Table 1.
Summary of 7 cases of P. micra infection in the knee.
| Study | Sex | Age | Native joint or TKA? | Onset of knee pain | Dental history | Associated CPPD | Antibiotic treatment | Invasive interventions | Outcomes |
|---|---|---|---|---|---|---|---|---|---|
| Stoll, 1996 [17] | F | 68 | TKA | 4 y after TKA | Tooth abscess | No | 6 wk of IV clindamycin and IV rifampin | 12 d of daily needle aspiration and irrigation | Antibiotics continued for 2 mo after which dose reduced by 1/3 and continued for 2 y. No recurrence of infection and the patient regained full function of knee. |
| Riesbeck, 1999 [18] | M | 86 | Native | Sudden-onset | Bridges in upper and lower jaw but no periodontal disease | Since clinical relevance of the bacterial finding was considered vague, it was concluded that the diagnosis most likely was CPPD | IV cloxacillin | Arthroscopic irrigation | Found to have concurrent multiple myeloma without bony metastasis. Patient never fully regained function and became wheelchair bound. |
| Baghban, 2016 [19] | M | 65 | Native | Gradual onset for 3 wks | Dental work 2 mo before presentation; Periodontal disease without frank infection | No | 3 wk of IV clindamycin followed by 3 wk of IV ampicillin-sulbactam (switched due to allergic reaction to clindamycin) | Open irrigation and debridement | Normalization of ESR and CRP after 6 wk of antibiotic therapy. However, patient required a cane to ambulate. |
| Dietvorst, 2016 [20] | F | 68 | Native | Sudden-onset | None | Yes | 6 wk of po Clindamycin | Arthroscopic irrigation | Found to have concurrent CPPD disease. |
| Roy, 2017 [21] | M | 61 | Native | Sudden-onset after trauma | Dental cleaning 6 mo before presentation | No | IV ceftriaxone and metronidazole | TKA with debridement | Normalization of CRP after 10 wk of antibiotic therapy. |
| Sultan, 2018 [22] | M | 73 | Native | 2 d after local steroid injection | None | Yes | 6 wk of IV penicillin G | Arthroscopic irrigation | Patient regained full function of knee with some residual low-grade pain. |
| Bangert, 2019 [23] | F | 81 | TKA | 3 y after TKA | Periodontal disease without frank infection | Yes | IV moxifloxacin | TKA with debridement | Found to have concurrent CPPD Disease. Passed away from intraoperative cardiac arrest |
CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; F, female; M, male; TKA, total knee arthroplasty; CPPD, calcium pyrophosphate deposition disease.