Abstract
IntroductionRalstonia pickettii is an infrequent pathogen of invasive infections in healthy individuals. The microorganism is supposed to be of relatively low virulence, but can cause infections, mainly of the respiratory tract, in immunocompromised and cystic fibrosis patients. Ralstonia pickettii has also been associated with hospital outbreaks related to contamination of products used for medical care and laboratory diagnosis.Case presentationWe report here a case of septic arthritis due to Ralstonia pickettii in a female diabetic patient. The microorganism was identified from the synovial fluid by molecular-based methods, while the conventional synovial and blood cultures proved to be negative. The patient was treated by intravenous ceftazidime with complete remission of her symptoms; she was discharged 3 weeks after admission in a very good health. At follow-up examination 3 weeks later, she was still in good health condition without any sign of arthritis of the right knee and afebrile.ConclusionIn culture negative serious bacterial infections, as septic arthritis, the use of molecular-based techniques might be of outmost importance as additional and rapid diagnostic tools for the identification of the causative agent allowing a prompt and appropriate antimicrobial therapy and a favourable outcome.
Highlights
Ralstonia pickettii is an infrequent pathogen of invasive infections in healthy individuals
Infections due to Ralstonia pickettii are very rare in healthy individuals, since the microorganism is supposed to be of relatively low virulence and is often associated with pseudobacteremia or asymptomatic
Reports on bacteremia and septicemia caused by Ralstonia pickettii have already been described [7,8]
Summary
Formerly known as Pseudomonas (Burkholderia) pickettii, is a non-fermenting gram-negative bacillus that is found in water, soil, plants, fruits and vegetables [1]. Case presentation An 83-year-old female Greek patient of Caucasian origin patient was admitted to the Department of Medicine, Medical School University of Thessaly, Larissa, Greece because of fever and severe arthritis of the right knee. Her past medical history was positive of arterial hypertension, adult-onset diabetes mellitus and an episode of ischemic stroke. The results were available within three days from the date of specimen collection At this point the treatment was changed to intravenous administration of 2 g t.i.d. of ceftazidime as the patient had not responded to the previous antibiotic regimen. The conventional synovial fluid cultures and consecutive blood cultures failed to detect the microorganism; after a prolonged incubation of fifteen days no growth of microorganisms was observed
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