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Volume 29, Number 6—June 2023
CME ACTIVITY - Synopsis

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

Léa Ponderand, Thomas Guimard, Estibaliz Lazaro, Henry Dupuy, Olivia Peuchant, Nathalie Roch, Philippe Deroche, Tristan Ferry, Max Maurin, Aurélie Hennebique, Sandrine Boisset, Isabelle Pelloux, and Yvan CasparComments to Author 
Author affiliations: Grenoble Alpes University Hospital Center, Grenoble, France (L. Ponderand, M. Maurin, A. Hennebique, S. Boisset, I. Pelloux, Y. Caspar); Univ. Grenoble Alpes, CNRS, CEA, IBS, Grenoble, France (L. Ponderand, S. Boisset, Y. Caspar); Departmental Hospital Center of Vendée, La Roche sur Yon, France (T. Guimard); University Hospital Center of Haut-Lévêque, Pessac, France (E. Lazaro, H. Dupuy); University Hospital Center of Bordeaux, Bordeaux, France (O. Peuchant); William Morey Hospital Center, Chalon-sur-Saône, France (N. Roch); Dracy-le-Fort Orthopedic Center, Dracy-le-Fort, France (P. Deroche); Claude Bernard University Lyon 1, CNRS ENS Lyon, INSERM, Lyon, France (T. Ferry); Croix-Rousse University Hospital Center, Hospices Civils de Lyon, Lyon (T. Ferry); Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble (M. Maurin, A. Hennebique)

Main Article

Table 1

Clinical and biologic characteristics of patients with Francisella tularensis–related prosthetic joint infection*

Characteristic Case
1 2 3 4 (10) 5 (11) 6 (11) 7 (12) 8 (13)
Country France France France United States Switzerland Czech Republic United States Canada
Region
Vendée
Gironde
Aube
Colorado
NS
NS
Illinois
Ontario
Age, y
49
70
68
58
84
84
77
68
Sex
M
M
M
M
F
M
M
M
Exposure factors
Rural residence, dog
Hunter
Retired butcher, cooking with wild game
Farmer, possible rabbit carcass handling
Airborne transmission (rabbit barn in neighbor’s house)
Walk in tularemia- endemic area
Hunter
Hunter, tick bite 6 mo before surgery
Type of surgery
Left THR
Left TKA
Left THR
Left TKA
Right knee prosthesis
Right TKA
Right THR
Right TKA
Delay between diagnosis and prosthesis implantation
35 d
12 y
19 y
9 mo
12 y
8 y
7 d
6 mo
Clinical symptoms
Infected scar, fever
Feverish confusion, bilateral mediastinal and hilar lymphadenopathy, knee swelling
Joint pain
Repeated joint effusion
Erythema, joint pain
Fever, abdominal pain, confusion, painful knee effusion
Fever, joint pain and swelling, bullous skin lesion with itching
Joint pain, warm and swollen knee
CRP, mg/L
21
100
58
NA
81
98
16
NA
Leukocytes, G/L
4.45
4
NA
NA
NA
NA
NA
NA
Sample type
Abscess
Joint aspiration
3 tissues
Joint aspiration
7 tissues
Joint aspiration
Joint aspiration
Joint aspiration
No. positive samples/total
1/1
1/1
2/3
1/1
6/7
1/1
1/1
1/1
Delay to positivity
NA
7 d
5 d
24 h–48 h
12 d
4 d
7 d
3 d
Identification
Vitek 2 GN Biochemical assay; ISFtu2 PCR +; specific F. tularensis subspeciesholarctica PCR
Specific Francisella PCR; ISFtu2 PCR +; 16S-23S PCR + sequencing
MALDI-TOF MS (Microflex LT); ISFtu2 PCR +; specific F. tularensis subspecies holarctica PCR
Sequencing
16S rRNA gene sequencing
16 S rRNA gene sequencing
MALDI-TOF MS
Sequencing
Serologic results MAT 640; IFA IgG 1,280; IgM 640 ELISA IgG 1.5; IgM 3.58; IFA IgG 640; IgM 640 MAT 160 ND IgM 232.6 U/mL; IgG 126.4 U/mL MAT 80 Positive (titers NA) MAT 320

*CRP, C-reactive protein; IFA, immunofluorescence assay; MALDI-TOF MS, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; MAT, microagglutination test; Microflex LT, Bruker Daltonics; NA, not available; ND, not done; NS, not specified; THR, total hip replacement; TKA, total knee arthroplasty; +, positive.

Main Article

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Page created: March 29, 2023
Page updated: May 18, 2023
Page reviewed: May 18, 2023
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