Plesiomonas shigelloides Periprosthetic Knee Infection After Consumption of Raw Oysters
Periprosthetic infections are a leading cause of morbidity after total joint arthroplasty. Common pathogens include Staphylococcus aureus, streptococcus, enterococcus, Escherichia coli, and Pseudomonas aeruginosa. However, there are many cases in which rare bacteria are isolated. This case report describes a periprosthetic knee infection caused by Plesiomonas shigelloides. In the United States, P shigelloides and 2 other Vibrionaceae family members, Vibrio vulnificus and Vibrio parahaemolyticus, are most often contracted from eating raw oysters and shellfish. P shigelloides usually causes a self-limiting watery diarrhea, but in immunosuppressed people it can cause septicemia. In this case report, a chemically and biologically immunosuppressed man consumed raw oysters and developed P shigelloides septicemia and acute periprosthetic knee infection that required surgical intervention.
Although P shigelloides infection is rare, outbreaks have occurred around the world.7-11,14 Infections are most commonly associated with consumption of raw shellfish or freshwater fish or with water contamination.12 In the United States, the only described vector for disease has been consumption of raw oysters and shellfish—in particular, those harvested from the warm waters of the Gulf Coast.8,9P shigelloides usually causes a self-limiting watery diarrhea. However, in children and immunosuppressed patients, P shigelloides can lead to life-threatening septicemia.12 In the United States, P shigelloides cases often occur in the summer, likely related to the easy growth of the bacteria from shellfish in the Gulf Coast’s warm water and mud.8 This predilection for summer infections has been documented around the world.15Our patient reported eating raw oysters imported to the US Southwest from an unknown location. He likely was susceptible to P shigelloides infection, as he was immunosuppressed with etanercept and prednisone. However, there were no traditional diarrheal symptoms. Case reports have described nondiarrheal symptoms in children and other immunosuppressed people.12There is much to learn from this case report. Most important, it highlights the need to obtain a complete history and perform a thorough physical examination. Our patient’s 2 key historical findings, immunosuppressive medication use and raw oyster consumption, point strongly toward Vibrionaceae infection. Although a majority of periprosthetic infections are caused by common organisms, such as Staphylococcus and Streptococcus species, orthopedic clinicians should continue to expand their knowledge of periprosthetic infections, as many other pathogens can cause disease.
Am J Orthop. 2017;46(1):E32-E34. Copyright Frontline Medical Communications Inc. 2017. All rights reserved.
