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Level of evidence: moderate (systemic review of published cases)

This study conducted a systematic review of published cases to examine osteoarticular infections (OAIs) caused by Gemella morbillorum (G. morbillorum), a rare clinical occurrence. The review included 16 studies covering 16 patients, with half having arthritis and the other half osteomyelitis/discitis. The study outlined demographic and clinical characteristics, microbiological data, management, and outcomes.

The key findings were as follows:

1. Patient Characteristics: Eight patients had arthritis, and eight had osteomyelitis/discitis. Most common risk factors were immunosuppression, poor dental hygiene/dental infections, and recent gastrointestinal endoscopy.
2. Joint Involvement: Arthritis cases occurred in native joints and prosthetic joints. Knee and hip joints were frequently affected in arthritis, while thoracic vertebrae were common sites for osteomyelitis/discitis.
3. Infection Sources: In more than half of the cases, the source of G. morbillorum infection was identified, commonly from odontogenic and gastrointestinal sources.
4. Microbiological Data: Blood cultures were positive in a significant percentage of cases, with associated endovascular infection found in some bacteremia cases.
5. Spread and Complications: Contiguous spread, such as adjacent mediastinitis, was documented in specific cases, particularly in sternal and thoracic vertebral osteomyelitis.
6. Treatment: Surgical interventions were performed in 75% of cases. G. morbillorum strains were generally susceptible to penicillin and cephalosporins.
7. Outcomes: All patients with reported outcomes achieved complete recovery.

The study concludes that G. morbillorum is an emerging pathogen for OAIs in susceptible populations with specific risk factors. A thorough evaluation of the infectious focus is recommended for source control. In cases of G. morbillorum bacteremia, a high suspicion for associated endovascular infection is crucial.