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

Abstract

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.

Bilateral Prosthetic Knee Joint Infection Caused by Brucella melitensis: A Rare Case Report from Iran

“…In previous reports, most cases had implant loosening; hence, the prosthesis was removed to be treated success-fully (13)(14)(15). These case reports were in contrast with the case we reported in this study.…”

Periprosthetic joint infection due to Brucella infection: A report of a rare presentation and review of the literature

“…After long-term incubation of the intraoperative specimens, cultures returned positive for Brucella infection and she received combined antibiotic therapy through rifampin and doxycycline for 6 months. Unfortunately, because we were clinically not suspected of the diagnosis of Brucellosis, safety laboratory precautions were not implemented while examining the specimen, the physician, and laboratory technician became infected [5].…”

“…In this case, the diagnosis of PJI was made according to Parvizi et al criterion [4]. Unfortunately, because we were clinically not suspected of the diagnosis of Brucellosis, safety laboratory precautions were not implemented while examining the specimen, the physician, and laboratory technician became infected [5]. Although the occurrence of PJI due to Brucellosis is a very rare entity [6], early diagnoses of this rare presentation lead to a better outcome and avoid unwitting infection of laboratory staff.…”