J Bone Jt Infect 2018; 3(4):222-225. doi:10.7150/jbji.25519

Research Paper

Erysipelas or cellulitis with a prosthetic joint in situ

Marjan Wouthuyzen-Bakker1✉, Jaime Lora-Tamayo2, Eric Senneville3, Matthew Scarbourough4, Tristan Ferry5, Ilker Uçkay6, Mauro J Salles7, Karina O'Connell8, Josean A Iribarren9, Dace Vigante10, Rihard Trebse11, Cedric Arvieux12, Alex Soriano13, Javier Ariza14, Group of Investigators for Streptococcal Prosthetic Joint Infection

1. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, the Netherlands.
2. Department of Internal Medicine, Hospital Universitario 12 de Octubre. Instituto de Investigación i+12. Madrid, Spain.
3. Department of Infectious Diseases, Gustave Dron Hospital of Tourcoing, France.
4. The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
5. Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France.
6. Department of Infectious Diseases, Hôpitaux Universitaires Genève, Switzerland.
7. Department of Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brasil.
8. Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
9. Department of Infectious Diseases, Hospital Universitario Donostia, San Sebastián, Spain.
10. Hospital of Traumatology and Orthopaedics, Riga, Latvia.
11. Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.
12. Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.
13. Service of Infectious Diseases, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain.
14. Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain.


We describe a case of a 60-year old male who developed an acute prosthetic joint infection (PJI) of the knee, secondary to erysipelas of the lower leg due to beta-hemolytic Group G streptococci. As it is unknown how often this phenomenon occurs in patients with prosthetic implants and which patients are most prone to develop this complication, we analyzed: i) the incidence of the development of a PJI in these patients and ii) the clinical characteristics of streptococcal PJI during an episode of erysipelas/cellulitis. Based on a retrospective analysis of patients with a prosthetic implant in situ presenting at the emergency department with erysipelas/cellulitis, 1 out of 10 patients developed a PJI. An additional analysis within a multicenter cohort on streptococcal PJI demonstrated in 22 patients that a secondary PJI due to erysipelas/cellulitis mostly develops in young implants (<5 years old). In 20 cases (91%), the skin infection was in the same limb as the joint prosthesis suggesting contiguous spread of bacteria. These data emphasizes the importance of preventive measures to reduce the occurrence of skin infections in patients with prosthetic implants, and if an erysipelas or cellulitis does occur, to monitor patients carefully.

Keywords: cellulitis, erysipelas, prosthetic joint infection, contiguous focus, streptococci

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How to cite this article:
Wouthuyzen-Bakker M, Lora-Tamayo J, Senneville E, Scarbourough M, Ferry T, Uçkay I, Salles MJ, O'Connell K, Iribarren JA, Vigante D, Trebse R, Arvieux C, Soriano A, Ariza J, Group of Investigators for Streptococcal Prosthetic Joint Infection. Erysipelas or cellulitis with a prosthetic joint in situ. J Bone Jt Infect 2018; 3(4):222-225. doi:10.7150/jbji.25519. Available from http://www.jbji.net/v03p0222.htm