Letter to the Editor
Septic Arthritis Caused by Sphingomonas paucimobilis in an Immunocompetent Patient
Artritis séptica por Sphingomonas paucimobilis en un paciente inmunocompetente
a Servicio de Reumatología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
b Unidad Docente Medicina Familiar y Comunitaria, Hospital Da Costa, Burela, Lugo, Spain
c Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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"saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "378" "paginaFinal" => "379" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandro Souto, María Guinda, Antonio Mera, Fernanda Pardo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "Souto" "email" => array:1 [ 0 => "souto_alex@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Guinda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Mera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Fernanda" "apellidos" => "Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Docente Medicina Familiar y Comunitaria, Hospital Da Costa, Burela, Lugo, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis séptica por <span class="elsevierStyleItalic">Sphingomonas paucimobilis</span> en un paciente inmunocompetente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Septic arthritis is an inflammatory joint disease produced by invasion and multiplication of pathogenic microorganisms. Most cases of septic arthritis are caused by microorganisms of the genus Staphylococcus and Streptococcus. Non-fermenting Gram-negative bacilli (Pseudomonas, Stenotrophomonas, Acinetobacter, and Burkholderia) are a frequent causes of nosocomial infection associated with immunosuppression situations, and <span class="elsevierStyleItalic">Sphingomonas paucimobilis</span> (<span class="elsevierStyleItalic">S. paucimobilis</span>) (formerly <span class="elsevierStyleItalic">Pseudomonas paucimobilis</span>) is also a Gram-negative aerobic fermentor that now emerges as an opportunistic pathogen.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of septic arthritis by <span class="elsevierStyleItalic">S. paucimobilis</span> in a 41-year-old man with a history of frequent episodes of hyperuricemia and gout in his left knee. In the past year, he presented several episodes of acute monoarthritis treated with nonsteroidal anti-inflammatory drugs, colchicine, and intraarticular infiltration of triamcinolone. The patient presented with symptoms of pain and swelling of left knee which had lasted for 3 months without fever. Physical examination showed: temperature 36.5<span class="elsevierStyleHsp" style=""></span>°C and left knee arthritis with preserved but painful active and passive mobility. Arthrocentesis was performed, resulting in inflammatory synovial fluid, without evidence microcrystals under the polarized light microscope. The fluid was sent to the microbiology department in a sterile syringe and blood culture bottles for aerobic and anaerobic culture.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Gram stain showed abundant polymorphonuclear leukocytes and intracellular Gram-negative bacilli, and the culture-negative bacilli isolated were identified as <span class="elsevierStyleItalic">S. paucimobilis</span> by ID32GN Api (bioMerieux, Marcy L’etoile 3. France), sensitive to beta-lactams, aminoglycosides, quinolones, and cotrimoxazole. Laboratory analysis upon the patient's admission showed 8070 leukocytes/L (70% neutrophils and 30% lymphocytes), erythrocyte sedimentation rate of 42<span class="elsevierStyleHsp" style=""></span>mm the first hour and CRP 8.04<span class="elsevierStyleHsp" style=""></span>mg/dl. CBC, coagulation, and biochemistry were normal. Echocardiogram was normal and X-rays showed a slight increase in soft tissue suprarrotulian density, indicative of effusion; the CT with intravenous contrast observed loosening of articular recesses, with slight enhancement of the synovium.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Daily articular drainage was performed and the patient was treated with ceftazidime (6<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h) plus gentamicin (240<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h), with clinical improvement, so gentamicin was discontinued after 8 days of treatment, continuing only with ceftazidime. After 15 days and with several negative cultures we reisolated <span class="elsevierStyleItalic">S. paucimobilis</span>, so treatment was changed to meropenem and ceftazidime (4<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h/7 days) to complete 21 days of intravenous antibiotic therapy in total. The patient underwent surgical treatment consisting of joint lavage and synovectomy. After 22 days of treatment, it was substituted to oral therapy with ciprofloxacin (1.5<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h) plus trimethoprim-sulfamethoxazole (800/160<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) for 3 months.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S. paucimobilis</span> is isolated in nature from soil and water,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and in hospital settings from distilled water equipment, dialysis fluids, nebulizers, and other instruments used for respiratory therapy.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> It can cause a variety of nosocomial infections such as community acquired pneumonia, bacteremia, catheter-related infection, osteomyelitis, septic arthritis, meningitis, peritonitis, postoperative endophthalmitis, pleural empyema, and infections of the urinary tract, and bile ducts. These infections are manifested mainly in patients with some form of immunosuppression, patients undergoing an invasive procedure or patients with peritoneal<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> dialysis catheters. The microorganism has not demonstrated a high degree of virulence and no cases of death from infection due to <span class="elsevierStyleItalic">S. paucimobilis</span> are reported. Its low pathogenicity is due to the lack of lipopolysaccharide in the outer membrane of the Gram-negative cell wall, which is associated with endotoxic activity, and this would explain the good condition of the patient despite successive positive cultures and the prognosis of most cases of infection described by <span class="elsevierStyleItalic">S. paucimobilis</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There was no knowing what was the origin of the infection by <span class="elsevierStyleItalic">S. paucimobilis</span> was. It is possible that the patient was colonized and transient bacteremia allowed the organism to reach the joint, or that the patient became infected due to an improper procedure (direct inoculation) in one of the infiltrations to which he was subjected.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Particularly striking is the extreme difficulty in eradicating <span class="elsevierStyleItalic">S. paucimobilis</span>, despite antibiotic therapy and adequate daily articular drainage. Although there are only two cases of arthritis described by <span class="elsevierStyleItalic">S. paucimobilis</span>, both in immunocompromized patients,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> it seems necessary to monitor infections caused by opportunistic pathogens in immunocompetent patients, if only because of the high hospital cost involved.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please, cite this article as: Souto A, et al. Artritis séptica por <span class="elsevierStyleItalic">Sphingomonas paucimobilis</span> en un paciente inmunocompetente. Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.06.002">http://dx.doi.org/10.1016/j.reuma.2012.06.002</span>.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Susceptibility of <span class="elsevierStyleItalic">Pseudomonas paucimobilis</span> to 24 antimicrobial agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.L. Smalley" 1 => "V.R. Hansen" 2 => "V.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 16 | 30 |
| 2024 October | 63 | 34 | 97 |
| 2024 September | 77 | 20 | 97 |
| 2024 August | 106 | 37 | 143 |
| 2024 July | 89 | 31 | 120 |
| 2024 June | 93 | 31 | 124 |
| 2024 May | 80 | 31 | 111 |
| 2024 April | 74 | 23 | 97 |
| 2024 March | 103 | 38 | 141 |
| 2024 February | 71 | 27 | 98 |
| 2024 January | 58 | 19 | 77 |
| 2023 December | 75 | 29 | 104 |
| 2023 November | 65 | 40 | 105 |
| 2023 October | 41 | 33 | 74 |
| 2023 September | 86 | 33 | 119 |
| 2023 August | 45 | 12 | 57 |
| 2023 July | 65 | 29 | 94 |
| 2023 June | 57 | 27 | 84 |
| 2023 May | 48 | 18 | 66 |
| 2023 April | 54 | 15 | 69 |
| 2023 March | 87 | 30 | 117 |
| 2023 February | 64 | 28 | 92 |
| 2023 January | 70 | 23 | 93 |
| 2022 December | 80 | 37 | 117 |
| 2022 November | 91 | 26 | 117 |
| 2022 October | 97 | 27 | 124 |
| 2022 September | 77 | 32 | 109 |
| 2022 August | 93 | 42 | 135 |
| 2022 July | 68 | 34 | 102 |
| 2022 June | 49 | 38 | 87 |
| 2022 May | 64 | 43 | 107 |
| 2022 April | 55 | 42 | 97 |
| 2022 March | 64 | 47 | 111 |
| 2022 February | 53 | 35 | 88 |
| 2022 January | 45 | 43 | 88 |
| 2021 December | 62 | 46 | 108 |
| 2021 November | 45 | 52 | 97 |
| 2021 October | 93 | 60 | 153 |
| 2021 September | 46 | 50 | 96 |
| 2021 August | 43 | 50 | 93 |
| 2021 July | 47 | 38 | 85 |
| 2021 June | 65 | 46 | 111 |
| 2021 May | 71 | 43 | 114 |
| 2021 April | 164 | 139 | 303 |
| 2021 March | 80 | 118 | 198 |
| 2021 February | 51 | 25 | 76 |
| 2021 January | 33 | 19 | 52 |
| 2020 December | 56 | 24 | 80 |
| 2020 November | 56 | 20 | 76 |
| 2020 October | 34 | 17 | 51 |
| 2020 September | 45 | 23 | 68 |
| 2020 August | 35 | 16 | 51 |
| 2020 July | 34 | 11 | 45 |
| 2020 June | 50 | 16 | 66 |
| 2020 May | 46 | 13 | 59 |
| 2020 April | 41 | 22 | 63 |
| 2020 March | 31 | 9 | 40 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 1 | 0 | 1 |
| 2019 March | 1 | 0 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 36 | 3 | 39 |
| 2018 March | 55 | 8 | 63 |
| 2018 February | 37 | 4 | 41 |
| 2018 January | 38 | 4 | 42 |
| 2017 December | 51 | 1 | 52 |
| 2017 November | 57 | 7 | 64 |
| 2017 October | 50 | 6 | 56 |
| 2017 September | 64 | 2 | 66 |
| 2017 August | 88 | 7 | 95 |
| 2017 July | 74 | 7 | 81 |
| 2017 June | 105 | 6 | 111 |
| 2017 May | 100 | 4 | 104 |
| 2017 April | 66 | 4 | 70 |
| 2017 March | 66 | 42 | 108 |
| 2017 February | 50 | 2 | 52 |
| 2017 January | 64 | 7 | 71 |
| 2016 December | 104 | 13 | 117 |
| 2016 November | 84 | 4 | 88 |
| 2016 October | 106 | 13 | 119 |
| 2016 September | 120 | 4 | 124 |
| 2016 August | 115 | 7 | 122 |
| 2016 July | 77 | 9 | 86 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 0 | 10 | 10 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 32 | 5 | 37 |
| 2015 June | 73 | 9 | 82 |
| 2015 May | 81 | 20 | 101 |
| 2015 April | 72 | 12 | 84 |
| 2015 March | 69 | 4 | 73 |
| 2015 February | 97 | 9 | 106 |
| 2015 January | 65 | 11 | 76 |
| 2014 December | 111 | 5 | 116 |
| 2014 November | 86 | 15 | 101 |
| 2014 October | 85 | 6 | 91 |
| 2014 September | 61 | 8 | 69 |
| 2014 August | 61 | 9 | 70 |
| 2014 July | 64 | 8 | 72 |
| 2014 June | 89 | 13 | 102 |
| 2014 May | 93 | 13 | 106 |
| 2014 April | 95 | 14 | 109 |
| 2014 March | 94 | 14 | 108 |
| 2014 February | 85 | 13 | 98 |
| 2014 January | 75 | 16 | 91 |
| 2013 December | 54 | 7 | 61 |
| 2013 November | 48 | 10 | 58 |
| 2013 October | 68 | 11 | 79 |
| 2013 September | 53 | 14 | 67 |
| 2013 August | 50 | 17 | 67 |
| 2013 July | 60 | 9 | 69 |
| 2013 June | 44 | 12 | 56 |
| 2013 May | 49 | 25 | 74 |
| 2013 April | 63 | 12 | 75 |
| 2013 March | 56 | 23 | 79 |
| 2013 February | 44 | 12 | 56 |
| 2013 January | 43 | 21 | 64 |
| 2012 December | 60 | 21 | 81 |
| 2012 November | 11 | 4 | 15 |
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