetic retention with the proper prolonged course of antibiotics. At 6-month follow-up, the patient revealed excellent functional outcomes with no signs of recurrent infection detected.
Article Details
Section
Case Report
References
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2. Brown-Elliott BA, Wallace RJ. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002; 15(4): 716-46.
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6. Porat MD, Austin MS. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty. 2008; 23(5): 787-9.
7. Parvizi J, Fassihi SC, Enayatollahi MA. Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthop Clin North Am. 2016; 47(3): 505-15.
8. Larsen LH, Lange J, Xu Y, Schønheyder HC. Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol. 2012; 61(Pt 3): 309-16.
9. Devi DG, Indumathi V, Indira S, Babu PS, Sridharan D, Belwadi MS. Injection site abscess due to Mycobacterium fortuitum: a case report. Indian J Med Microbiol. 2003; 21(2): 133-4.
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11. Wunsh SE, Boyle GL, Leopold IA, Littman ML. Mycobacterium fortuitum infection of corneal graft. Arch Ophthalmol. 1969; 82(5): 602-7.
12. Carson LA, Petersen NJ, Favero MS, Aguero SM. Growth characteristics of atypical mycobacteria in water and their comparative resistance to disinfectants. Appl Environ Microbiol. 1978; 36(6): 839-46.
13. Tortoli E. Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev. 2003; 16(2): 319-54.
14. Steingrube VA, Gibson JL, Brown BA, Zhang Y, Wilson RW, Rajagopalan M, et al. PCR amplification and restriction endonuclease analysis of a 65-kilodalton heat shock protein gene sequence for taxonomic separation of rapidly growing mycobacteria. J Clin Microbiol. 1995; 33(1): 149-53.
15. Control CfD, Prevention. Nontuberculous mycobacterial infections after cosmetic surgery--Santo Domingo, Dominican Republic, 2003-2004. MMWR Morb Mortal Wkly Rep. 2004; 53(23): 509.
16. Wallace Jr RJ, Musser JM, Hull SI, Silcox VA, Steele LC, Forrester GD, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis. 1989; 159(4): 708-16.
17. Henry MW, Miller AO, Kahn B, Windsor RE, Brause BD. Prosthetic joint infections secondary to rapidly growing mycobacteria: Two case reports and a review of the literature. Infect Dis (Lond). 2016; 48(6): 453-60.
18. Jitmuang A, Yuenyongviwat V, Charoencholvanich K, Chayakulkeeree M. Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection. BMC Infect Dis. 2017; 17(1): 802.
19. Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Rapidly growing mycobacterial infections: spectrum of diseases, antimicrobial susceptibility, pathology and treatment outcomes. J Med Assoc Thai. 2003; 86(8): 772-80.
20. Silcox VA, Good RC, Floyd MM. Identification of clinically significant Mycobacterium fortuitum complex isolates. J Clin Microbiol. 1981; 14(6): 686-91.
21. Muthusami JC, Vyas FL, Mukundan U, Jesudason MR, Govil S, Jesudason SB. Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery. ANZ J Surg. 2004; 74(8): 662-6.
22. Brown BA, Wallace RJ Jr, Onyi GO, De Rosas V, Wallace RJ 3rd. Activities of four macrolides, including clarithromycin, against Mycobacterium fortuitum, Mycobacterium chelonae, and M. chelonae-like organisms. Antimicrob Agents Chemother. 1992; 36(1): 180-4.
23. Nash KA, Zhang Y, Brown-Elliott BA, Wallace RJ Jr. Molecular basis of intrinsic macrolide resistance in clinical isolates of Mycobacterium fortuitum. J Antimicrob Chemother. 2005; 55(2): 170-7.
24. Schinsky MF, Morey RE, Steigerwalt AG, Douglas MP, Wilson RW, Floyd MM, et al. Taxonomic variation in the Mycobacterium fortuitum third biovariant complex: description of Mycobacterium boenickei sp. nov., Mycobacterium houstonense sp. nov., Mycobacterium neworleansense sp. nov. and Mycobacterium brisbanense sp. nov. and recognition of Mycobacterium porcinum from human clinical isolates. Int J Syst Evol Microbiol. 2004; 54(Pt 5): 1653-67.
25. Han XY, Dé I, Jacobson KL. Rapidly growing mycobacteria: clinical and microbiologic studies of 115 cases. Am J Clin Pathol. 2007; 128(4): 612-21.
26. Wallace RJ, Brown BA, Onyi GO. Susceptibilities of Mycobacterium fortuitum biovar. fortuitum and the two subgroups of Mycobacterium chelonae to imipenem, cefmetazole, cefoxitin, and amoxicillin-clavulanic acid. Antimicrob Agents Chemother. 1991; 35(4): 773-5.
27. Wang SX, Yang CJ, Chen YC, Lay CJ, Tsai CC. Septic arthritis caused by Mycobacterium fortuitum and Mycobacterium abscessus in a prosthetic knee joint: case report and review of literature. I Intern Med. 2011; 50(19): 2227-32.
28. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4): 367-416.
29. Cheung I, Wilson A. Mycobacterium fortuitum infection following total knee arthroplasty: a case report and literature review. Knee. 2008; 15(1): 61-3.
30. Cornelius L, Reddix R, Burchett C, Bond G, Fader R. Cluster of Mycobacterium fortuitum prosthetic joint infections. J Surg Orthop Adv. 2007; 16(4): 196-8.
31. Venter R, Solomon C, Baartman M. Mycobacterium fortuitum as infectious agent in a septic total knee replacement: Case study and literature review. SA Orthop J. 2015; 14(2): 52-6.
32. Herold RC, Lotke PA, MacGregor RR. Prosthetic joint infections secondary to rapidly growing Mycobacterium fortuitum. Clin Orthop Relat Res. 1987; (216): 183-6.
33. Saccente M. Mycobacterium fortuitum group periprosthetic joint infection. Scand J Infect Dis. 2006; 38(8): 737-9.
34. Booth JE, Jacobson J, Kurrus TA, Edwards TW. Infection of prosthetic arthroplasty by Mycobacterium fortuitum. J Bone Joint Surg Am. 1979; 61(2): 300-2.
2. Brown-Elliott BA, Wallace RJ. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002; 15(4): 716-46.
3. Buser GL, Laidler MR, Cassidy PM, Moulton-Meissner H, Beldavs ZG, Cieslak PR. Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010-2016. Emerg Infect Dis. 2019; 25(5): 849.
4. Cruz JDC, de Janeiro AMR. Mycobacterium Fortuitum: A new acid-fast bacillus pathogenic for man. Acta Med Rio de Janeiro. 1938; 1: 297.
5. Eid AJ, Berbari EF, Sia IG, Wengenack NL, Osmon DR, Razonable RR. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Clin Infect Dis. 2007; 45(6): 687-94.
6. Porat MD, Austin MS. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty. 2008; 23(5): 787-9.
7. Parvizi J, Fassihi SC, Enayatollahi MA. Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthop Clin North Am. 2016; 47(3): 505-15.
8. Larsen LH, Lange J, Xu Y, Schønheyder HC. Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol. 2012; 61(Pt 3): 309-16.
9. Devi DG, Indumathi V, Indira S, Babu PS, Sridharan D, Belwadi MS. Injection site abscess due to Mycobacterium fortuitum: a case report. Indian J Med Microbiol. 2003; 21(2): 133-4.
10. Dross IC, Abbatiello AA, Jenney FS, Cohen AC. Pulmonary infection due to M. fortuitum. Am Rev Respir Dis. 1964; 89: 923-5.
11. Wunsh SE, Boyle GL, Leopold IA, Littman ML. Mycobacterium fortuitum infection of corneal graft. Arch Ophthalmol. 1969; 82(5): 602-7.
12. Carson LA, Petersen NJ, Favero MS, Aguero SM. Growth characteristics of atypical mycobacteria in water and their comparative resistance to disinfectants. Appl Environ Microbiol. 1978; 36(6): 839-46.
13. Tortoli E. Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev. 2003; 16(2): 319-54.
14. Steingrube VA, Gibson JL, Brown BA, Zhang Y, Wilson RW, Rajagopalan M, et al. PCR amplification and restriction endonuclease analysis of a 65-kilodalton heat shock protein gene sequence for taxonomic separation of rapidly growing mycobacteria. J Clin Microbiol. 1995; 33(1): 149-53.
15. Control CfD, Prevention. Nontuberculous mycobacterial infections after cosmetic surgery--Santo Domingo, Dominican Republic, 2003-2004. MMWR Morb Mortal Wkly Rep. 2004; 53(23): 509.
16. Wallace Jr RJ, Musser JM, Hull SI, Silcox VA, Steele LC, Forrester GD, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery. J Infect Dis. 1989; 159(4): 708-16.
17. Henry MW, Miller AO, Kahn B, Windsor RE, Brause BD. Prosthetic joint infections secondary to rapidly growing mycobacteria: Two case reports and a review of the literature. Infect Dis (Lond). 2016; 48(6): 453-60.
18. Jitmuang A, Yuenyongviwat V, Charoencholvanich K, Chayakulkeeree M. Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection. BMC Infect Dis. 2017; 17(1): 802.
19. Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Rapidly growing mycobacterial infections: spectrum of diseases, antimicrobial susceptibility, pathology and treatment outcomes. J Med Assoc Thai. 2003; 86(8): 772-80.
20. Silcox VA, Good RC, Floyd MM. Identification of clinically significant Mycobacterium fortuitum complex isolates. J Clin Microbiol. 1981; 14(6): 686-91.
21. Muthusami JC, Vyas FL, Mukundan U, Jesudason MR, Govil S, Jesudason SB. Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery. ANZ J Surg. 2004; 74(8): 662-6.
22. Brown BA, Wallace RJ Jr, Onyi GO, De Rosas V, Wallace RJ 3rd. Activities of four macrolides, including clarithromycin, against Mycobacterium fortuitum, Mycobacterium chelonae, and M. chelonae-like organisms. Antimicrob Agents Chemother. 1992; 36(1): 180-4.
23. Nash KA, Zhang Y, Brown-Elliott BA, Wallace RJ Jr. Molecular basis of intrinsic macrolide resistance in clinical isolates of Mycobacterium fortuitum. J Antimicrob Chemother. 2005; 55(2): 170-7.
24. Schinsky MF, Morey RE, Steigerwalt AG, Douglas MP, Wilson RW, Floyd MM, et al. Taxonomic variation in the Mycobacterium fortuitum third biovariant complex: description of Mycobacterium boenickei sp. nov., Mycobacterium houstonense sp. nov., Mycobacterium neworleansense sp. nov. and Mycobacterium brisbanense sp. nov. and recognition of Mycobacterium porcinum from human clinical isolates. Int J Syst Evol Microbiol. 2004; 54(Pt 5): 1653-67.
25. Han XY, Dé I, Jacobson KL. Rapidly growing mycobacteria: clinical and microbiologic studies of 115 cases. Am J Clin Pathol. 2007; 128(4): 612-21.
26. Wallace RJ, Brown BA, Onyi GO. Susceptibilities of Mycobacterium fortuitum biovar. fortuitum and the two subgroups of Mycobacterium chelonae to imipenem, cefmetazole, cefoxitin, and amoxicillin-clavulanic acid. Antimicrob Agents Chemother. 1991; 35(4): 773-5.
27. Wang SX, Yang CJ, Chen YC, Lay CJ, Tsai CC. Septic arthritis caused by Mycobacterium fortuitum and Mycobacterium abscessus in a prosthetic knee joint: case report and review of literature. I Intern Med. 2011; 50(19): 2227-32.
28. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4): 367-416.
29. Cheung I, Wilson A. Mycobacterium fortuitum infection following total knee arthroplasty: a case report and literature review. Knee. 2008; 15(1): 61-3.
30. Cornelius L, Reddix R, Burchett C, Bond G, Fader R. Cluster of Mycobacterium fortuitum prosthetic joint infections. J Surg Orthop Adv. 2007; 16(4): 196-8.
31. Venter R, Solomon C, Baartman M. Mycobacterium fortuitum as infectious agent in a septic total knee replacement: Case study and literature review. SA Orthop J. 2015; 14(2): 52-6.
32. Herold RC, Lotke PA, MacGregor RR. Prosthetic joint infections secondary to rapidly growing Mycobacterium fortuitum. Clin Orthop Relat Res. 1987; (216): 183-6.
33. Saccente M. Mycobacterium fortuitum group periprosthetic joint infection. Scand J Infect Dis. 2006; 38(8): 737-9.
34. Booth JE, Jacobson J, Kurrus TA, Edwards TW. Infection of prosthetic arthroplasty by Mycobacterium fortuitum. J Bone Joint Surg Am. 1979; 61(2): 300-2.