BACKGROUND: Among patients with hip joint endoprosthesis, periprosthetic osteolysis is the most common complication following primary arthroplasty, and subsequent implant loosening is the leading cause of arthroplasty revision. Causes of stability loss, though not always evident, can be mechanical, allergic, or infectious (bacterial and fungal agents) in nature. Microsporidia, widespread opportunistic fungal pathogens that infect most human tissues, are a potential infectious cause of stability loss. Infections caused by Encephalitozoon species-one of the most common microsporidial pathogens in humans-primarily localize to intestinal and respiratory tracts, but can disseminate to tissues throughout the body. METHODS: We examined 53 immunocompetent patients, 23 after revision and 30 after primary hip arthroplasty, for infection by Encephalitozoon species. Periprosthetic tissue, urine sediments, and stool samples were tested by microscopic examination and genus-specific nested polymerase chain reaction followed by genotyping. RESULTS: Ten patients had Encephalitozoon-positive periprosthetic tissues, 9 (39%) after revision and 1 (3.3%) after primary hip arthroplasty. Among the tissue-positive postrevision patients, 7 had a positive urine sample and 1 had a positive stool sample. Encephalitozoon cuniculi genotype II was identified in 88.8% (16/18) of samples. Two urine samples were positive for a novel Encephalitozoon species. CONCLUSIONS: Encephalitozoon cuniculi should be considered as a cause of osteolysis in hip periprosthetic tissue, leading to a loss of implant stability.

Biology Centre Institute of Parasitology Czech Academy of Sciences Czech Republic

Department of Biology and Medical Parasitology Wroclaw Medical University Poland

Department of Physiotherapy Wroclaw Medical University Wroclaw Poland

Faculty of Agriculture University of South Bohemia České Budějovice Czech Republic

Nonresident Department of Traumatic Orthopedic Surgery Provincial Specialist Hospital Wroclaw Poland

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Clin Infect Dis. 2018 Sep 28;67(8):1235-1236. doi: 10.1093/cid/ciy263. PubMed

Citace poskytuje Crossref.org

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