Brucellar prosthetic arthritis in a total knee replacement

Orti, Ana; Roig, P; Alcalá, Rafael; Navarro, V. Castro; Salavert, Miguel; Martin, C.; Zorraquino, Alfredo; Merino, J.

doi:10.1007/bf01700416

Cited by 23 publications

(23 citation statements)

References 13 publications

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“…All patients who had been checked were strongly positive for Brucella specific serum tests. Nevertheless, this infection is very unusual in periprosthetic joint infection of the knee and only nine cases were reported in the literature (2,3,5,(17)(18)(19). In this case, if the authors had been aware of this infection, the serum indicators of brucellosis could have tested and the cultures incubated in a longer time period to detect the Brucella spp.…”

Section: Discussionmentioning

confidence: 95%

Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

2016

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Introduction: Brucellosis is a zoonotic infectious disease with worldwide distribution, especially in the south and central American countries, the Middle-East and the Mediterranean areas. Knee prosthesis infection due to Brucella spp. is very rare with the first case reported in 1991 and the ninth case reported in 2010. Case Presentation: Here is reported a case of a 68-year-old female patient, referring to Shafa Orthopedic hospital, Tehran, Iran, complaining about a discharge from right total knee arthroplasty. All of the knee joint aspirations and laboratory tests were negative for infection. Initially, no clear reason was found for this painful operated knee and it was decided to revise it; however, intraoperative samples were positive for Brucella melitensis. Unfortunately, serum indicators of Brucellosis (Wright, Coombs Wright and 2-mercaptoethanol (2ME) tests) had not been checked in the preoperative evaluations. After six months of antibiotic therapy for brucellosis, a second stage revision surgery was performed successfully. Conclusions: Prosthetic infection by Brucella species is very uncommon, this is the tenth case of total knee prosthesis infection with Brucella spp. reported in the literature but all orthopedic surgeons, especially those who work in the endemic areas, should evaluate a suspected joint for brucellosis.

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Section: Discussionmentioning

confidence: 95%

Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

2016

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“…Systemic brucellosis is the most common clinical form of the disease but hematogenous spread may result in focal forms of infection. Endocarditis, glomerulonephritis, uveitis, splenic abscess, hepatic abscess, and prosthetic device infection all represent hematogenous spread of the infection [4][5][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…According to Memish et al [3], more than 8,000 cases are reported per year to public health authorities. The mode of transmission is usually consumption of unpasteurized milk or infected dairy products or direct contact with livestock [4]. Breast involvement in animals is common, whereas in humans it is an extremely rare condition.…”

Section: Introductionmentioning

confidence: 99%

Breast Brucellosis in Taif, Saudi Arabia: cluster of six cases with emphasis on FNA evaluation

Nemenqani

Yaqoob

Khoja

2009

J Infect Dev Ctries

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Background: Brucellosis is an endemic zoonosis seen in a variety of geographical locations such as the Middle East and Latin American and Mediterranean countries. Brucellosis is hyper-endemic in Saudi Arabia with an incidence of 5.4 per 1000 per year. Breast involvement very rarely occurs as a focal complication of brucellosis. Methodology: We report six cases of breast brucellosis retrieved from the files of the patients. Fine needle aspiration (FNA) was performed on all patients. In all cases direct smears were made at the patient's side for assessment of sample quality. Cytospin and cell block preparation was done and Gram, periodic acid-Schiff and Ziel-Nelson stains were done on all samples. Microbiological analysis included routine fungal and bacterial culture for tuberculosis. Results: Age range was 20 to 48 years with a median of 22 years. Two patients gave history of raw milk ingestion, one was lactating, and one patient was pregnant. Cytomorphologic features of brucellosis in the breast include an abscess-like background with granulomatous inflammation. Cytology of the patients presented with breast abscess showed predominant neutrophilic infiltrate compatible with acute pyogenic inflammation. Culture was positive for B. melitensis in all cases. Conclusion: Brucellosis should be kept in mind in the differential diagnosis of breast abscess in endemic areas where ingestion of unpasteurized milk and milk products is common. Needle aspiration establishes a preliminary diagnosis and has the advantage of material submission for microbiologic cultures and provides focal treatment along with long-term combined antibacterial treatment for the control of systemic infection.

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“…It is a systemic disease in which every organ can be affected [1]. Osteoarticular complications are common (up to 10%-85% of all cases) and can manifest as sacroiliitis, arthritis, spondylitis, osteomyelitis, tenosynovitis and borsitis [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Total knee prosthesis infection by Brucella melitensis: case report and review of the literature

Marchese¹,

Bianchi²,

Cavenago³

2006

J Orthopaed Traumatol

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We refer a case of total knee prosthesis infected by Brucella melitensis: a 74-years-old woman, affected by knee arthritis and operated 9 years before in a different hospital with the implant of a total prosthesis to the left knee. The lapse of time between the joint implant and the onset of the general symptoms of infection was 36 months. The infection localized to the left knee 12 months later. The source was identified with the consumption of a diary unpasteurized product. The first treatment was conservative by antibiotic cocktail, then the prosthetic implant removal has become necessary. To our knowledge, in the literature only 8 cases of brucellar prosthetic infection have been previously reported (5 knee and 3 hip prosthesis): in 7 cases Brucella melitensis was isolated, in one Brucella abortus.Key words Brucellosis • Total knee arthroplasty mals (e.g. livestock breeding, veterinary medicine, butchery) and one that is related to the consumption of nonpasteurized milk and milk products [1,2]. In only 15%-20% of all cases is the diagnosis of brucellosis confirmed by culture. Most cases are diagnosed by serology with the agglutination test of Wright [3].The initial symptons of a brucellosis infection are non-specific (recurrent fever, excessive sweating, migraine headaches, apathy and asthenia). The most frequent complications affect the osteoarticular complex and can include polyarthralgia, spondylitis, sacroiliitis, coxitis, osteomyelitis and aseptic arthritis. Because brucella organisms grow intracellularly, it is necessary to use an antibiotic that not only is active against the brucella bacteria but is also able to penetrate the cell membrane. Tetracycline, rifampicin, co-trimoxazole and ami-

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Brucellar prosthetic arthritis in a total knee replacement

Cited by 23 publications

References 13 publications

Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

Infected Total Knee Arthroplasty by Brucella melitensis: A Rare Case Report

Breast Brucellosis in Taif, Saudi Arabia: cluster of six cases with emphasis on FNA evaluation

Total knee prosthesis infection by Brucella melitensis: case report and review of the literature

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