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      Knieprotheseninfekt mit Capnocytophaga canimorsus: Prothesenerhalt oder -wechsel?

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          Abstract

          Zusammenfassung. Wir präsentieren den Fall einer 83-jährigen Patientin mit einer periprothetischen Knieprotheseninfektion mit Capnocytophaga canimorsus. Er ist die Erstbeschreibung einer erfolgreichen prothesenerhaltenden Behandlung eines periprothetischen Infekts mit C. canimorsus. Dieser Krankheitserreger kommt kommensalisch in Hunde- und Katzenspeichel vor und wird meist bei Tierbissen übertragen. Aufgrund seiner schlechten Kultivierbarkeit könnte C. canimorsus für einen Teil der Kultur-negativen periprothetischen Infekte verantwortlich sein.

          Knee Prosthesis Infection with Capnocytophaga canimorsus: Retention or Removal?

          Abstract. We describe the case of an 83-year-old patient with a periprosthetic knee infection caused by Capnocytophaga canimorsus. It is the first published case of a periprosthetic joint infected with C. canimorsus and successfully treated with long-term antibiotics, saving the prosthetic joint. C. canimorsus is a commensal bacterium in dog and cat saliva and is most often transmitted by bites. Because of the fastidious and slow-growing characteristics it could account for some of the culture-negative periprosthetic joint infections.

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          Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites.

          T. Butler (2015)
          Newly named in 1989, Capnocytophaga canimorsus is a bacterial pathogen found in the saliva of healthy dogs and cats, and is transmitted to humans principally by dog bites. This review compiled all laboratory-confirmed cases, animal sources, and virulence attributes to describe its epidemiology, clinical features, and pathogenesis. An estimated 484 patients with a median age of 55 years were reported, two-thirds of which were male. The case-fatality rate was about 26%. Its clinical presentations included severe sepsis and fatal septic shock, gangrene of the digits or extremities, high-grade bacteremia, meningitis, endocarditis, and eye infections. Predispositions were prior splenectomy in 59 patients and alcoholism in 58 patients. Dog bites before illness occurred in 60%; additionally, in 27%, there were scratches, licking, or other contact with dogs or cats. Patients with meningitis showed more advanced ages, higher male preponderance, lower mortality, and longer incubation periods after dog bites than patients with sepsis (p < 0.05). Patients with prior splenectomy presented more frequently with high-grade bacteremia than patients with intact spleens (p < 0.05). The organism possesses virulence attributes of catalase and sialidase production, gliding motility, cytotoxin production, and resistance to killing by serum complement due to its unique lipopolysaccharide. Penicillin is the drug of choice, but some practitioners prefer third-generation cephalosporins or beta-lactamase inhibitor combinations. C. canimorsus has emerged as a leading cause of sepsis, particularly post-splenectomy sepsis, and meningitis after dog bites.
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            Capnocytophaga canimorsus a novel pathogen for joint arthroplasty.

            We report the case of a 59-year-old man with Waldenstrom's macroglobulinemia and active alcohol use who presented with bilateral knee pain 5 years after a bilateral staged TKA. Cultures of synovial fluid and periprosthetic tissue specimens from both knees yielded, after prolonged anaerobic incubation, a catalase- and oxidase-positive gram-negative bacillus, which was identified as Capnocytophaga canimorsus by 16S ribosomal RNA PCR analysis. C. canimorsus, an organism that is commonly found in dog and cat saliva, is a rare cause of various infections in immunocompromised and healthy individuals. However, a review of the medical literature indicates C. canimorsus has not been reported previously to cause infection after joint arthroplasty. The patient was immunocompromised by cytotoxic chemotherapy, corticosteroids, and alcohol use. The patient was managed successfully with bilateral two-stage exchange and 6 weeks of intravenous ertapenem therapy. Because of its fastidious and slow-growing characteristics, C. canimorsus may be an unrecognized cause of culture-negative joint arthroplasty infections, especially in cases when dog and cat exposure is evident in the clinical history.
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              Prosthetic‐joint infections

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                Author and article information

                Contributors
                Journal
                prx
                Praxis
                Hogrefe AG, Bern
                1661-8157
                1661-8165
                2017
                : 106
                : 9
                : 483-485
                Affiliations
                [ 1 ]Klinik für Rheumatologie, Geriatrie und Rehabilitation, Spitäler Schaffhausen
                [ 2 ]Klinik für Chirurgie und Orthopädie, Spitäler Schaffhausen
                [ 3 ]Radiologie und Nuklearmedizin, Spitäler Schaffhausen
                [ 4 ]Zentrallabor, Spitäler Schaffhausen
                Author notes
                Prof. Dr. med. Thomas Stoll, Chefarzt Klinik für Rheumatologie, Geriatrie und Rehabilitation, Kantonsspital Schaffhausen, Geissbergstrasse 81, 8208 Schaffhausen, E-Mail thomas.stoll@ 123456spitaeler-sh.ch
                Article
                prx_106_9_483
                10.1024/1661-8157/a002662
                eed06fb7-2e5b-4192-92e9-bba190bc6507
                Copyright @ 2017
                History
                : Eingegangen: 18. Januar 2017
                : 16. Februar 2017
                Categories
                Praxis-Fall

                General medicine,Medicine,Cardiovascular Medicine,Radiology & Imaging,Respiratory medicine,Pharmacology & Pharmaceutical medicine
                Capnocytophaga canimorsus,Periprothetischer Gelenkinfekt,C. canimorsus,Periprosthetic joint infection

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