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J Clin Microbiol ; 52(6): 2259-61, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24719439

ABSTRACT

We describe the evaluation of culture-negative synovial fluid from a 3-year-old boy by PCR and electrospray ionization followed by mass spectrometry (PCR/ESI-MS). Our patient developed a diffuse rash and fever with systemic signs and symptoms of sepsis, but four sets of blood cultures obtained prior to initiation of antibiotics were negative. After 1 week of illness, he developed right-knee swelling. Analysis of synovial fluid was consistent with infection, but cultures of specimens obtained following initiation of antimicrobial treatment were negative for growth. PCR/ESI-MS detected Streptobacillus moniliformis in the synovial fluid sample. Our patient completed an appropriate course of antibiotic treatment and remained completely asymptomatic in follow-up evaluation. This unique case suggests that PCR/ESI-MS may be a useful diagnostic tool for direct detection of unusual or unexpected pathogens directly from clinical specimens, particularly when samples have been obtained from patients following initiation of antibiotic therapy.


Subject(s)
Rat-Bite Fever/diagnosis , Rat-Bite Fever/pathology , Streptobacillus/isolation & purification , Animals , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Humans , Male , Polymerase Chain Reaction/methods , Rat-Bite Fever/drug therapy , Rat-Bite Fever/microbiology , Rats , Spectrometry, Mass, Electrospray Ionization/methods , Synovial Fluid/microbiology , Treatment Outcome
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