Bacillus species infection of the joints is a very rare occurrence, with sporadic reports in the medical literature.
Case Report:
A 67-year-old woman with osteoarthritis developed infection in the knee joint after arthroscopy. Percutaneous needle aspiration of articular fluid performed post-operatively showed a positive culture for Bacillus species. The diagnosis of septic arthritis was, however, not confirmed as the results were considered contamination. Failure of treatment with beta-lactam antibiotics on two occasions and successful cure of infective arthritis by long-term administration of a fluoroquinolone confirmed iatrogenic clinical joint infection with Bacillus species.
Conclusion:
Any clinically suspected joint infection must be treated as septic arthritis until proved otherwise.
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References
1.
DrobniewskiFA. Bacillus cereus and related species. Clin Microbiol Rev, 1993; 6:324–338.
2.
FarrarWE. Serious infections due to “non-pathogenic” organisms of the genus Bacillus. Am J Med, 1963; 34:134–141.
3.
Van Der ZwetWC, ParlevlietGA, SavelkoulPHet al.Outbreak of Bacillus cereus infections in a neonatal intensive care unit traced to balloons used in manual ventilation. J Clin Microbiol, 2000; 38:4131–4136.
4.
HernaizC, PicardoA, AlosJI, Gomez-GarcesJL. Nosocomial bacteremia and catheter infection by Bacillus cereus in an immunocompetent patient. Clin Microbiol Infect, 2003; 9:973–975.
5.
Garcia-ArribasML, PlazaCJ, De La RosaMC, MossoMA. Characterisation of Bacillus cereus strains isolated from drugs and evaluation of their toxins. J Appl Bacteriol, 1988; 64:257–264.
6.
Ashkenazi-HoffnungL, KaufmanZ, BrombergMet al.Seasonality of Bacillus species isolated from blood cultures and its potential implications. Am J Infect Control, 2009; 37:495–499.
7.
KurokiR, KawakamiK, QinLet al.Nosocomial bacteremia caused by biofilm-forming Bacillus cereus and Bacillus thuringiensis. Intern Med, 2009; 48:791–796.
8.
DohmaeS, OkuboT, HiguchiWet al.Bacillus cereus nosocomial infection from reused towels in Japan. J Hosp Infect, 2008; 69:361–367.
9.
MatsumotoS, SuenagaH, NaitoKet al.Management of suspected nosocomial infection: An audit of 19 hospitalized patients with septicemia caused by Bacillus species. Jpn J Infect Dis, 2000; 53:196–202.
10.
HsuehPR, TengLJ, YangPCet al.Nosocomial pseudoepidemic caused by Bacillus cereus traced to contaminated ethyl alcohol from a liquor factory. J Clin Microbiol, 1999; 37:2280–2284.
11.
DubouixA, BonnetE, AlvarezMet al.Bacillus cereus infections in Traumatology-Orthopaedics Department: Retrospective investigation and improvement of healthcare practices. J Infect, 2005; 50:22–30.
12.
CuchacovichR, JapaS, HuangWQet al.Detection of bacterial DNA in Latin American patients with reactive arthritis by polymerase chain reaction and sequencing analysis. J Rheumatol, 2002; 29:1426–1429.
13.
AnğO, BaşkirO, GüvenerZ. Case of arthritis with Bacillus cereus as the secondary etiologic agent. Tip Fak Mecm, 1969; 32:708–712.
ReboliAC, BryanCS, FarrarWE. Bacteremia and infection of a hip prosthesis caused by Bacillus alvei. J Clin Microbiol, 1989; 27:1395–1396.
16.
FongSY, TanJL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore, 2004; 33:228–234.
17.
KusmanovaSI, AtanassovAN, AndreevSA, SolakovPT. Minor and major complications of arthroscopic synovectomy of the knee joint performed by rheumatologist. Folia Med, 2003; 45:55–59.
McAllisterDR, ParkerRD, CooperAEet al.Outcome of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sport Med, 1999; 27:562–570.
20.
KaneD, VealeDJ, FitzGeraldO, ReeceR. Survey of arthroscopy performed by rheumatologists. Rheumatology, 2002; 41:210–215.
21.
HollanderJL. Intrasynovial corticosteroid therapy in arthritis. Md State Med J, 1969; 19:62–66.
22.
GrayRG, TenenbaumJ, GottliebNL. Local corticosteroid injection treatment in rheumatic disorders. Semin Arthritis Rheum, 1981; 10:231–254.
GeirssonAJ, StatkeviciusS, VíkingssonA. Septic arthritis in Iceland 1990–2002: Increasing incidence due to iatrogenic infections. Ann Rheum Dis, 2008; 67:638–643.
25.
RyanMJ, KavanaghR, WallPG, HazlemanBL. Bacterial joint infections in England and Wales: Analysis of bacterial isolates over a four year period. Br J Rheumatol, 1997; 36:370–373.
26.
AkessonA, HedstromSA, RipaT. Bacillus cereus: A significant pathogen in post-operative and posttraumatic wounds on orthopedic wards. Scand J Infect Dis, 1991; 23:71–77.
WeberDJ, SaviteerSM, RutalaWA, ThomannCA. In vitro susceptibility of Bacillus spp. to selected antimicrobial agents. Antimicrob Agents Chemother, 1988; 32:642–645.
29.
DanM, KeynanO, FeldbrinZ, PochF. Concentrations of moxifloxacin in serum and synovial fluid, and ex vivo bactericidal activity against arthritis-causing pathogens. Diagn Microbiol Infect Dis, 2004; 48:283–286.
30.
SchefferD, HofmannS, PietschM, WenischC. Infections in orthopedics and traumatology. Pathogenesis and therapy. Orthopade, 2008; 37:709–718.
31.
EspositoS, LeoneS, NovielloSet al.Outpatient parenteral antibiotic therapy for bone and joint infections: An Italian multicenter study. J Chemother, 2007; 19:417–422.
32.
CoakleyG, MathewsC, FieldMet al.British Society for Rheumatology Standards, Guidelines and Audit Working Group. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford), 2006; 45:1039–1041.
33.
MargarettenME, KohlwesJ, MooreD, BentS. Does this adult patient have septic arthritis?JAMA, 2007; 297:1478–1488.
34.
Matucci Cerinic M (coordinatore). Linee guida per la diagnosi e cura delle malattie rheumatiche. Consiglio Sanitario. Servizio Sanitario della Toscana, Italia. www.usl5.toscana.it/NewDocs/files/../LG%20Reumatologia.doc. 2010 February 16.
