Letter to the Editor
Joint Prosthesis Infection by Streptococcus mutans
Infección de prótesis articular por Streptococcus mutans
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(B) Agar chocolate culture.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus mutans (Sm)</span> is a microorganism of oral microbiota, which causes dental decay, bacteriaemia and endocarditis. Only a single case report of arthritis from this microorganism<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> has been published.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of joint prosthesis infection by <span class="elsevierStyleItalic">Sm</span>. A 73 year-old male presented with distal oedemas and cellulite in the lower left limb (LLL). The patient had a history of morbid obesity, high blood pressure, dyslipidemia, type 2 diabetes mellitus and chronic renal disorder. Total right and left hip replacements had been performed (1998–1999); left knee replacement (2014) due to medial tibiofemoral compartment gonarthrosis in varus knee. He had non complicated cellulite in LLL 2 years previously. There was no history of oral treatment. Findings from Venus Doppler Ultrasound were: oedema of the subcutaneous cell tissue in LLL, with joint effusion in the anterior compartment of the knee. Possible infection of the total prosthesis was diagnosed and cellulite of the left knee; an extraction of the cement spacer with extraction of the tibial and femoral component was performed. The patella polyethylene was removed and the fragmented external side was extracted. The cemented knee prosthesis was positioned, with semi-constrained, fixed plates, SAMO trecking; with no patella prosthesis. There were no clinical signs or laboratory analysis compatible with sepsis or bacteriaemia. No clinical or radiological signs were compatible with osteomyelitis. One hundred cc of seropurulent liquid was obtained by evacuative arthrocentesis. Inoculated synovial fluid was sent in blood culture bottles to the microbiology laboratory. Antibiotic therapy with intravenous vancomycin and rifampin was initiated. After 30<span class="elsevierStyleHsp" style=""></span>h of incubation in Bactec 9240 (BD) <span class="elsevierStyleItalic">Sm</span> was identified directly from aerobic bottle, using mass spectrometry (MALDI-TOF®, Bruker). In Gram (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) staining, pleomorphic variable gran bacilli were observed. The appearance of the colonies is represented in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B. The direct bottle phenotype identification (panel WalkAway®, Beckman) the following 48<span class="elsevierStyleHsp" style=""></span>h was compatible with the identification of MALDI-TOF®. Antibiotic sensitivity was undertaken in addition to micro dilution (panel WalkAway®), using concentration gradient (E-test®, Bio-Merieux), following the directives of EUCAST version 6.0 2016-01-01. The microorganism was sensitive to penicillin, cefotaxime, clindamycin and vancomycin. Minimum inhibitory concentration (MIC), levofloxacin<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1, linezolid<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1 and daptomycin<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>.5.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Twelve days after hospital admittance surgery was performed, with synovial fluid being taken again and the re-identification of <span class="elsevierStyleItalic">Sm.</span></p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient's evolution was favourable with obvious clinical improvement compared with his pre-surgical status and after 18 days the patient was discharged from hospital with an outpatient antibiotic treatment (levofloxacin: 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h oral administration for 42 days).</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sm</span> is a pleomorphic streptococcus (bacillary in an acidic medium and coccus in a neutral or alkaline medium). Described by Clarke in 1924 (tooth decay) and later its capacity to produce endocarditis was observed. The <span class="elsevierStyleItalic">Sm</span> group includes isolated species in humans (<span class="elsevierStyleItalic">mutans</span>, <span class="elsevierStyleItalic">sobrinus</span>, <span class="elsevierStyleItalic">criceti</span>, <span class="elsevierStyleItalic">ratti</span> and <span class="elsevierStyleItalic">downei</span>) and other isolated species in animals. The <span class="elsevierStyleItalic">mutans</span> species is the producer of caries and the mother–child transmission is probably through oral secretions, with this species being the one most frequently associated with bacteriaemia. It may be confused with other streptococci and enterococci. Its isolation and identification may be difficult, as was corroborated by Emmerson and Eykyn, and also by Schelenz and Cois, reporting cases of endocarditis in which the agent had been erroneously determined as diphtheroid.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–3</span></a> It is resistant to phagocytosis by polymorphonuclear leukocytes<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> and may participate in the pathogenesis of atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Many reports have been published associating <span class="elsevierStyleItalic">Sm</span> with the production of <span class="elsevierStyleItalic">biofilm</span> in dental plaque and in materials used in odontology,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> but there are few or no studies regarding Sm adherence to material used in prostheses or osteoarticular tissues. It has been suggested that the bacteria wall could contribute to the inducement of arthritis in animal models.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> The bacterial protein <span class="elsevierStyleSmallCaps">I</span>/<span class="elsevierStyleSmallCaps">II</span> (pathogen-associated molecular pattern [PAMP]) could contribute to adverse evolution in osteoarthritis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> It has been described that non C serotypes are prone to extra-oral translocation.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> It has been associated with conditions such as Behçet's disease, Sjögren syndrome and rheumatoid arthritis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Few infections of the joints have been reported. Before molecular identification techniques (sequencing) and proteomic techniques were available (MALDI-TOF®), identification posed a diagnostic challenge due to <span class="elsevierStyleItalic">Sm's</span> ability to present as a “gram positive bacillus” to Gram stain and its possible confusion with other microorganisms.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Parra-Grande M, Hernández-Ros P, Prats-Sánchez I, López-García P. Infección de prótesis articular por <span class="elsevierStyleItalic">Streptococcus mutans</span>. Reumatol Clin. 2019;15:e78–e79.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 745 "Ancho" => 1500 "Tamanyo" => 121924 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Gram stain direct from the sample. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 50 | 46 | 96 |
| 2024 September | 60 | 48 | 108 |
| 2024 August | 75 | 59 | 134 |
| 2024 July | 55 | 31 | 86 |
| 2024 June | 70 | 26 | 96 |
| 2024 May | 60 | 46 | 106 |
| 2024 April | 65 | 22 | 87 |
| 2024 March | 52 | 29 | 81 |
| 2024 February | 38 | 16 | 54 |
| 2024 January | 33 | 16 | 49 |
| 2023 December | 51 | 22 | 73 |
| 2023 November | 52 | 34 | 86 |
| 2023 October | 47 | 27 | 74 |
| 2023 September | 86 | 39 | 125 |
| 2023 August | 45 | 13 | 58 |
| 2023 July | 54 | 27 | 81 |
| 2023 June | 51 | 21 | 72 |
| 2023 May | 51 | 21 | 72 |
| 2023 April | 38 | 7 | 45 |
| 2023 March | 77 | 19 | 96 |
| 2023 February | 69 | 27 | 96 |
| 2023 January | 49 | 19 | 68 |
| 2022 December | 75 | 35 | 110 |
| 2022 November | 47 | 27 | 74 |
| 2022 October | 69 | 33 | 102 |
| 2022 September | 47 | 45 | 92 |
| 2022 August | 45 | 44 | 89 |
| 2022 July | 33 | 38 | 71 |
| 2022 June | 46 | 25 | 71 |
| 2022 May | 38 | 50 | 88 |
| 2022 April | 48 | 36 | 84 |
| 2022 March | 63 | 33 | 96 |
| 2022 February | 65 | 26 | 91 |
| 2022 January | 91 | 31 | 122 |
| 2021 December | 49 | 38 | 87 |
| 2021 November | 38 | 37 | 75 |
| 2021 October | 67 | 44 | 111 |
| 2021 September | 41 | 38 | 79 |
| 2021 August | 33 | 30 | 63 |
| 2021 July | 40 | 22 | 62 |
| 2021 June | 40 | 28 | 68 |
| 2021 May | 52 | 33 | 85 |
| 2021 April | 112 | 72 | 184 |
| 2021 March | 48 | 27 | 75 |
| 2021 February | 60 | 21 | 81 |
| 2021 January | 53 | 17 | 70 |
| 2020 December | 57 | 14 | 71 |
| 2020 November | 34 | 16 | 50 |
| 2020 October | 26 | 21 | 47 |
| 2020 September | 32 | 18 | 50 |
| 2020 August | 18 | 21 | 39 |
| 2020 July | 20 | 10 | 30 |
| 2020 June | 27 | 12 | 39 |
| 2020 May | 20 | 9 | 29 |
| 2020 April | 19 | 19 | 38 |
| 2020 March | 2 | 0 | 2 |
| 2019 November | 1 | 0 | 1 |
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