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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Bibliographic Details
Published in:BMC infectious diseases Vol. 21; no. 1; pp. 151 - 5
Main Authors: 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
Language:English
Published: London BioMed Central 05.02.2021
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
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
Online Access:Get full text
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Description
Summary: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.
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ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-021-05831-3