A case report on Mycobacterium houstonense infection after total hip arthroplasty

Abstract

Background: Mycobacterium houstonense is a category of rapidly growing mycobacteria that is gram-positive, acid-fast, polycrystalline, and non-spore-forming. There have been few reports of human infection caused by Mycobacterium houstonense worldwide.

Case presentation: We present a case of chronic periprosthetic joint infection caused by Mycobacterium houstonense in an elderly female patient. The patient developed signs of infection after undergoing total hip arthroplasty. Despite receiving antibiotic treatment and revision surgery, the signs of infection recurred repeatedly. Multiple bacterial cultures during the treatment period were negative. Later, we identified the pathogenic bacteria Mycobacterium houstonense through mNGS testing, isolated the bacteria from the ultrasonically centrifuged fluid of the prosthesis and obtained drug sensitivity results. Finally, we performed a revision surgery and treated the patient with moxifloxacin and clindamycin. After treatment, the patient did not show signs of infection recurrence during 24 months of follow-up.

Conclusion: Through a relevant literature search, we believe that Mycobacterium houstonense may show higher sensitivity to amikacin and quinolone antibiotics. Additionally, clarifying occult infection sources through methods such as gene testing will improve the diagnosis and treatment of periprosthetic joint infection.

Keywords: Metagenomic next-generation sequencing; Mycobacteria houstonense; Periprosthetic joint Infection; Rapidly growing mycobacteria; Two-stage revision Surgery.

Fig. 1

Pictures related to the treatment period. (a) The surgical incision at the patient’s first visit; (b) The X-ray image at the patient’s first visit; (c) The surgical incision at the patient’s second visit; (d) Prosthesis removed during the operation; (e) X-ray for the patient’s left hip joint before discharge; (f) The patient’s incision with 24 months’ follow-up