Sepsis, Endocarditis, and Purulent Arthritis due to a Rare Zoonotic Infection with Streptococcus equi Subspecies zooepidemicus

Table 2

Published cases with septic arthritis due to Streptococcus equi subsp. zooepidemicus.

Number	Age/sex	Year/nationality	Diagnosis	Comorbidity	Contamination	Antibiotic therapy	Pattern of resistance	Duration of treatment	Outcome	Reference
1	60/M	2008, Germany	Purulent arthritis	Chronic back pain	Horses (cutaneous wound)	IV amoxicillin with clavulanic acid, gentamicin	Tetracycline	5 weeks and 4 days	None	[13]
2	72/F	2003, Spain	Septic arthritis	None	Milk-borne outbreak	Beta-lactam agent	Sensitive to penicillin, erythromycin, vancomycin, rifampin, and levofloxacin, but resistant to clindamycin and tetracycline	Unknown	Limited mobility	[3]
3	79/M	2003, Spain	Bacteraemia and septic arthritis	DMII, AH, HD	Milk-borne outbreak	Beta-lactam agent	Same as case number 3	Unknown	Recovered	[3]
4	62/M	2011, Finland	Bacteraemia septic arthritis (in two joints)	DMII,	Horses	Cefuroxime (first three days), changed to IV vancomycin (unknown duration), changed to penicillin G with clindamycin (2 weeks), changed to oral cephalexin and clindamycin for 1 week	Sensitive to erythromycin, clindamycin, penicillin, vancomycin, and cephalexin	Unknown, but >3 weeks	Recovered	[1]
5	70/M	1985, England	Septic arthritis, sepsis, acute renal failure	AH, HD, osteo- and rheumatoid type arthropathy	No daily animal contact, possible ingested unpasteurised milk	IV penicillin G (3 week), oral penicillin (3 months)	Unknown	3 months and 3 weeks	Recovered	[14]
6	78/M	2003–2015, Sweden	Sepsis, and septic arthritis	AH, HD, CLL	Unknown			12 weeks and 8 days	Unknown	[15]
7	71/M	2003–2015, Sweden	Septic arthritis	WM	Unknown	Penicillin G followed by amoxicillin	Unknown	17 weeks and 1 day	Unknown	[15]
8	79/M	2003–2015, Sweden	Septic arthritis	AH	Horses	Penicillin G followed by amoxicillin	Unknown	17 weeks and 1 day	Unknown	[15]
9	42/M	Unknown	Septic arthritis	None	Horses	Penicillin G	Unknown	Unknown	Recovered	[16]
10	74/F	1992, USA	Septic arthritis, bacteraemia	None	No relation to contact with animals	Penicillin changed to vancomycin due to suspicion of penicillin allergy	Unknown	5 weeks	Recovered	[16]

The table includes 10 of the 16 cases. The last six cases are not included because the information in the articles was either impossible to get access to or not detailed enough to fulfil the table: One case of purulent arthritis in the article “An outbreak of Streptococcus equi subspecies zooepidemicus associated with consumption of fresh goat cheese.” Three more cases are described in “Group C streptococcal bacteremia: analysis of 88 cases.” Finally, two cases from England presented in “Group C streptococci in human infection—a study of 308 isolates with clinical correlations.” AH: arterial hypertension; IHD: ischemic heart disease; HD: heart disease; DMII: diabetes mellitus type II; WM: Waldenströms macroglobulinemia; CLL: chronic lymphatic leukaemia; USA: the United States of America.