Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Actinomyces gerencseriae hip prosthesis infection: a case report

  • Grégory Dubourg1, 2,
  • Marion Delord3,
  • Frédérique Gouriet1, 2,
  • Pierre-Edouard Fournier1, 2 and
  • Michel Drancourt1, 2, 4Email author
Journal of Medical Case Reports20159:223

https://doi.org/10.1186/s13256-015-0704-7

Received: 13 May 2015

Accepted: 31 August 2015

Published: 28 September 2015

Abstract

Introduction

Actinomyces bacteria are part of the human oropharyngeal microbiota. They have been associated with abdominal, cervicofacial and thoracic infections and a few cases of joint infections have also been described. In particular, Actinomyces gerencseriae, formerly described as Actinomyces israelii serovar II, has rarely been associated with human infections, mostly involving cervicofacial lesions and periodontal diseases. Here, we report one case of hip prosthesis infection due to A. gerencseriae.

Case presentation

A 72-year-old Caucasian male developed an inflammatory collection on the outside of the right thigh where a hip prosthesis had been implanted for 11 years. Culturing a fluid sample from the collection puncture found Staphylococcus hominis and a Gram-positive bacillus unidentified by matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF). Sequencing the 16S rRNA gene amplified from both the specimen and the isolate identified A. gerencseriae. Treatment adjusted with amoxicillin and trimethropim-sulfamethoxazole cured the infection.

Conclusion

The recently described A. gerencseriae has rarely been involved in human infections. We report the first case of A. gerencseriae joint infection in a hip prosthesis.

Keywords

Actinomyces gerencseriae InfectionOrthopedic deviceHip prosthesis

Introduction

Actinomyces bacteria are commensal members of the of oropharynx [1], digestive tract [2] and urogenital tract microbiota [3]. As pathogens, they are responsible for cervicofacial lesions [4], abdominopelvic infections [5] and respiratory tract infections [6]. Actinomyces bacteria have rarely been reported as being responsible for central nervous system (CNS) infections, skin infections [7] and bone and joint infections [7]. In this genus, Actinomyces israelii serovar II has been reclassified as Actinomyces gerencseriae, a commensal member of the human oral flora [8]; being further associated with cervicofacial infections [4], dental diseases [9, 10], in cases of osteoradionecrosis [11], but very rarely causing infection at other sites [12].

Here, we describe the first case of hip prosthesis infection due to this microorganism.

Case presentation

A 72-year-old Caucasian male was diagnosed with an infected periprosthetic hematoma of the right hip. His medical history included bilateral osteoarthritis cured by the implantation of a right hip prosthesis 11 years previously and a left hip prosthesis four years previously, along with three myocardial infarctions followed by the implantation of ten coronary artery stents and the recent implantation of an implantable cardiac defibrillator (ICD) and consecutive warfarin treatment. Overdosage of the latter drug caused a right iliopsoas hematoma. Over the following three months, the patient presented with Guillain-Barré syndrome, which rapidly resolved after the administration of immunoglobulins, and angiocholitis cured by the administration of amoxicillin-clavulanate.

At the same time, he was diagnosed with fistulization of the infected iliopsoas hematoma on the outside of the right thigh, which had been neglected in view of other intercurrent medical episodes. This was subsequently treated for eight weeks by amoxicillin-clavulanate and fusidic acid without microbiological documentation. Four months later, the right hip collection persisted and an incision with drainage was conducted. Several PCR tests, including 16S rRNA gene amplification [13] performed on the sampled fluid, were negative and the standard culture was sterile. At that time, the white blood cell count was normal at 8.4×109/L (the neutrophil count was 6.2×109/L) and the platelet count was 246×109/L. The erythrocyte sedimentation rate was elevated at 82mm/hour. A second specimen, sampled eight weeks later, grew two types of colonies on Columbia agar with 5% sheep blood (bioMérieux, Marne la Coquette, France) incubated at 37°C in a 5% CO2-enriched and anaerobic atmosphere. Matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF-MS) [14], that allows bacterial identification through their mass spectra, identified one colony as Staphylococcus hominis with an identification score of 2.02. However, MALDI-TOF-MS identification of the second colony failed. This Gram-positive bacillus was then identified by PCR-sequencing of the 16S rRNA gene as previously described [13]. A 1,486-bp sequence (GenBank LN624398) yielded 99.2% similarity with A. gerencseriae (Genbank X80414) using NCBI BLAST (http://www.ncbi.nlm.nih.gov). This isolate was deposited in the Collection de Souches de l’Unité des Rickettsies (=CSUR P1401). This A. gerencseriae MALDI-TOF-MS spectrum was subsequently added to the database (Fig. 1) in order to be specifically compared to eight other Actinomyces spectra available in the database (Fig. 2). Further amplification and sequencing of the 16S rRNA gene directly on the sampled fluid yielded a 999-bp sequence exhibiting 98.9% sequence similarity with A. gerencseriae (Genbank NR029280) and 99.7% sequence similarity with that of the isolate (GenBank LN624398). The antibiotic regimen was adapted with amoxicillin and trimethoprim-sulfamethoxazole after the minimum inhibitory concentrations had been measured at 0.023mg/L and <1mg/L, respectively. This treatment was stopped three weeks later due to kidney failure. Further microbiological investigation found Staphylococcus aureus and ofloxacin combined with rifampicin was finally prescribed.
Fig. 1

Reference mass spectrum from A. genrencseriae strain URMITE (= CSUR P1401). Spectra from 12 individual colonies were compared and a reference spectrum was generated

Fig. 2

Gel view comparing A. genrencseriae strain URMITE (= CSUR P1401). The gel view displays the raw spectra of loaded spectrum files arranged in a pseudo-gel like look. The x-axis records the m/z value. The left y-axis displays the running spectrum number originating from subsequent spectra loading. Peak intensity is expressed by a greyscale code. The color bar and the right y-axis indicate the relation between the peak color displayed and peak intensity in arbitrary units. Displayed species are indicated on the left, while the URMITE strain is highlighted as blue

This patient presented a mixed infection of a hip prosthesis with A. gerencseriae being one of the three documented organisms. The presence of this organism was definitively confirmed by two different techniques. Thus, direct 16S rRNA gene amplification in a puncture product strengthened the culture results, excluding laboratory contamination and indicating that the microorganism was indeed present in the collected specimen. Moreover, A. gerencseriae [8] inhabits the human oral microbiota [15] but not human skin, rendering the probability of per-operative contamination highly improbable. Also, A. genrencseriae is not known as a laboratory contaminant and we had no other case documented in our laboratory. Therefore, we interpreted A. genrencseriae as being part of a mixed hip prosthesis infection in this patient.

In this case, A. genrencseriae was firmly identified on the basis of two independent 16S rRNA gene PCR amplifications and sequencing which yielded the identical partial 16S rRNA gene sequence. However, MALDI-TOF-MS identification failed since A. genrencseriae was not incorporated into the commercial database we used; accordingly, we added its spectrum in order to allow for its subsequent identification by MALDI-TOF-MS.

Although the species A. genrencseriae has been known for 25 years, it has been implicated only rarely in infections, mainly head and neck infections including periodontal disease [9], cervicofacial infected lesions [4], mandibular osteoradionecrosis [12], ulcerative gingivitis (NUG) and oral inflammatory lesions [10]. Involvement in eye infections and chronic granulomatous diseases has also been reported [12].

Conclusions

A. genrencseriae is a fastidious organism [15] whose identification still requires 16S rRNA gene sequencing, pending incorporation of the appropriate spectrum in MALDI-TOF-MS databases. These particularities explain why very few cases of A. genrencseriae infection have been reported. The case reported here indicates that A. genrencseriae infections are by no means limited to head and neck infections.

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Declarations

Acknowledgement

This study was supported by Unité de Recherche sur les Maladies Infectieuses Tropicales et Émergentes, Méditerranée Infection, Marseille, France

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.

Authors’ Affiliations

(1)
Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198
(2)
Pôle de Maladies Infectieuses, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille
(3)
Pôle de Maladies Infectieuses, Hôpital Nord, Assistance Publique Hôpitaux de Marseille
(4)
Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine

References

  1. Sutter VL. Anaerobes as normal oral flora. Rev Infect Dis. 1984;6:S62–6.View ArticlePubMedGoogle Scholar
  2. Hoyles L, Clear JA, McCartney AL. Use of denaturing gradient gel electrophoresis to detect Actinobacteria associated with the human faecal microbiota. Anaerobe. 2013;22:90–6.View ArticlePubMedGoogle Scholar
  3. Hilt EE, McKinley K, Pearc MM, Rosenfeld AB, Zilliox MJ, Mueller ER, et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J Clin Microbiol. 2014;52:871–6.View ArticlePubMedPubMed CentralGoogle Scholar
  4. Pulverer G, Schutt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis. 2003;37:490–7.View ArticlePubMedGoogle Scholar
  5. Smego Jr RA, Foglia G. Actinomycosis. Clin Infect Dis. 1998;26:1255–61.View ArticlePubMedGoogle Scholar
  6. Hsieh MJ, Liu HP, Chang JP, Chang CH. Thoracic actinomycosis. Chest J. 1993;104:366–70.View ArticleGoogle Scholar
  7. Valour F, Sénéchal A, Dupieux C, Karsenty J, Lustig S, Breton P, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183.PubMedPubMed CentralGoogle Scholar
  8. Johnson JL, Moore LV, Kaneko B, Moore WEC. Actinomyces georgiae sp. nov., Actinomyces gerencseriae sp. nov., designation of two genospecies of Actinomyces naeslundii, and inclusion of A. naeslundii serotypes II and III and Actinomyces viscosus serotype II in A. naeslundii genospecies 2. Int J Syst Evol Microbiol. 1990;40:273–86.Google Scholar
  9. Beighton D. The complex oral microflora of high-risk individuals and groups and its role in the caries process. Community Dent Oral Epidemiol. 2005;33:248–55.View ArticlePubMedGoogle Scholar
  10. Kuyama K, Fukui K, Ochiai E, Maruyama S, Iwadate K, Saku T, et al. Identification of the actinomycete 16S ribosomal RNA gene by polymerase chain reaction in oral inflammatory lesions. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:485–91.View ArticlePubMedGoogle Scholar
  11. Store G, Eribe ER, Olsen I. DNA-DNA hybridization demonstrates multiple bacteria in osteoradionecrosis. Int J Oral Maxillofac Surg. 2005;34:193–6.View ArticlePubMedGoogle Scholar
  12. Könönen E, Wade WG. Actinomyces and related organisms in human infections. Clin Microbiol Rev. 2015;28(2):419–42.View ArticlePubMedPubMed CentralGoogle Scholar
  13. Morel AS, Dubourg G, Edouard S, Prudent E, Gouriet F, Casalta J, et al. Complementarity between targeted real-time specific PCR and conventional broad-range 16S rDNA PCR in the syndrome-driven diagnosis of infectious diseases. Eur J Clin Microbiol Infect Dis. 2014;34:561–70.View ArticlePubMedGoogle Scholar
  14. Seng P, Drancourt M, Gouriet F, La Scola B, Fournier PE, Rolain JM, et al. Ongoing revolution in bacteriology: routine identification of bacteria by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Clin Infect Dis. 2009;49:543–51.View ArticlePubMedGoogle Scholar
  15. Teles FR, Teles RP, Siegelin Y, Paster B, Haffajee AD, Socransky SS. RNA-oligonucleotide quantification technique (ROQT) for the enumeration of uncultivated bacterial species in subgingival biofilms. Mol Oral Microbiol. 2011;26:127–39.View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© Dubourg et al. 2015

Advertisement