Bulleidia extructa Periprosthetic Hip Joint Infection, United States

Bacille Calmette-Guerin vaccine–induced disease in HIV-infected and HIV-uninfect-ed children. et al. Danish bacille Calmette-Guerin vaccine–induced disease in human im-munodeficiency virus–infected children.tection of rifampicin-resistance mutations in Mycobacterium tuberculosis. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl To the Editor: Bulleidia extructa is an obligately anaerobic, nonmo-tile, non–spore-forming gram-positive bacillus first described in 2000 by Downes et al. (1), after having isolated a bacterium from the oral cavity of persons with periodontitis and den-toalveolar abscesses that did not correspond to any known species. After phenotypic and genetic characterization , the investigators proposed a new genus, Bulleidia, and the species B. extructa. Since then, additional reports have associated the organism with oral infections, specifically periodontal disease (2–5). While B. extructa's association with human periodontal disease is well documented, the bacterium has so far not been implicated in other pathogenic processes. We report here a case of a total hip arthroplasty infection caused by B. extructa in an immuno-competent patient. In November 2010, an 82-year-old man with a non-cemented right total hip arthroplasty that was performed 26 years previously was evaluated for right hip pain. He had been in his usual state of health without any complaints until a month earlier, when he lost his footing and hyperabducted his hip joints, involuntarily performing a split, while washing a boat cover with a power washer. Since then, he reported right hip pain that somewhat limited his mobility. Physical examination revealed an antalgic gait, mild swelling of the right lower extremity, and impaired hip mobility related to pain on the right side, specifically with extension, flexion, abduction, and adduction. Results of the patient's blood work were notable for normocytic anemia (hemoglobin 10.6 g/dL), thrombocytosis (459 × 10 9 /L), elevated erythrocyte sedimen-tation rate (101 mm/h), and elevated C-reactive protein (88.7 mg/L). Leu-kocyte count was within normal limits (9.6 × 10 9 cells/L). An ultrasound examination of the right hip joint showed extensive synovitis and a large, 4.3 × 5.0 × 5.1–cm vascular mass extending anteriorly from the joint space. Aspiration of the joint space yielded 1 mL of bloodstained fluid with 111,595 cells/ µL (95% neutrophils, 5% monocytes/ macrophages). Anaerobic bacterial culture grew a gram-positive bacil-lus identified as B. extructa by partial 16S rRNA sequencing. DNA was prepared for PCR amplification by using The generated 484-bp sequence differed by 2 bp from 483 bp of available sequence from B. extructa GenBank accession no. AF220064. …