Prosthetic hip joint infection by Bacillus Calmette-Guerin therapy following intravesical instillation for bladder cancer identified using whole-genome sequencing: a case report.

Riste, Michael, Davda, Pretin, Smith, E Grace, Wyllie, David H, Dedicoat, Martin, Jog, Simantini, Laird, Steven, Langman, Gerald, Jenkins, Neil, Stevenson, Jonathan and O'Shea, Matthew K (2021) Prosthetic hip joint infection by Bacillus Calmette-Guerin therapy following intravesical instillation for bladder cancer identified using whole-genome sequencing: a case report. BMC infectious diseases, 21 (1). p. 151. ISSN 1471-2334. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

BACKGROUND

Joint replacement is an effective intervention and prosthetic joint infection (PJI) is one of the most serious complications of such surgery. Diagnosis of PJI is often complex and requires multiple modalities of investigation. We describe a rare cause of PJI which highlights these challenges and the role of whole-genome sequencing to achieve a rapid microbiological diagnosis to facilitate prompt and appropriate management.

CASE PRESENTATION

A 79-year-old man developed chronic hip pain associated with a soft-tissue mass, fluid collection and sinus adjacent to his eight-year-old hip prosthesis. His symptoms started after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Synovasure™ and 16S polymerase chain reaction (PCR) tests were negative, but culture of the periarticular mass and genome sequencing diagnosed BCG infection. He underwent a two-stage joint revision and a prolonged duration of antibiotic therapy which was curative.

CONCLUSIONS

BCG PJI after therapeutic exposure can have serious consequences, and awareness of this potential complication, identified from patient history, is essential. In addition, requesting appropriate testing is required, together with recognition that traditional diagnostics may be negative in non-pyogenic PJI. Advanced molecular techniques have a role to enhance the timely management of these infections.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: QW Microbiology. Immunology
QZ Pathology. Oncology
W Public health. Health statistics. Occupational health. Health education
WC Communicabable diseases
WE Musculoskeletal. Orthopaedics
Divisions: Clinical Support > Infection Control
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 17 Feb 2021 13:21
Last Modified: 17 Feb 2021 13:21
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3987

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