Corynebacterium striatum Periprosthetic Hip Joint Infection: An Uncommon Pathogen of Concern?

BACKGROUND: Total hip arthroplasty is indubitably a dominant elective surgery in orthopaedics, contributing to prodigious improvement in the quality of life of patients with osteoarthritis. One of the most potentially devastating complications of this operation is periprosthetic joint infection. Immunocompromised patients might be afflicted by infrequent low-virulence organisms not typically detected with conventional procedures. Consequently, employing advanced identification methods, such as the circumstantial sonication of orthopaedic implants, could be crucial to managing such cases. CASE PRESENTATION: We present a peculiar case of a 72-year-old female patient suffering from a chronic periprosthetic hip infection due to Corynebacterium striatum. The pathogen was only identified after rigorous sonication of the extracted implants. The overall management of this case was immensely exacting, primarily because of the patient's impaired immune system, and was finally treated with two-stage revision in our Institution. LITERATURE REVIEW: Although copious literature exists concerning managing periprosthetic hip infections, no concrete guidelines are available for such infections in multimorbid or immunocompromised patients with rare low-virulence microorganisms. Hence, a diagnostic work-up, antibiotic treatment and appropriate revision timeline must be determined. Sonication of extracted implants could be a powerful tool in the diagnostic arsenal, as it can aid in identifying rare microbes, such as Corynebacterium spp. Pertinent antibiotic treatment based on antibiogram analysis and apposite final revision-surgery timing are the pillars for effective therapy of such infections. CLINICAL RELEVANCE: Corynebacterium striatum has been increasingly recognized as an emerging cause of periprosthetic hip infection in the last decade. A conspicuous rise in such reports has been observed in multimorbid or immunocompromised patients after the COVID-19 pandemic. This case is the first report of Corynebacterium striatum periprosthetic hip infection diagnosed solely after the sonication of extracted implants. This paper aims to increase awareness surrounding Corynebacterium spp. prosthetic joint infections, while highlighting the fields for further apposite research.

Acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient: a case report and literature review.

We present the first case of acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient. A 53-year-old Caucasian man was referred to the outpatient clinic, because of a swelling of the left submental and submandibular spaces. The patient was immunocompromised owing to medication against myasthenia gravis and type II diabetes mellitus. The patient underwent surgical debridement under local anesthesia. Histologic examination showed acute osteomyelitis and both blood and pus cultures isolated Rhodococcus equi. The patient was discharged on linezolid 600 mg orally twice a day for 6 months and remains free of the disease 2 years postoperatively. Most patients with Rhodococcus infection are immunocompromised. Infection with this organism is rare and usually causes a distinct clinical syndrome resembling pulmonary tuberculosis. Diagnosis is frequently missed or delayed. Not only clinicians but also laboratory specialists should be aware of this organism, so as to contribute to prompt diagnosis and treatment of such infections.

Sexual dimorphism of the scapula and the clavicle in a contemporary Greek population: applications in forensic identification.

Sex estimation is the grounds for an accurate identification of unknown human skeletal elements. The need for reliable methods distinguishing males from females based upon various skeletal elements is evident in cases of commingled, eroded and/or missing remains. The aim of this work lays on establishing criteria for sex estimation from the scapula and the clavicle in modern Greeks. A total of 147 left scapulae and 147 clavicles (66 females and 81 males) were used in the study. Eight and six measurements were taken on the scapula and clavicle respectively and data were subjected to principal components analysis (PCA) and discriminant function analysis (DFA). Posterior probabilities for the classification of each individual are also calculated. Statistical analysis was carried out using the software PAST (Paleontological Statistics) and SPSS (Statistical Package for Social Sciences) 18. The results supported the existence of pronounced sexual dimorphism, which was mainly attributed to size differences among the two groups. Univariate and multivariate methods of statistical classification showed high accuracy for all scapular and most clavicular measurements, verifying their value as sex indicators in the under study population. We recommend the use of this method for sex assessment from the scapula and the clavicle in cases exhibiting over 95% probability of correct classification. This is regardless of the overall high degree of accuracy reported here, as the method of choice in forensic contexts should always be case-driven.