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

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 challen...

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Veröffentlicht in:	BMC infectious diseases Jg. 21; H. 1; S. 151 - 5
Hauptverfasser:	Riste, Michael, Davda, Pretin, Smith, E. Grace, Wyllie, David H., Dedicoat, Martin, Jog, Simantini, Laird, Steven, Langman, Gerald, Jenkins, Neil, Stevenson, Jonathan, O’Shea, Matthew K.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London BioMed Central 05.02.2021 BioMed Central Ltd Springer Nature B.V BMC
Schlagworte:	Administration, Intravesical Aged Antibiotics Arthritis, Infectious - diagnosis Arthritis, Infectious - etiology Arthritis, Infectious - therapy Artificial hip joints Bacillus Bacillus Calmette-Guerin Bacillus Calmette-Guerin vaccine BCG BCG Vaccine - administration & dosage BCG Vaccine - adverse effects BCG Vaccine - genetics BCG Vaccine - isolation & purification BCG vaccines Bladder Bladder cancer Cancer Cancer therapies Care and treatment Case Report Case reports Case studies Complications and side effects Deoxyribonucleic acid Diagnosis DNA DNA sequencing Drug therapy Gene sequencing Genome, Bacterial - genetics Genomes Hip Hip Prosthesis - adverse effects Hip Prosthesis - microbiology Humans Infections Infectious bone diseases Infectious Diseases Internal Medicine Intravesical BCG therapy Joint diseases Male Medical Microbiology Medicine Medicine & Public Health Mycobacterium bovis Nucleotide sequencing Pain Parasitology Polyethylene Polymerase chain reaction Prostheses Prosthesis-Related Infections - diagnosis Prosthesis-Related Infections - etiology Prosthesis-Related Infections - therapy Prosthetic joint infection Surgery Therapy Treatment Outcome Tropical Medicine Tuberculosis and other mycobacterial diseases Urinary Bladder Neoplasms - drug therapy Whole genome sequencing United Kingdom Bacillus Calmette-Guerin Case report Intravesical BCG therapy Prosthetic joint infection Whole-genome sequencing Mycobacterium bovis
ISSN:	1471-2334, 1471-2334
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Zusammenfassung:	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.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Report-3 ObjectType-Case Study-4 ObjectType-Case Study-2 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1471-2334 1471-2334
DOI:	10.1186/s12879-021-05831-3