Borrelia burgdorferi causes prosthetic joint infection

In their case report “Borrelia burgdorferi—A Bacterium Worthy of Consideration in Culture-Negative Prosthetic Joint Infection,” Crowe and colleagues describe a patient who developed a prosthetic joint infection due to Borrelia burgdorferi. [1]

The 68-year-old woman presented to the orthopedic clinic with pain and swelling in her right knee, which had been ongoing for 2 weeks. Eight years earlier, she had a total knee replacement but lived pain free following the surgery.

One month prior to her knee pain, the patient had been treated with steroids for pain in her right hip.

In the preceding 4 months, she had also visited her primary care doctor complaining of fatigue. But she did not recall any tick bites or a rash.

According to the authors, the woman had elevated serum inflammatory markers and culture-negative aspirate with a high percentage of neutrophils.

“The patient underwent a standard prosthesis explant procedure, followed by the placement of an articulating antibiotic spacer.”

She was treated empirically with a 6-week course of IV vancomycin and ceftriaxone.

However, “Given her residence in a rural setting and frequent walks with her dogs in wooded settings,” Lyme disease testing was performed.

Test results were positive for Lyme by IgG and IgM, and she began treatment with IV doxycycline.

“One week after the first-stage explant, B. burgdorferi was determined to be the causative  microorganism.”

The second stage of her knee surgery was performed and after 1 year, the woman had no signs or symptoms of infection.

Authors conclude

• “B. burgdorferi as a cause for culture negative [prosthetic joint infections] should be a consideration for those patients in endemic areas, with or without known tick exposure.”