Background: Osteoarticular disease is the most common complication of brucellosis and has been described in 10–85% of patients. Spondylitis is the most prevalent clinical form, also arthritis, bursitis, tenosynovitis, sacroileitis and osteomyelitis have been also described.
Method: We describe our experience concerning three patients with brucellar prosthetic joint infection in Israel.
Results
Case 1: A 38 year old artist was admitted for revision of total hip replacement due to increased pain accompanied by loosening of the prosthesis. Four years prior admission total hip arthroplasty was performed due to psoriatic arthritis treated by methotrexate. Revision surgery demonstrated necrotic tissue which grew Brucella melitensis. Doxycycline and rifampicin were administered for 12 weeks. Second stage revision was performed on the 6th week of antibiotic therapy with favorable results.
Case 2: A 62 year old Arab male underwent right total knee arthroplasty 4 years prior admission due to osteoarthritis. Past medical history included hip arthritis. A second TKA was performed due to septic arthritis caused by Staphylococcus epidermidis and Acinetobacter baumanii. The first stage of the arthroplasty grew Brucella melitensis.
Antibiotic treatment and second stage revision surgery were followed successfully.
Case 3: A 67 year old Arab male was admitted due to fever, right pelvic and back pain lasting for 6 weeks. Five years prior admission the patient underwent left total knee arthroplasty. Computerized tomography was normal. Following admission severe left knee pain developed. Joint aspirate grew Brucella melitensis. Antibiotic treatment and two stages revision surgery were performed successfully.
In all three cases consumption of unpasteurized dairy products was documented. All three patients had serum brucella antibody titer of 1:1600.
Conclusion: Brucella melitensis should be added to the differential diagnosis of prosthetic joint infection, mainly in the Mediterranean basin and the Arabian Gulf. Only two other cases of brucella prosthetic joint infections were reported involving prosthetic knees.
