Letter to the Editor
Septic Arthritis Without a Clear Focus Due to Eikenella corrodens
Artritis séptica sin foco por Eikenella corrodens
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We obtained a sample of articular fluid and the patient was discharged to be seen thereafter by his primary care physician who, in turn, consulted with the rheumatology department. Anti-inflammatory therapy was prescribed, because the microbiological culture of the sample had been negative. Given the persistence of the clinical signs and symptoms, the patient returned to the emergency department 8 days later, and underwent arthrocentesis, which yielded a viscous, yellow fluid, that was neither cloudy nor purulent. It was injected into an aerobic blood culture bottle, and the patient was discharged and was asked to continue taking the anti-inflammatory therapy. Days later, the patient was examined in the rheumatology department, where he insisted on the persistence of pain and commented on the progressive swelling; he mentioned noting a feeling of chilliness during the evening (not measured by thermometer). He was admitted to the hospital and began to take cloxacillin (2<span class="elsevierStyleHsp" style=""></span>g/4<span class="elsevierStyleHsp" style=""></span>h) plus ceftriaxone (2<span class="elsevierStyleHsp" style=""></span>g/24<span class="elsevierStyleHsp" style=""></span>h), and arthrocentesis was again performed. The culture of the 2 samples resulted in the isolation of Gram-negative bacilli, which grew in blood agar and chocolate agar forming convex colonies, with rounded borders, but not in MacConkey agar; Gram staining revealed small, Gram-negative coccobacilli. The microorganism was not identified by manual means (API 20 NE<span class="elsevierStyleSup">®</span>) or by automatic techniques (MicroScan<span class="elsevierStyleSup">®</span>). The samples were sent for identification to a referral center (<span class="elsevierStyleItalic">Instituto de Salud Carlos III</span>, Madrid). The patient improved and was discharged 17 days later. He began to take oral levofloxacin (500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) plus rifampicin (300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h), a treatment that was replaced by amoxicillin/clavulanic acid (500<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h) after the identification of <span class="elsevierStyleItalic">E. corrodens</span>, which was maintained for 1 month. The patient remained asymptomatic until the treatment had been completed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The major causative agents of septic arthritis are <span class="elsevierStyleItalic">Staphylococcus aureus</span> and streptococci (60%–80% of cases depending on the series), followed by 20%–25% of cases due to Gram-negative bacilli (extreme ages of life, immunosuppression, etc.) and 5% of cases produced by anaerobic organisms (injuries, extension of abdominal infection, etc.).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E. corrodens</span> is rarely isolated as a cause of septic arthritis; in the review by Nolla et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> on pyogenic arthritis affecting native joints, the prevalence of infection by this microorganism was 1/268. Due to the presence of <span class="elsevierStyleItalic">E. corrodens</span> in the human oral cavity, most cases of septic arthritis and osteomyelitis produced by this microorganism are directly related to human bites or dental infections<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>; in the literature, there are also reports of cases of osteomyelitis secondary to a prick with a used toothpick.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Our patient reported no recent injury or bite, but he had lost some teeth. This led us to suppose that the origin of the infection could have been a bacteremia that could be traced to his own oral cavity, although he had not had any dental treatment of late. He mentioned having been pricked by a rosebush days before the onset of the clinical signs, but there are no reports in the literature of transmission of this microorganism by that route.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E. corrodens</span> is resistant to metronidazole, cloxacillin, oral first- and second-generation cephalosporins, clindamycin and macrolides, and β-lactamase-producing strains have been reported; the strain isolated in our patient was sensitive to amoxicillin/clavulanic acid and was β-lactamase-negative. The treatment of choice was considered to be amoxicillin/clavulanic acid or ceftriaxone.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guerrero Vadillo M, Sánchez Romero MI, Espinosa Malpartida M, Portero Azorín MF. Artritis séptica sin foco por <span class="elsevierStyleItalic">Eikenella corrodens</span>. 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Pedrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2015.01.009" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "94" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25767047" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Eikenella corrodens</span> discitis after spinal surgery. Case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.S.P. Ang" 1 => "C.C.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 10 | 17 |
| 2024 October | 59 | 38 | 97 |
| 2024 September | 47 | 26 | 73 |
| 2024 August | 71 | 39 | 110 |
| 2024 July | 46 | 34 | 80 |
| 2024 June | 74 | 25 | 99 |
| 2024 May | 101 | 40 | 141 |
| 2024 April | 53 | 18 | 71 |
| 2024 March | 64 | 32 | 96 |
| 2024 February | 33 | 17 | 50 |
| 2024 January | 52 | 19 | 71 |
| 2023 December | 30 | 32 | 62 |
| 2023 November | 32 | 20 | 52 |
| 2023 October | 25 | 25 | 50 |
| 2023 September | 47 | 35 | 82 |
| 2023 August | 35 | 16 | 51 |
| 2023 July | 39 | 24 | 63 |
| 2023 June | 27 | 23 | 50 |
| 2023 May | 40 | 25 | 65 |
| 2023 April | 24 | 10 | 34 |
| 2023 March | 52 | 35 | 87 |
| 2023 February | 40 | 29 | 69 |
| 2023 January | 28 | 21 | 49 |
| 2022 December | 44 | 30 | 74 |
| 2022 November | 63 | 25 | 88 |
| 2022 October | 42 | 38 | 80 |
| 2022 September | 25 | 45 | 70 |
| 2022 August | 27 | 36 | 63 |
| 2022 July | 28 | 43 | 71 |
| 2022 June | 30 | 32 | 62 |
| 2022 May | 31 | 34 | 65 |
| 2022 April | 31 | 43 | 74 |
| 2022 March | 36 | 35 | 71 |
| 2022 February | 43 | 32 | 75 |
| 2022 January | 33 | 38 | 71 |
| 2021 December | 42 | 39 | 81 |
| 2021 November | 41 | 43 | 84 |
| 2021 October | 58 | 40 | 98 |
| 2021 September | 38 | 42 | 80 |
| 2021 August | 36 | 41 | 77 |
| 2021 July | 28 | 39 | 67 |
| 2021 June | 31 | 26 | 57 |
| 2021 May | 40 | 37 | 77 |
| 2021 April | 107 | 66 | 173 |
| 2021 March | 43 | 22 | 65 |
| 2021 February | 42 | 19 | 61 |
| 2021 January | 34 | 18 | 52 |
| 2020 December | 27 | 15 | 42 |
| 2020 November | 51 | 15 | 66 |
| 2020 October | 34 | 11 | 45 |
| 2020 September | 39 | 24 | 63 |
| 2020 August | 29 | 21 | 50 |
| 2020 July | 11 | 14 | 25 |
| 2020 June | 30 | 13 | 43 |
| 2020 May | 15 | 10 | 25 |
| 2020 April | 14 | 10 | 24 |
| 2020 March | 14 | 2 | 16 |
| 2018 May | 3 | 2 | 5 |
| 2018 April | 34 | 5 | 39 |
| 2018 March | 70 | 7 | 77 |
| 2018 February | 40 | 11 | 51 |
| 2018 January | 18 | 6 | 24 |
| 2017 December | 33 | 9 | 42 |
| 2017 November | 22 | 18 | 40 |
| 2017 October | 20 | 8 | 28 |
| 2017 September | 22 | 15 | 37 |
| 2017 August | 34 | 23 | 57 |
| 2017 July | 46 | 35 | 81 |
| 2017 June | 4 | 10 | 14 |
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