Is Listeria monocytogenes an important pathogen for prosthetic joints?

Listeria monocytogenes usually causes meningitis or bacteremia, often in im munocompromised adults, pregnant women, or infants. We report a case of sep tic arthritis caused by L. monocytogenes in a patient with seronegative rhe umatoid arthritis (RA) whose hip replacement was infected. She subsequently died, probably secondary to an adult respiratory distress syndrome, a rare complication of listerial infection. We also reviewed all 18 previously re ported cases of septic arthritis caused by L. monocytogenes. The frequency of underlying RA, diabetes, neoplastic disease, and immunosuppressive thera py is prominent, as is the concurrent presence of a previous knee or hip re placement. Thus, the simultaneous presence of immune suppression and certai n medical disorders or their treatment and a prosthetic joint should alert the clinician to the possibility that L. monocytogenes is the offending mic robial agent. In contrast, in immunocompetent persons the usual Gram-positi ve cocci such as staphylococci, streptococci, or even pneumococci predomina te. Although the outcome of appropriate treatment with penicillin or ampici llin alone (or with an aminoglycoside or trimethoprim/sulfamethoxazole in p enicillin-allergic individuals) is usually favorable, complicating medical disorders can lead to death. Cephalosporins are rarely effective antimicrob ial agents in patients with Listeriosis.