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The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review

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...

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Autores principales: Ibranosyan, Marine, Beraud, Laetitia, Lemaire, Hélène, Ranc, Anne-Gaëlle, Ginevra, Christophe, Jarraud, Sophie, Descours, Ghislaine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802335/
https://www.ncbi.nlm.nih.gov/pubmed/31638905
http://dx.doi.org/10.1186/s12879-019-4488-z
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author Ibranosyan, Marine
Beraud, Laetitia
Lemaire, Hélène
Ranc, Anne-Gaëlle
Ginevra, Christophe
Jarraud, Sophie
Descours, Ghislaine
author_facet Ibranosyan, Marine
Beraud, Laetitia
Lemaire, Hélène
Ranc, Anne-Gaëlle
Ginevra, Christophe
Jarraud, Sophie
Descours, Ghislaine
author_sort Ibranosyan, Marine
collection PubMed
description 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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spelling pubmed-68023352019-10-22 The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review Ibranosyan, Marine Beraud, Laetitia Lemaire, Hélène Ranc, Anne-Gaëlle Ginevra, Christophe Jarraud, Sophie Descours, Ghislaine BMC Infect Dis Case Report 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. BioMed Central 2019-10-21 /pmc/articles/PMC6802335/ /pubmed/31638905 http://dx.doi.org/10.1186/s12879-019-4488-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Ibranosyan, Marine
Beraud, Laetitia
Lemaire, Hélène
Ranc, Anne-Gaëlle
Ginevra, Christophe
Jarraud, Sophie
Descours, Ghislaine
The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title_full The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title_fullStr The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title_full_unstemmed The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title_short The clinical presentation of Legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
title_sort clinical presentation of legionella arthritis reveals the mode of infection and the bacterial species: case report and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802335/
https://www.ncbi.nlm.nih.gov/pubmed/31638905
http://dx.doi.org/10.1186/s12879-019-4488-z
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