Brucella melitensis periprosthetic joint infection

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Microbiology

Background:

• Brucellosis is a common zoonotic infection globally.
• Periprosthetic joint infections (PJI) are a rare complication of brucellosis.
• Raising clinical awareness for Brucella PJI, especially in non-endemic regions, is crucial.

Purpose of the Study:

• To summarize the current medical literature on Brucella PJI.
• To report a case of Brucella PJI.
• To provide insights into diagnosis and management strategies.

Main Methods:

• Case-based literature review.
• Systematic search of multiple databases (February 1983 - December 2023).
• Inclusion of 42 previously reported cases and one new case.

Main Results:

• The study analyzed 43 cases of Brucella PJI, predominantly affecting the knee and hip.
• Common symptoms included local joint pain and systemic signs.
• Diagnosis often relied on positive cultures (synovial fluid, tissue) and serology (97% positive).
• Treatment involved combinations of doxycycline, rifampin, and aminoglycosides, with surgical intervention (two-stage exchange arthroplasty) in many cases.

Conclusions:

• Brucella PJI is a rare but severe manifestation of brucellosis.
• Consider Brucella PJI in patients with joint pain, particularly those from endemic areas or with negative cultures for common pathogens.
• Further research is needed to establish uniform recommendations for antimicrobial therapy duration and surgical procedures due to the possibility of relapse.