title: Isolated Lactobacillus chronic prosthetic knee infection.
abstract: Lactobacillus is a gram-positive rod bacteria found primarily in the gastrointestinal and female genital tracts. Prosthetic infections in implants are being increasingly reported. The authors present a case of a 58-year-old patient with Lactobacillus septic prosthetic knee joint infection. To the authors’ knowledge, this is the first reported case of chronic prosthetic knee infection with isolated Lactobacillus species. Lactobacillus has been most commonly implicated with bacteremia and endocarditis and rarely with pneumonia, meningitis, and endovascular infection, and a vast majority of the cases are reported in immunocompromised patients. In the current case, diabetes mellitus, hepatitis, malnutrition, anemia, and liver failure were comorbid conditions, placing the patient at increased risk of infection. The findings suggest that further case series are necessary to establish the significance of Lactobacillus as an etiologic agent in chronic low-virulence, and potentially vancomycin-resistant, prosthetic joint infection. The need also exists for further research aimed at the risk of prosthetic joint infection with oral intake of certain probiotic foods and supplements. The goal of this case report is to bring to light the potential of this organism to be a cause of subtle chronic prosthetic joint infection.
authors.forename: David M
authors.initials: DM
authors.lastname: Bennett
authors.forename: Tatyana
authors.initials: T
authors.lastname: Shekhel
authors.forename: Matt
authors.initials: M
authors.lastname: Radelet
authors.forename: Michael D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D001168:Arthritis / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002908:Chronic Disease; D020878:Device Removal; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology; D006801:Humans; D007719:Knee Joint / Q000382:microbiology* / Q000601:surgery; D007720:Knee Prosthesis / Q000382:microbiology; D007778:Lactobacillus / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D012086:Reoperation