Forgotten intrauterine contraceptive device - A threat to total hip prosthesis: A case report with review of the literature

A Case of Actinomyces Prosthetic Hip Infection

Actinomyces is a species of gram-positive anaerobic commensal organisms found in the human oropharynx, gastrointestinal, and genitourinary tracts, which most often are implicated in cervicofacial infections. Rarely do these organisms cause joint infections. We present the case of a 68-year-old man with a prosthetic hip infection due to Actinomyces species. He underwent surgical incision and drainage with replacement of the prosthetic joint. Cultures grew Actinomyces species, and he was treated with a four-week course of ampicillin-sulbactam followed by eight weeks of amoxicillin-clavulanate. This organism is an uncommon pathogen, and few cases of prosthetic joint infection due to Actinomyces have previously been reported.

Prosthetic Joint Infection due to Actinomyces species: A case series and review of literature

Background: Actinomyces prosthetic joint infections (APJIs) are rare and optimal medical and surgical treatment strategies are unknown. The purpose of our study was to characterize the demographics, risk factors, management and outcomes of patients with PJIs due to Actinomyces spp. Methods: Using a retrospective cohort study design, the medical records of all patients with Actinomyces spp. total hip or knee arthroplasty infection (APJI) seen at a single institution between January 1, 1969 and December 31, 2016 were reviewed. We abstracted information including patient demographics, co-morbidities, joint age, surgical history, microbiology, management and outcomes. A simultaneous literature search via PubMed was performed to identify cases of APJI published in literature and a descriptive analysis was performed. Results: Eleven cases were identified over a 47 year study period at our institution. Seven patients (64%) were female. The median age at the time of diagnosis of infection was 71 years (range, 57-89). The knee was involved in six cases (55%) followed by the hip in 5 (45 %) cases. Three cases had dentures, broken teeth, or poor dentition. Actinomyces odonotlyticus was the most commonly found subspecies at our institution. Median ESR and CRP values were 61mm/hr and 64 mg/L respectively. Eight (72%) patients were managed with 2 stage exchange. Most patients received a course of beta-lactam therapy for 6 weeks. Ten cases (91%) were free of failure after a median duration of follow-up of 2 years (range, 0.67 - 5 years). The median duration from joint arthroplasty to the onset of symptoms was 162 days, range (20-3318). Six (54%) had a history of prior PJI with a different microorganism at the same joint site and 4 patients had history of prior 2 stage exchange (36%). In the literature group, we identified 12 cases and the most common subspecies was Actinomyces israelii; most patients underwent two stage exchange and were treated with 6 weeks of beta lactam antibiotics. Conclusions: Based on our observational study, Actinomyces PJI presents as a late complication of TJR, may be associated with prior PJI at the index joint and antecedent dental manipulation may portend as an additional risk factor. Treatment includes two stage exchange and beta- lactam therapy for 6weeks. These results will help clinicians in improved understanding and management of APJIs which although are rare but warrant special attention as population with implanted joint arthroplasties continues to rise.

Cutaneous actinomycosis and long-term management through using oral and topical antibiotics: A case report

Actinomycosis is a subacute or chronic suppurative bacterial infection which caused because of filamentous gram-positive, anaerobic to microaerophilic nonacid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon, and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. A 61- year-old Yemeni male firstly presented to the surgical department in King Fahd Central Hospital with multiple swelling, petted lesions and boring of sensation in the right foot. Local examination showed multiple erythematous nodules and plaques with discharge in the right leg, and active sinus was not determined.