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

Abstract

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.

Brucella Periprosthetic Joint Infection Involving Bilateral Knees with Negative Synovial Fluid Alpha-Defensin

“…There is no consensus on how best Brucella PJI should be treated. Published case reports of Brucella -related PJI suggest that in the absence of radiological evidence of joint loosening, standard anti- Brucella antimicrobial therapy alone may be appropriate [19]. Our patient did not have evidence of joint loosening; hence, she was exclusively treated with anti- Brucella antimicrobial therapy, resulting in sustained clinical and microbiological cure without the need for revision surgery further supporting current dogma.…”

“…There is currently no consensus on how best Brucella PJI should be treated with regard to surgical intervention or duration of antimicrobial therapy. It is suggested based on a review of 24 cases with Brucella -related PJI that in the absence of radiological evidence of joint loosening, antimicrobial therapy alone may be appropriate [19].…”

Atypical presentation of shoulder brucellosis misdiagnosed as subacromial bursitis: A case report

“…Human infections can be transmitted through fluids of infected animals, for example via the consumption of unpasteurized dairy products or from aerosols of infected individuals[ 8 , 9 ]. Brucellosis can cause either an acute febrile illness, after a usual incubation period of 1-4 wk but ranging up to 6 mo, or a chronic infection, which can occur without focus and can affect any organ system[ 10 , 11 ]. The musculoskeletal system and spine are the most common sites of infection, however, and in general there is a wide spectrum of clinical manifestations that may last from several days up to several years[ 6 ].…”

Biosafety Concerns Related toBrucellaand Its Potential Use as a Bioweapon

“…The incubation period is particularly prolonged for brucellosis, most cases ranging from 1 to 4 weeks but in some instances extending to as long as 6 months. 12 It has been suggested that the emergence of new, more virulent potential biological weapons make inclusion of Brucella among agents of bioterrorism to be mainly of historical significance. 6 Brucella spp.…”