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Actinomyces gerencseriae hip prosthesis infection: a case report
© Dubourg et al. 2015
Received: 13 May 2015
Accepted: 31 August 2015
Published: 28 September 2015
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.
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.
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.
Actinomyces bacteria are commensal members of the of oropharynx , digestive tract  and urogenital tract microbiota . As pathogens, they are responsible for cervicofacial lesions , abdominopelvic infections  and respiratory tract infections . Actinomyces bacteria have rarely been reported as being responsible for central nervous system (CNS) infections, skin infections  and bone and joint infections . In this genus, Actinomyces israelii serovar II has been reclassified as Actinomyces gerencseriae, a commensal member of the human oral flora ; being further associated with cervicofacial infections , dental diseases [9, 10], in cases of osteoradionecrosis , but very rarely causing infection at other sites .
Here, we describe the first case of hip prosthesis infection due to this microorganism.
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.
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  inhabits the human oral microbiota  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 , cervicofacial infected lesions , mandibular osteoradionecrosis , ulcerative gingivitis (NUG) and oral inflammatory lesions . Involvement in eye infections and chronic granulomatous diseases has also been reported .
A. genrencseriae is a fastidious organism  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.
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.
This study was supported by Unité de Recherche sur les Maladies Infectieuses Tropicales et Émergentes, Méditerranée Infection, Marseille, France
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