A first case of prosthetic joint infection with Actinomyces radingae

Available online 18 January 2023, 102662

Author links open overlay panelAbstract

Prosthetic joint infection is a common clinical orthopedic problem but infections caused by Actinomyces species have been rarely reported. An increasing number of reports identifying Actinomyces in cases of prosthetic joint infection suggest it may be an emerging pathogen. We describe here the first known case of a prosthetic joint infection caused by Actinomyces radingae.

Introduction

Actinomyces species have been recognized for over a century to cause disease in humans [1]. They are slow-growing, fastidious organisms, that cause a wide spectrum of pathology ranging from superficial localized infection to invasive disseminated disease [2]. Identification of Actinomyces species has been historically difficult using conventional laboratory techniques but widespread uptake of molecular methods including time of flight mass spectrometry (MALDI TOF) has improved detection [3]. In recent years, this has led to the reclassification and recognition of several additional pathogenic Actinomyces sub-species. Although Actinomyces species are known to cause a wide range of clinical pathology, bone and joint infection is infrequent and cases of prosthetic joint infection with Actinomyces have been rarely reported.

Actinomyces radingae is a novel pathogenic sub-species of the Actinomyces family. It has been recovered most often as a component of chronic skin and soft tissue infections but has not previously been a known cause of disease within the musculoskeletal system. Although a majority of human infection is due to Actinomyces israelii it is clear several other sub-species are increasingly contributing to pathology. A recent rise in reports of human infection with Actinomyces radingae suggests it may be an emerging pathogen. Given the rapidly increasing numbers of total joint arthroplasties this may have clinical relevance when assessing patients with suspected prosthetic joint infections [4,5]. Here we describe the first known case of a prosthetic joint infection caused by Actinomyces radingae.

Section snippetsCase description

A 69-year-old male presented to the hospital with a four-month history of right gluteal pain. He had a known history of congestive heart failure with a cardiac pacemaker, type two diabetes mellitus, hypertension, hypothyroidism, obesity, and spinal stenosis. He had a right total hip arthroplasty placed in 2011 for osteoarthritis with no previous noted complications.

The patient initially presented to his outpatient orthopedic provider with progressive right-sided gluteal pain which he initially

Discussion and literature review

Actinomycetes are filamentous gram-positive bacilli that are considered commensals of the human microbiome. They most commonly colonize the oropharynx, gastrointestinal tract, and urogenital tract of humans but rarely cause disease [6]. Over thirty species of Actinomyces have been identified but Actinomyces israelii is by far the most prevalent species isolated in clinical infection accounting for 70–80% of all Actinomycosis [6,7]. Clinical syndromes including cervicofacial actinomycosis,

Conclusion

Although Actinomyces are colonizers of the human microbiome they appear to be emerging pathogens with the potential to cause PJI. We presented here the first known case of Actinomyces radingae prosthetic hip infection in an immunocompetent host. Infections likely occur from hematogenous seeding but intraarticular joint injection may also be a potential mechanism. More research is needed to better understand the clinical risk factors, pathogenesis, and optimal treatment for infections with

Ethical statement

Identifying information has been removed from the case to preserve anonymity and informed consent was obtained prior to publication.

Declaration of competing interest

None of the authors (AK, SN, SP) have any conflicts of interest or disclosures to declare.

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