Total diz artroplasti ameliyatı sonrası gelişen Nocardia farcinica enfeksiyonu

Öz

Enfeksiyon, total diz protezi uygulamalarında önemli bir komplikasyondur ve ciddi bir morbiditeye sahiptir. Bu yazıda, çimentolu total diz protezi uygulamasından sonra ortaya çıkan Nocardia farcinica enfeksiyonu olgumuzu sunuyoruz. Yetmiş sekiz yaşındaki erkek hasta, sol gonartroz nedeniyle total diz artroplastisi ameliyatı sonrası birinci ayda başlayan dizde hareket kısıtlılığı, ağrı ve şişlik yakınmaları ile polikliniğimize başvurdu. Artroskopik debridman, sinevektomi ve antibiyotik tedavisinin ardından iyileşme sağlanamayınca, hastanın total diz protez komponentleri çıkarıldı. Tedavisinde yirminci ayını dolduran hastanın dizinde henüz iyileşme sağlanamamıştır ve olgunun izlemi devam etmektedir.

Anahtar Kelimeler

• Artroplasti; diz; enfeksiyon; Nocardia.

The Nocardia farcinica infection developing after total knee arthroplasty surgery

Öz

Infection is an important complication in total knee prosthesis implementations and possesses a serious morbidity. We present a case of Nocardia farcinica infection which appeared after application of cemented total knee prosthesis. A 78-year-old male patient had referred to the outpatient clinic with the complaints of restricted movement, pain and swelling of the knee which started after a month following total knee arthroplasty surgery due to left gonarthrosis. As no improvement could be achieved after arthroscopic debridement, synovectomy and antibiotherapy, the components of the total knee prosthesis were removed from him. Although improvement could not be achieved in the knee of the patient at the end of 20-month therapy, the case has still being followed-up.

Anahtar Kelimeler

• Arthroplasty
• infection
• knee
• Nocardia

Kaynakça

1. Steckelberg JM, Osmon DR. Prosthetic joint infection. In: Bisno AL, Waldvogel FA, editors. Infections associated with indwelling medical devices. 3rd ed. Washington, DC: American Society for Microbiology; 2000. p. 173-209.
2. Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 2001;33: 94Garvin KL, Hanssen AD. Infection after total hip arthroplasty: past, present and future. J Bone Joint Surg Am 1995; 77:1576-88.
3. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 2006; 19:259-82.
4. Corti ME, Villafane-Fioti MF. Nocardiosis: a review. Int J Infect Dis 2003;7:243-50.
5. McNeil MM, Brown JM. The medically important aerobic actinomycetes, epidemiology and microbiology. Clin Microbiol Rev 1994;7:358-417.
6. Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol 2003;41:4497-501. Beaman BL, Beaman L. Nocardia species: host-parasite relationship. Clin Microbiol Rev 1994;7:213-64.
7. Lerner PI. Nocardiosis. Clin Infect Dis 1996;22:891-903.
8. Mamelak AN, Obana WG, Flaherty JF, Rosenblum ML. Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 1994;35:622-31.

9. Kalb RE, Kaplan MH, Grossman ME. Cutaneous nocardiosis. Case reports and review. J Am Acad Dermatol 1985;13: 125Sorrell TC, Mitchell DH, Iredell JR. Nocardia species. Mandell GL, Bennett JE, Dolin R, editors. In: Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingston; 200 p. 2916-24.
10. Munksgaard B. Nocardia infections. Am J Transplant 2004;4: 47Wallace RJ, Steele LC, Sumter GY, Smith JM. Antimicrobial susceptibility patterns of Nocardia asteroides. Antimicrob Agents Chemother 1988;32:1776-9.
11. Matulionyte R, Rohner P, Uckay I, Lew D, Garbino J. Secular trends of Nocardia infection over 15 years in a tertiary care hospital. J Clin Pathol 2004;57:807-12.
12. Menéndez R, Cordero PJ, Santos M, Gobernado M, Marco V. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J 1997;10:1542-6.
13. Yildiz O, Alp E, Tokgoz B, Tucer B, Aygen B, Sumerkan B, et al. Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect Dis 2005;11:493-512.
14. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al.; Infectious Diseases Society of America. Practice guideliness for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1373-406.
15. Moylett EH, Pacheco SE, Brown-Elliott BA, Perry TR, Buescher ES, Birmingham MC, et al. Clinical experience with linezolid for the treatment of Nocardia infection. Clin Infect Dis 2003;36:313-8.
16. Geiseler PJ, Andersen BR. Results of therapy in systemic nocardiosis. Am J Med Sci 1979;278:188-94.
17. Ambrosioni J, Lew D, Garbino J. Nocardiosis: updated clinical review and experience at a tertiary center. Infection 2010;38:89-97.
18. Provost F, Laurent F, Camacho Uzcategui R, Boiron P. Molecular study of persistance of Nocardia asteroides and Nocardia otitidiscaviarum strains in patients with long-term nocardiosis. J Clin Microbiol 1997;35:1157-60.
19. Kanemitsu K, Kunishima H, Saga T, Harigae H, Ishikawa S, Takemura H, et al. Efficacy of amikacin combinations for nocardiosis. Tohoku J Exp Med 2003;201:157-63.
20. Gomez-Flores A, Welsh O, Said-Fernandez S, LozanoGarza G, Tavarez-Alejandro RE, Vera-Cabrera L. In vitro and in vivo activities of antimicrobials against Nocardia brasiliensis. Antimicrob Agents Chemother 2004;48:832-37. Audenaert E, Almafragi A, Vuylsteke M, Verdonckt C, Verdonk R. Nocardia farcinica arthritis of the knee. A case report. Acta Orthop Belg 2004;70:386-8.
21. Kahraman S, Genctoy G, Arici M, Cetinkaya Y, Altun B, Caglar S. Septic arthritis caused by Nocardia asteroides in a renal transplant recipient. Transplant Proc 2004;36:1415-8. Nizam I, Kohan L, Kerr D. Nocardia nova septic arthritis following total knee replacement: a case report. J Orthop Surg 2007;15:390-2.