Total Hip Arthroplasty Infected by <i>Brucella</i>: A Report of Two Cases

Ruiz-Ibán, M A; Crespo, Pastor Villavicencio; Diaz-Peletier, R; Rozado, AM; López-Pardo, A.

doi:10.1177/230949900601400122

Cited by 12 publications

(14 citation statements)

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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%

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%

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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“…Sacroiliac joint is the most common site of involvement [ 7 ], followed by knee or ankle joints [ 8 ]. Monoarthritis of the hip in children [ 9 ] and even prosthetic hip infections [ 10 ] caused by Brucella e have been previously reported, but rarely in healthy young adults.…”

Section: Discussionmentioning

confidence: 99%

Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report

et al. 2014

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IntroductionBrucellosis is a systemic infectious disease which is still a challenging medical problem in rural areas such as northern China. It rarely occurs in urban areas such as Shenzhen in southern China. Osteoarticular involvements are frequently seen in brucellosis, and rarely is arthritis the only clinical presentation. We report a case of hip septic arthritis caused by Brucella melitensis in an urban area of Shenzhen, China.Case presentationA 29-year-old Chinese woman, Han ethnical group presented to our hospital with left hip pain persisting for one month. She had a history of contact with goats one month before admission. Her clinical examination showed marked tenderness and limited movement of her left hip. Further imaging showed effusion of her left hip joint. Inflammatory markers including erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were raised. Our clinical diagnosis was septic arthritis of the left hip. A left hip arthroscopy was performed and the culture was positive for Brucella melitensis. She returned to normal activity after completing a standard antibiotic regimen, including gentamicin at 120mg daily for 2 weeks, doxycycline at 100mg daily and rifampicin at 450mg for a total of 12 weeks.ConclusionsBrucellosis is endemic in some rural areas of China, but rare in urban areas such as Shenzhen in southern China. However, more cases will be expected in urban areas due to increasing migration within China. Physicians should consider brucellosis as one of the differential diagnosis of arthritis. Early surgical intervention is recommended to prevent further joint destruction.

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“…Surgical debridement, retention of implant, and antibrucella therapy were performed in one patient. 7 Six patients were treated with antibrucella treatment only. The mean duration of antibiotic therapy for all patients was 5.8 months.…”

Section: Resultsmentioning

confidence: 99%

“…Most authors suggested a minimum duration of antibrucella therapy of 6 weeks. 7 , 8 , 18 , 19 There is no evidence that a shorter period of antibrucella treatment will give the same results. In our pooled analysis, the mean duration of antifungal therapy was 5.8 months (range 6 weeks–26 months).…”

Section: Discussionmentioning

confidence: 99%

“…2 Correct management for Brucellar infection diagnosed through aspiration or over a well fixed TJA is still unclear. 7 Traditionally, routine treatment usually includes the surgical removal of all bioprosthetic components. 3 Debridement without removal of prosthesis is a controversial issue due to the potential risk of relapse of infection.…”

Section: Introductionmentioning

confidence: 99%

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Brucella infection following total joint arthroplasty: A systematic review of the literature

Kim

Park

Lee

2018

Acta Orthopaedica et Traumatologica Turcica

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IntroductionThe aim of this systematic review was to analyze the results of published treatment options in Brucella infection following total joint arthroplasty (TJA).MethodsWe performed a systematic review of the literature regarding outcomes of Brucella infection after TJA (hip and knee). We searched multiple databases for articles in the area published from 1950 to 2016.ResultsA total of 18 patients (12 male and 6 female; mean age 59 years) from 14 published studies were identified. The minimum follow-up time was 6 months (range, 6–120 months). Seven patients were treated with debridement or antibrucella treatment only. Eleven patients (61%) underwent removal of the prosthesis and were treated with one or two-stage exchange arthroplasty. The mean duration of antibiotic therapy was 5.8 months. There was no relapse of infection.ConclusionsIn the absence of loosening of the components of the prosthesis, an attempt to treat Brucella infection medically might be a reasonable choice. One or two-stage exchange arthroplasty could provide successful results without relapse of infection when combined with appropriate antibiotherapy.Level of evidenceLevel III, therapeutic study.

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Total Hip Arthroplasty Infected by Brucella: A Report of Two Cases

Cited by 12 publications

References 12 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

Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report

Brucella infection following total joint arthroplasty: A systematic review of the literature

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