S. lugdunensisNative-Joint Septic Arthritis: Case Report and Review of the Literature

Abstract

Staphylococcus lugdunensis是一种肤色分类为凝固酶负数Staphylococcus(CoNS). Though CoNS is typically associated with less aggressive clinical disease thanStaphylococcus aureus那there is growing awareness thatS. lugdunensismay be as virulent asS.金黄色葡萄球菌。之间的联系S. lugdunensisand infective endocarditis is well known, but few reports of native-joint disease with this organism exist. We report a case a 28-year-old male with no prior medical problems presenting with native-joint septic arthritis. Cultures grewS. lugdunensis。To our knowledge, this is the fifth case reported in the literature.

1。Introduction

S. lugdunensiswas first described in 1988 [1]。它仍然是一种罕见的病原体，但它已经与各种临床传染综合征有关，包括心血管，软组织，骨骼和假体关节感染。S. lugdunensishas been associated with higher severity and mortality than other coagulase-negativeStaphylococcus(CONS) species, presenting with features more similar to disease caused byS.金黄色葡萄球菌。案例系列具有本机瓣膜感染性心内膜炎（即）引起的S. lugdunensisreported mortality as high as 42% and surgical needs for more than 51% of cases [2-5.]。For prosthetic valve IE, mortality exceeded 78%. Soft-tissue infections and pyogenic disease involvingS. lugdunensis还报道了并且可能比曾经在社区收购的感染中思想更常见[6.]。S. lugdunensisandS.金黄色葡萄球菌can infect joints via direct inoculation or hematogenous spread. The association betweenS. lugdunensisand prosthetic joint disease is well established, with reports of infections ranging between 6 weeks and 4 years after implantation [4.那7.那8.]。缺乏关于涉及本地关节的报告。

2。案例介绍

一个28岁的男性，没有过去的医学史，呈现给急诊室，两周右膝疼痛。他否认了最近发生的任何性传播疾病，非法药物使用或膝关节疼痛事先发作。他没有向膝盖报告创伤。过度反击的疼痛药物没有缓解他的痛苦，这进展了并最终限制了他使用他的联合的能力。

On examination, the patient was afebrile. His right knee was erythematous, warm, swollen, and with reduced range of motion. A moderate effusion was noticed. He was unable to bare weight on the affected leg. Laboratory analysis revealed leukocytosis, with white blood cell counts of 12,100 per microliter (mcL). Imaging revealed mild soft-tissue swelling and a moderate effusion. A diagnostic arthrocentesis was performed, and fluid analysis revealed 28,875 white blood cells per mcL, predominantly neutrophilic. Gram stain revealed Gram-positive cocci in clusters at 1 day of growth. At 48 hours, cultures grewS. lugdunensis。磁共振成像（MRI）揭示了弥漫性软组织水肿，在膝盖周围的Popliteal FOSTA中最突出，膝关节的大膝关节积液（图）1）。六个滑膜样品成长S. lugdunensis。通过BioMerieux Vitek 2抗菌易感性测试获得敏感性，显示出仅抗恶毒素的抗性。

The patient underwent washout by orthopedic surgery on day one and day three. Vancomycin was given for four days and subsequently changed to clindamycin. The patient completed seven days of parenteral antibiotics and transitioned to oral clindamycin for the remainder of a four-week course. He had full clinical resolution at his third week of therapy.

3.。讨论与文献综述

本土关节静脉关节炎引起S. lugdunensis很少见。我们对英语文学的审查发现只有四个案例[7.那9.-11.]。一种案例没有现有的联合疾病或慢性医疗条件，而所有其他病例都有类风湿性关节炎（RA）[7.那9.-11.]。Preexisting joint disease is a known risk factor for bacterial arthritis [12.]。One prospective study of bacterial arthritis reported preexisting joint disease in 40% of cases, most commonly RA [13.]。The most common pathogen associated with bacterial arthritis isS金黄色葡萄球菌[12.]。However, the incidence of CoNS has risen in the past two decades and is more common with prosthetic joints. An observational study with 7275 total hip and knee arthroplasties over 38 years found 75 cases of prosthetic joint infections, with CoNS causing 18 infections, 3 of which wereS. lugdunensis[14.]。期间的缺点发病率从10％增加到21％[15.]。

S. lugdunensis被归类为缺点。然而，仍保留部分凝结酶活性并具有许多相似之处S.金黄色葡萄球菌[4.那8.]。凝集试验通常用于区分缺点S.金黄色葡萄球菌那but performance characteristics of these tests forS. lugdunensis是可变的，可以导致错误识别S.金黄色葡萄球菌[4.那16.]。Thus, the true burden ofS. lugdunensismay be underappreciated. Samples may be reported asS.金黄色葡萄球菌，两种病原体都会导致类似的疾病。两种生物都是皮肤共生，与软组织感染，菌血症和感染性心内膜炎有关。喜欢S金黄色葡萄球菌那S. lugdunensis会导致严重的疾病。感染性心内膜炎byS. lugdunensis可以出现并发症，如瓣膜穿孔，心肌脓肿，栓塞中风和死亡[2那4.那11.]。Soft-tissue infections can be purulent and may progress to bacteremia and infective endocarditis [10.那11.]。

没有随机控制数据引导细菌化脓性关节炎的治疗，并且存在数据的缺陷S. lugdunensis感染。三种病例在文献中报告接受联合灌溉，清创或其他外科干预措施，并没有说明（表1）[7.那9.-11.]。Antimicrobial courses included beta-lactams, glycopeptides, or lincomycins [7.那9.-11.]。还报告了利福莫霉素组合治疗的成功[7.那9.]。

4.。Conclusion

The present case contributes to a small but growing list of cases of native-joint septic arthritis byS. lugdunensis。Clinicians must be aware of the association betweenS. lugdunensisand severe clinical disease. Lincomycin-based therapy was a successful treatment option for our case. Further studies are needed to compare different therapeutic options.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

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Copyright

Copyright © 2017 C. Danielle Tan et al. This is an open access article distributed under the创意公共归因许可证那which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.