title: Septic arthritis due to Legionella cincinnatiensis: case report and review of the literature.
abstract: Legionella spp. are an important cause of pulmonary and rarely extrapulmonary infections. L. cincinnatiensis has only been implicated in five cases to date. We herein report the first case of L. cincinnatiensis septic arthritis in a 90-year old lady with a past medical history of chronic kidney disease. She developed septic arthritis of her left wrist after having received intraarticular corticosteroid injections and oral corticosteroids administered for presumed chondrocalcinosis. Appropriate antimicrobial treatment of L. cincinnatiensis septic arthritis was delayed until identification of this organism in joint biopsies by broad-range bacterial PCR targeting the 16S rRNA gene with subsequent rDNA sequence analysis and by culture on special media. Reviewing all reported cases of septic arthritis caused by Legionella spp. other than L. cincinnatiensis it is notable that diagnosis was established by PCR in the majority of cases and only subsequently confirmed by special culture. Although most patients were immunosuppressed, outcome was favourable. Treatment consisted of a fluoroquinolone alone or in combination with rifampicin or a macrolide. Our case highlights the need for a high index of suspicion for infections with unusual/fastidious organisms when symptoms are suggestive of septic arthritis but conventional methods fail to identify a causative organism.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Banderet
authors.affiliation: Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Annette
authors.initials: A
authors.lastname: Blaich
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Evelin
authors.initials: E
authors.lastname: Soleman
authors.affiliation: Swiss National Reference Centre for Legionella, Servizio di microbiologia EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gaia
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. michael.osthoff@usb.ch.|Department of Clinical Research, University Hospital Basel, Basel, Switzerland. michael.osthoff@usb.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Osthoff
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007875:Legionella / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D007876:Legionellosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D018942:Macrolides / Q000627:therapeutic use; D012329:RNA, Bacterial / Q000032:analysis; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D012293:Rifampin / Q000627:therapeutic use; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D018942:Macrolides; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D012293:Rifampin
keywords: Legionella cincinnatiensis; Polymerase-chain reaction; Septic arthritis