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Septic Arthritis of the Knee in a Patient With Actinomyces meyeri Bacteremia

Duggal, Abhijit MD, MPH*†; Waraich, Kanwaljit MD*†; Cutrona, Anthony MD, FIDSA, FACP*‡

Infectious Diseases in Clinical Practice: November 2009 - Volume 17 - Issue 6 - p 411-413
doi: 10.1097/IPC.0b013e31819fe439
Case Reports

Actinomyces are filamentous, gram-positive, anaerobic commensals in the oropharyngeal and intestinal tracts in humans. Invasion of breached or necrotic tissue results in infection with this organism. Dental procedures are a well-documented risk factor for local and systemic Actinomyces infections. Actinomyces meyeri can cause serious systemic infections including brain abscesses, endocarditis, osteomyelitis, and empyema, but there are no previous reports of joint involvement with A. meyeri. Skeletal involvement in actinomycosis is usually secondary to local spread from the soft tissues. Hematogenous seeding of bones and joints is extremely rare. We report the first case of A. meyeri bacteremia with septic arthritis of the knee joint in a woman on chronic corticosteroids who underwent a recent dental extraction. We also review the medical literature for the last 30 years of joint involvement as a result of Actinomyces species.

From the *Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown; and †Department of Internal Medicine, and ‡Division of Infectious Diseases, Western Reserve Care System, Youngstown, OH.

Reprints: Abhijit Duggal, MD, MPH, Department of Internal Medicine, Western Reserve Care System, 500 Gypsy Lane, Youngstown, OH. E-mail:

The authors have no personal involvement or financial support with any organization with financial interest in the subject matter or with any actual or potential conflict of interest.

This work was performed at Northside Hospital, Western Reserve Care System, Youngstown, OH.

© 2009 Lippincott Williams & Wilkins, Inc.