title: Septic arthritis due to Clostridium ramosum.
abstract: OBJECTIVE
  Clostridium species are anaerobic bacilli that are rarely reported as etiologic agents of infectious arthritis. Previous cases of arthritis caused by Clostridium ramosum have not been reported. We describe the first 2 cases of C. ramosum arthritis.
  
  
  METHODS
  We reviewed the etiology of arthritis in our hospital during the previous 15 years.
  
  
  RESULTS
  Both patients had underlying immunocompromising conditions and their infections involved a joint with preexisting disease: patient 1 had rheumatic arthritis and a prosthetic joint; patient 2, chronic renal failure on dialysis and hip osteoarthritis. The infection was hematogenously acquired and the course was indolent but destructive in both the cases. Management included open arthrotomy and resection arthroplasty. The infection had a persisting and relapsing course, and prolonged antibiotic treatment was required. In the literature review, we found 55 previous cases of arthritis caused by Clostridium species between 1966 and 2014; Clostridium perfringens was the most common infecting species; the infection was traumatically acquired in most of the cases. A total of 15 patients have been described with infections caused by C. ramosum; none had septic arthritis. The majority were elderly or immunocompromised adults. Proper collection, transportation and processing of clinical specimens is essential for diagnosing clostridial infections. More information about the best management of clostridial arthritis are needed.
  
  
  CONCLUSIONS
  We describe the first 2 cases of septic arthritis caused by C. ramosum. They shared several pathogenic and clinical features. The possibility of anaerobic arthritis should always be considered when collecting diagnostic specimens. An increasing number of clostridial arthritis cases are likely to be diagnosed in future years.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Jiménez
authors.affiliation: Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Prim
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Crusi
authors.affiliation: Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d׳Investigació Biomèdica Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: nbenito@santpau.cat.
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
mesh_terms: D001170:Arthritis, Infectious / Q000000981:diagnostic imaging*; D003013:Clostridium / Q000302:isolation & purification; D003015:Clostridium Infections / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography
keywords: Anaerobic arthritis; Clostridial arthritis; Clostridium; Septic arthritis