Leuconostoc mesenteroides periprosthetic knee infection, an unusual fastidious Gram-positive bacteria: a case report.
Periprosthetic joint infections are mainly caused by Gram-positive cocci. Leuconostoc mesenteroides is a rare microorganism mainly causing bloodstream infections. At times, it might be confused with another type of cocci and give rise to misdiagnosed infections. Molecular diagnosis and biofilm production comprise important techniques to guide antibiotic treatment.



A 68-year-old Hispanic female with a previous history of bilateral knee arthroplasty presented with acute right-knee inflammation and gait impairment. Blood tests showed inflammatory response and knee x-ray revealed no prosthesis loosening. Irrigation and debridement was performed. Gram-positive cocci were obtained from cultures, and then biochemical and molecular identification revealed L. mesenteroides. Susceptibility and biofilm production were performed. The patient was treated with IntraVenous (IV) Ceftriaxone for ten days and was then switched to Amoxicillin-Clavulanate for 3 months with clinical and laboratory success.



Microbiology diagnosis of fastidious microorganisms is mandatory to treat periprosthetic joint infections adequately. L. mesenteroides may infect non-immunocompromised persons; however, treatment guidelines are lacking.
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico. raffcend@yahoo.com.
Rafael
R
Franco-Cendejas
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Claudia A
CA
Colín-Castro
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Melissa
M
Hernández-Durán
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Luis E
LE
López-Jácome
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Silvestre
S
Ortega-Peña
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Guillermo
G
Cerón-González
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Samuel
S
Vanegas-Rodríguez
Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Jaime A
JA
Mondragón-Eguiluz
Hip and Knee Reconstruction Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
Eduardo
E
Acosta-Rodríguez
D000368:Aged; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D000070007:Leuconostoc mesenteroides / Q000302:isolation & purification*; D016459:Prosthesis-Related Infections / Q000175:diagnosis*
Biofilm; Case report; Leuconostoc mesenteroides; Periprosthetic joint infection