Hospital-Associated Transmission of<i>Brucella melitensis</i>outside the Laboratory1

Lowe, Christopher F.; Showler, Adrienne; Perera, Suzette; McIntyre, Susan; Qureshi, Roohi; Patel, Samir N.; Allen, Vanessa; Devlin, Hannah; Muller, Matthew P.

doi:10.3201/eid2101.141247

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…After removal of duplicates, 47 remained. 18 reports contained data on 23 patients with 26 Brucella -related prosthetic joint infections; only 3 were in returning travellers [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Table 1 summarises all 24 patients including: gender, country of exposure, type of implant and time to symptom onset.…”

Section: Resultsmentioning

confidence: 99%

“…Synovial fluid from Brucella -infected joints is likely to have a lower bacillary load than culture bottles or plates and therefore exposure to synovial fluid during joint aspiration or joint revision surgery probably represents a lower risk exposure. Nevertheless, a case of transmission during joint aspiration has been described, to a radiology technician who assisted with injecting synovial fluid from a Brucella -infected joint from a syringe into a sample container [20]. Neither UK [3] nor US guidelines [23] provide recommendations for risk assessment of potential Brucella exposure outside the laboratory, or recommendations for PPE while performing joint aspiration or surgery.…”

Section: Resultsmentioning

confidence: 99%

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Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature

Lewis

Folb

Kalra

et al. 2016

Travel Medicine and Infectious Disease

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SummaryBackgroundBrucella spp. prosthetic joint infections are infrequently reported in the literature, particularly in returning travellers, and optimal treatment is unknown.MethodWe describe a prosthetic joint infection (PJI) caused by Brucella melitensis in a traveller returning to the UK from Thailand, which we believe to be the first detailed report of brucellosis in a traveller returning from this area. The 23 patients with Brucella-related PJI reported in the literature are summarised, together with our case.ResultsThe diagnosis of Brucella-related PJI is difficult to make; only 30% of blood cultures and 75% of joint aspiration cultures were positive in the reported cases. Culture of intraoperative samples provides the best diagnostic yield. In the absence of radiological evidence of joint loosening, combination antimicrobial therapy alone may be appropriate treatment in the first instance; this was successful in 6/7 [86%] of patients, though small numbers of patients and the likelihood of reporting bias warrant caution in drawing any firm conclusions about optimal treatment. Aerosolisation of synovial fluid during joint aspiration procedures and nosocomial infection has been described.ConclusionsBrucella-related PJI should be considered in the differential of travellers returning from endemic areas with PJI, including Thailand. Personal protective equipment including fit tested filtering face piece-3 (FFP3) mask or equivalent is recommended for personnel carrying out joint aspiration when brucellosis is suspected. Travellers can reduce the risk of brucellosis by avoiding unpasteurised dairy products and animal contact (particularly on farms and abattoirs) in endemic areas and should be counselled regarding these risks as part of their pre-travel assessment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature

Lewis

Folb

Kalra

et al. 2016

Travel Medicine and Infectious Disease

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“… 14 - 16 In addition, brucellosis is considered one of the most common laboratory-transmitted infectious diseases, accounting for 2% of all infections. 17 - 18 In Saudi Arabia, brucellosis is an endemic zoonotic disease. Ministry of Health reported incidence of 18/100,000 population/year in 2011.…”

Section: Epidemiologymentioning

confidence: 99%

Pediatric brucellosis

Bukhari

2018

SMJ

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“…Although person-to-person transmission of brucellosis is rare, transmission may occur in contact with contaminated blood and by aerosol-producing diagnostic procedures [ 18 ]. For patients suffering from human brucellosis during hospitalisation, standard precautions and contact precautions for those with draining wounds are required.…”

Section: Discussionmentioning

confidence: 99%

Brucellosis in a refugee who migrated from Syria to Germany and lessons learnt, 2016

et al. 2016

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A teenage woman migrating from Syria arrived in May 2015 in Germany. She gave birth to a healthy child in early 2016, but became febrile shortly after delivery. Blood cultures revealed Brucella melitensis. In retrospect, she reported contact with sheep in Syria and recurrent pain in the hip joints over about five months before diagnosis of brucellosis. We discuss consequences for adequate treatment of mother and child as well as for clinical and laboratory management.

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Hospital-Associated Transmission ofBrucella melitensisoutside the Laboratory1

Cited by 11 publications

References 14 publications

Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature

Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature

Pediatric brucellosis

Brucellosis in a refugee who migrated from Syria to Germany and lessons learnt, 2016

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