Brucella melitensis prosthetic joint infection

Abstract

Periprosthetic joint infection (PJI) due to Brucella spp. is rare. We report a case in a 75-year-old man and review 29 additional cases identified in a literature search. The diagnosis of Brucella PJI is challenging, in particular in non-endemic countries. Serological tests prior to joint aspiration or surgical intervention are reasonable. Involvement of infection control and timely information to laboratory personnel is mandatory upon diagnosis. There is no uniform treatment concept, neither with respect to surgical intervention nor for the duration of antimicrobials. Most cases have a successful outcome, irrespective of surgical modality, and with an antimicrobial combination regimen for 12 or more weeks.

An Unusual Case of Brucella abortus Prosthetic Joint Infection

“…Time interval between implantation of prosthesis and diagnosis of PJI in cases documented to date ranges from immediately post operatively to 168 months with a median time interval of 48 months. 4 Time between implantation and diagnosis of infection in this case was 180 months and is the longest interval to date to our knowledge. Most documented cases of Brucella prosthetic joint infection described are Brucella melitensis i.e.…”

“…Duration of antimicrobial therapy has ranged from 6 weeks to 2 years in cases documented to date with a median of 16 weeks. 4 This case highlights a number of teaching points. The patient was treated for brucellosis and systemic symptoms resolved.…”

“…12 patients had consumed unpasteurised dairy products, 6 patients worked as a farmer or shepherd and 5 patients reported contact with cattle or goats. 4 The optimal surgical approach to PJI is unknown because of the lack of large-scale, randomized, prospective studies. Successful outcomes have been reported following one and two stage exchange.…”

“…Previous authors have reported drinking unpasteurised milk and exposure to animals such as cattle, sheep and goats as risk factors for brucellosis and Brucella prosthetic joint infection. 4 Patients with a prosthesis in situ should be alerted to the need to avoid such risk factors.…”

Comparative proteomic and genomic analyses of Brucella abortus biofilm and planktonic cells

“…additionally, biofilm-grown microorganisms have an inherent lack of susceptibility to antibiotics (11)(12)(13). Brucella melitensis (B. melitensis) has been suggested to form biofilms during its life cycle (14). Wild-type B. abortus can also develop biofilms under nutritionally deficient, microaerobic conditions (15).…”