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Roussotte M, Massy E. Case report of arthritis caused by Legionella anisa and review of the literature. BMC Infect Dis 2022; 22:633. [PMID: 35858834 PMCID: PMC9297545 DOI: 10.1186/s12879-022-07475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Legionella spp. is recognized as a common cause of community acquired pneumonia, with Legionella pneumophila serogroup 1 being the most prevalent. At least 70 species are described so far but few are identified in pathogenic conditions. Data on extrapulmonary infections are scarce. CASE PRESENTATION A 73-yar-old male with chronic lymphoid leukemia was hospitalized for an insidious wrist arthritis. Ultrasound of the wrist showed a carpal and radiocarpal fluid effusion with positive Doppler signal. While routine bacterial cultures remained sterile, 16S rRNA PCR identified Legionella anisa. Ciprofloxacin 500 mg twice a day for a period of six weeks improved arthritis with full recovery at the end of the treatment. CONCLUSION Legionella non pneumophila are a rare cause of septic arthritis especially found in immunosuppressed patients and identification of species could help clinician to adapt antibiotherapy.
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Affiliation(s)
- M Roussotte
- Department of Rheumatology, Hospices Civils de Lyon, Service de Rhumatologie Sud, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69310, Pierre Bénite, France
| | - E Massy
- Department of Rheumatology, Hospices Civils de Lyon, Service de Rhumatologie Sud, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69310, Pierre Bénite, France.
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Ibranosyan M, Beraud L, Lemaire H, Ranc AG, Ginevra C, Jarraud S, Descours G. The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review. BMC Infect Dis 2019; 19:864. [PMID: 31638905 PMCID: PMC6802335 DOI: 10.1186/s12879-019-4488-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Legionella is a common cause of pneumonia, extrapulmonary infections like arthritis are scarce. Here, we describe a case of monoarthritis due to Legionella bozemanii, with no history of pneumonia. We provide a literature review of the 9 previously published Legionella arthritis and highlight a dichotomous epidemiology suggesting different physiopathological pathways leading to joint infection. CASE PRESENTATION A 56-year old woman under immunosuppressive treatment by oral and intra-articular corticosteroids, methotrexate, and tocilizumab for an anti-synthetase syndrome was hospitalized for worsening pain and swelling of the left wrist for 3 days. Clinical examination showed left wrist synovitis and no fever. The arthritis occurred a few days after an accidental fall on wet asphalt responsible for a cutaneous wound followed by a corticosteroid intra-articular injection. Due to both the negativity of conventional culture of articular fluid and suspicion of infection, 16S rRNA and specific PCRs were performed leading to the identification of L. bozemanii. Legionella-specific culture of the articular fluid was performed retrospectively and isolated L. bozemanii. The empiric antibiotic therapy was switched for oral levofloxacin and rifampin and the patient recovered after a 12-week treatment. CONCLUSION We report a case of L. bozemanii monoarthritis in an immunosuppressed woman, following a fall on wet asphalt and intra-articular corticosteroid injection. The review of the literature found that the clinical presentation reveals the mode of infection and the bacterial species. Monoarthritis more likely occurred after inoculation in patients under immunosuppressive therapy and were associated with non-Legionella pneumophila serogroup 1 (Lp1) strains that predominate in the environment. Polyarthritis were more likely secondary legionellosis localizations after blood spread of Lp1, the most frequently found in pneumonia. In both settings, 16S rRNA and Legionella-specific PCR were key factors for the diagnosis.
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Affiliation(s)
- Marine Ibranosyan
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France
| | - Laetitia Beraud
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France
| | - Hélène Lemaire
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Hôpital Lyon Sud, Service de Rhumatologie, Pierre-Bénite, France.,Hospices Civils de Lyon, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Service de Rhumatologie, Lyon, France
| | - Anne-Gaëlle Ranc
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France
| | - Christophe Ginevra
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,CIRI, Centre International de Recherche en Infectiologie, Equipe Pathogénèse des Légionelles, Lyon, France.,Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Lyon, France.,Univ Lyon 1, Lyon, France
| | - Sophie Jarraud
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France.,CIRI, Centre International de Recherche en Infectiologie, Equipe Pathogénèse des Légionelles, Lyon, France.,Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Lyon, France.,Univ Lyon 1, Lyon, France
| | - Ghislaine Descours
- Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Laboratoire de Bactériologie, Lyon, France. .,Hospices Civils de Lyon, Groupement Hospitalier Nord, Institut des Agents Infectieux, Centre National de Référence des Légionelles, Lyon, France. .,CIRI, Centre International de Recherche en Infectiologie, Equipe Pathogénèse des Légionelles, Lyon, France. .,Inserm, U1111, Université Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Lyon, France. .,Univ Lyon 1, Lyon, France.
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Huang Y, Ma Y, Miao Q, Pan J, Hu B, Gong Y, Lin Y. Arthritis caused by Legionella micdadei and Staphylococcus aureus: metagenomic next-generation sequencing provides a rapid and accurate access to diagnosis and surveillance. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:589. [PMID: 31807570 DOI: 10.21037/atm.2019.09.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Legionella spp. is an important pulmonary pathogen but rarely causes extra-pulmonary infections. We report a case of joint infection caused by Legionella micdadei and Staphylococcus aureus in a 54-year-old male with medication history of oral steroid for systemic lupus erythematosus (SLE). He developed arthritis in his right metacarpophalangeal (MCP) joints without precursor pneumonia. In the joint aspirate, S. aureus was detected through culture. The existence of L. micdadei and S. aureus were indicated by metagenomic next-generation sequencing (mNGS) and confirmed by 16S rRNA sequence analysis. After oral levofloxacin treatment for 54 days, the patient's symptoms ameliorated and blood test results improved, which were consistent with the dynamic trend of reads numbers in mNGS data. Our case included, arthritis caused by Legionella spp. have been reported in 11 patients. However, our case is the first to report septic arthritis caused by L. micdadei in native joints and monitored by mNGS. This case demonstrated an application of mNGS for etiological diagnosis and semi-quantification in joint aspirate. mNGS may serve as a promising tool for rapid and accurate etiological diagnosis and surveillance, contributing to appropriate antimicrobial drug applications and timely medication adjustments when necessary.
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Affiliation(s)
- Yingnan Huang
- Department of infectious diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yuyan Ma
- Department of infectious diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qing Miao
- Department of infectious diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jue Pan
- Department of infectious diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bijie Hu
- Department of infectious diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yanping Gong
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin 300308, China
| | - Yang Lin
- Wuhan research and development of infectious diseases department, BGI-Wuhan, Wuhan 430075, China
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Banderet F, Blaich A, Soleman E, Gaia V, Osthoff M. Septic arthritis due to Legionella cincinnatiensis: case report and review of the literature. Infection 2016; 45:551-555. [PMID: 27848164 DOI: 10.1007/s15010-016-0964-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Legionella spp. are an important cause of pulmonary and rarely extrapulmonary infections. L. cincinnatiensis has only been implicated in five cases to date. We herein report the first case of L. cincinnatiensis septic arthritis in a 90-year old lady with a past medical history of chronic kidney disease. She developed septic arthritis of her left wrist after having received intraarticular corticosteroid injections and oral corticosteroids administered for presumed chondrocalcinosis. Appropriate antimicrobial treatment of L. cincinnatiensis septic arthritis was delayed until identification of this organism in joint biopsies by broad-range bacterial PCR targeting the 16S rRNA gene with subsequent rDNA sequence analysis and by culture on special media. Reviewing all reported cases of septic arthritis caused by Legionella spp. other than L. cincinnatiensis it is notable that diagnosis was established by PCR in the majority of cases and only subsequently confirmed by special culture. Although most patients were immunosuppressed, outcome was favourable. Treatment consisted of a fluoroquinolone alone or in combination with rifampicin or a macrolide. Our case highlights the need for a high index of suspicion for infections with unusual/fastidious organisms when symptoms are suggestive of septic arthritis but conventional methods fail to identify a causative organism.
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Affiliation(s)
- Florian Banderet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Annette Blaich
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Evelin Soleman
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Valeria Gaia
- Swiss National Reference Centre for Legionella, Servizio di microbiologia EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Michael Osthoff
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
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Currie SL, Beattie TK. Compost and Legionella longbeachae: an emerging infection? Perspect Public Health 2015; 135:309-15. [DOI: 10.1177/1757913915611162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human disease caused by Legionella species is dominated by Legionella pneumophila, the main causative agent in cases of Legionnaires’ disease. However, other species are known to cause infection, for example, Legionella longbeachae causes an equivalent number of cases of disease as L. pneumophila in Australia and New Zealand. Infection with L. longbeachae is commonly associated with exposure to composts and potting soils, and cases of infection with this organism have been increasing in Europe over the past ten years. The increase in incidence may be linked to factors such as increased awareness of clinical presentation, or due to changing formulation of growing media, although it should be noted that the presence of Legionella species in growing media does not correlate with the number of cases currently seen. This is likely due to the variables associated with infection, for example, host factors such as smoking or underlying health conditions, or difference in growing media storage or climate, especially warm humid conditions, which may affect survival and growth of these organisms in the growing media environment. There are numerous unknowns in this area and collaboration between growing media manufacturers and researchers, as well as more awareness among diagnosing clinicians, laboratory staff and the general public is necessary to reduce risk. More research is needed before definitive conclusions can be drawn: L. pneumophila research currently dominates the field and it is likely that the overreliance on diagnostic techniques such as the urinary antigen test, which is specific for L. pneumophila Sg 1, is detrimental to the diagnosis of L. longbeachae infection.
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Affiliation(s)
- Sandra L Currie
- Department of Civil & Environmental Engineering, University of Strathclyde, Glasgow, UK
| | - Tara K Beattie
- Department of Civil & Environmental Engineering, University of Strathclyde, Glasgow, UK
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Molnar-Kimber KL, Kimber CT. Each type of cause that initiates rheumatoid arthritis or RA flares differentially affects the response to therapy. Med Hypotheses 2011; 78:123-9. [PMID: 22051110 DOI: 10.1016/j.mehy.2011.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/06/2011] [Accepted: 10/07/2011] [Indexed: 01/21/2023]
Abstract
The autoimmune disease rheumatoid arthritis (RA) presents difficulty in diagnosis, commonly observed flare ups, polycyclical nature of RA progression, and variable response to therapies. Congruent with multiple causes, literature has documented various infectious agents, environmental factors, physical trauma, silica and food sensitivities as potential causes of RA or RA flares in different populations. We propose that these>36 events can initiate RA or RA flares which complicates treatment decisions. Each pharmaceutical medicine benefits 15-82% of RA patients. Predictive factors are needed. Because the initiating cause of RA or RA flare affects the type of joint damage, initial inflammatory response, adaptive immune response, and potential molecular mimicry, we propose the "RA cause affects response to therapy" (RACART) theory. The potential cause combined with confounding factors such as genetic risk factors, nutritional status, epigenetic status, inflammatory levels, and detoxification ability may help predict responses to various therapies.
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