1999 Resident Poster Competition
Bahaeldeen A. Laz M.D.
ST. LOUIS UNIVERSITY
Infection of Knee Joint Prosthesis With Tularemia
Introduction: Prosthetic devices are particularly vulnerable to infection which can cause major morbidity and mortality. Francisella tularensis is the causative organism of Tularemia (Rabbit fever), which is an acute infectious disease usually characterized by a primary ulcerative local lesion, lymphadenopathy, atypical pneumonia, and a typhoid-like febrile illness. It is not described as a cause of prosthetic joint infection.
Abstract: 81 year-old male with degenerative joint disease. The patient underwent total right knee joint replacement in January '98, and had been doing well until he presented in July '98 with a two week history of increasing pain and swelling in his right knee associated with a low-grade fever and chills. The patient is a farmer from Missouri and he recalled skinning squirrels in June, and he has had two episodes of tick bites three weeks before presentation. Physical examination reveals no skin infection or lymphadenopathy. Examination of the right knee showed a tender, swollen joint with 2+ effusion and restriction of motion, the patient had knee joint fluid aspiration and the culture grew. Francisella tularensis, with a negative blood culture, the patient was admitted for intravenous Gentamicin and underwent surgical irrigation and debridement of his right knee. He recovered completely after three weeks of IV Gentamicin and oral ciprofloxacin.
Conclusion: This is a first case report of Francisella tularensis infecting a prosthetic joint. Tularemia has thirty percent mortality rate if left untreated. Francisella tularensis should be included in the differential diagnosis of organisms causing prosthetic joint infection.
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Alan D Forker, MD MACP
Missouri Chapter Governor
Patrick Mills
Missouri Chapter Executive Director
