TABLE 1.
Main characteristics of 8 patients with septic arthritis due to Erysipelothrix rhusiopathiaea
| Patient (reference) | Sex, age (yr) | Debilitating conditions, exposure to animals | Suspected mechanism causing bacteria to spread to joint | Clinical features (duration before diagnosis) | Surgical procedures; antibiotherapy (duration) | Outcome (follow-up) |
|---|---|---|---|---|---|---|
| A (2) | M, 55 | Hemodialysis due to terminal PKD; occupation of butcher | Penetration through occupational skin injury | Acute shoulder monoarthritis, 38°C (4 days) | Arthrotomy, lavage; i.v. benzylpenicillin (3 weeks) | Cured (NP) |
| B (4) | M, 67 | Diabetes mellitus, CLL; no exposure known | Unknown | Chronic elbow mono-arthritis, fever NP (3 months) | Arthroscopic lavage; no antibiotics | Cured (NP) |
| C (1) | M, 18 | No debilitating conditions; septic knee laceration on rock by seashore | Inoculation during surgery, from preoperative cutaneous infection | Acute postoperative knee monoarthritis, 38.5°C (6 days) | Arthroscopic lavage + debridement; i.v. benzylpenicillin + ciprofloxacin (5 weeks) and then oral clindamycin + ciprofloxacin (16 weeks) | Cured (5 months) |
| D (9) | F, 41 | Oral and intra-articular steroids for SLE; Koi fish | Penetration through minor skin injury while cleaning aquariums | Chronic knee monoarthritis, no fever (1 month) | Arthroscopic lavage + synovectomy; i.v. penicillin (4 weeks) and then oral ciprofloxacin (2 weeks) | Cured (12 months) |
| E (6) | M, 76 | Aortic valve replacement, gout; fishing | Metastasis of an infective endocarditisb (?) | Chronic knee monoarthritis, no fever (6 months) | No surgical procedure; i.v. benzylpenicillin (4 weeks) and repeated arthrocentesis | Cured (NP) |
| F (7) | M, 76 | Long-term high-dose steroid use for rheumatoid arthritis and lupus nephritis; exposure to pigs while working in tanning factory | Total knee arthroplasty may have exacerbated preoperative latent chronic knee infection | Chronic prosthetic knee monoarthritis,c fever NP (14 months) | 2-stage exchange revision with lavage, debridement, synovectomy, and antibiotic-loaded spacer; i.v. benzylpenicillin + levofloxacin (3 weeks) and then oral clindamycin + levofloxacin (7 weeks) | Cured (12 months) |
| G (8) | F, 73 | Idiopathic osteoarthritis; hunting with his dog | Chronic wound of the heel | Chronic prosthetic hip monoarthritis,c fever NP (10 months) | 2-stage exchange revision with lavage, debridement, and antibiotics-loaded spacer; i.v. benzylpenicillin + levofloxacin (3 weeks) and then oral amoxicillin (8 weeks) | Cured (4 months) |
| Reported case | F, 68 | Alcoholism, gout, systemic steroids to treat very itchy skin lesions; feeding swine | Penetration through self-induced cutaneous abrasions or unrecognized erysipeloid | Chronic prosthetic knee monoarthritis,c no fever (2 months) | 2-stage exchange revision with lavage, debridement, synovectomy, and antibiotic-loaded spacer; i.v. imipenem + ofloxacin (2 weeks) and then oral clindamycin + ofloxacin (24 weeks) | Cured with sequelae (32 months) |
a
Abbreviations: M, male; F, female; CLL, chronic lymphocytic leukemia; i.v., intravenous; NP, information not provided; PKD, polycystic kidney disease; SLE, systemic lupus erythematosus.
b
This hypothesis is very unlikely considering infective endocarditis is “rejected” using modified Duke criteria and three hemocultures remained sterile.
c
With radiographic evidence of periprosthetic osteolysis.