Case Studies and Literature Review of Francisella tularensis-Related Prosthetic Joint Infection.

Tularemia is a zoonotic infection caused by Francisella tularensis. Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica-related prosthetic joint infection that occurred in France during 2016-2019. We also reviewed relevant literature and found only 5 other cases of Francisella-related prosthetic joint infections worldwide, which we summarized. Among those 8 patients, clinical symptoms appeared 7 days to 19 years after the joint placement and were nonspecific to tularemia. Although positive cultures are typically obtained in only 10% of tularemia cases, strains grew in all 8 of the patients. F. tularensis was initially identified in 2 patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; molecular methods were used for 6 patients. Surgical treatment in conjunction with long-term antimicrobial treatment resulted in favorable outcomes; no relapses were seen after 6 months of follow-up.

Culture-negative prosthetic joint arthritis related to Coxiella burnetii.

BACKGROUND: The number of hip and knee arthroplasty procedures is steadily increasing as life expectancy increases. Coxiella burnetii may be responsible for culture-negative prosthetic joint arthritis and is associated with antibiotic failure and repeated surgeries. We report the first case series of C. burnetii-related culture-negative prosthetic joint arthritis. METHODS: Cases were retrieved from the French National Referral center for Q fever. Diagnosis was based on (18)fluorodeoxyglucose positron emission tomography, serology, broad-range polymerase chain reaction, and C. burnetii-specific polymerase chain reaction. RESULTS: Four cases of C. burnetii-related culture-negative prosthetic joint arthritis were found. Standard bacteriologic procedures would have missed the diagnosis in all cases. Etiologic diagnosis improved the outcome in all but 1 case. CONCLUSIONS: A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas.

Use of freeze-dried bone allografts in revision total hip arthroplasty.

Acetabular loosenings with severe bone loss require a large amount of graft material to fill the defect. Although all donors are systematically subjected to serologic screening, bone allografts that are chemically processed, freeze-dried, and radiosterilized ensure a higher level of microbiological safety than radiosterilised deep-frozen allografts. The bone allograft used in this study meets this requirement. Therefore, it was both interesting and important to evaluate its outcome in revision acetabuloplasty. This phase II multi-centre study involves 44 revision total hip replacements (35 evaluable) in patients with acetabular bone defects who received allografts obtained from femoral heads harvested from living donors. The results obtained at 40 months follow-up confirmed that reconstructions using a small amount of graft material have a satisfactory outcome. Where an allograft is used in association with an acetabular ring, good primary stability is provided by the ring and secondary stability is ensured by graft incorporation (which, in our study, has often shown to be enhanced by the use of bone cement). The advantages of this type of bone allograft are its greater ease of use and storage at room temperature.