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

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Lewis, Joseph M, Folb, Jonathan, Kalra, Sanjay, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536 and Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791 (2016) 'Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature'. Travel Medicine and Infectious Disease, Vol 14, Issue 5, pp. 444-450.

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Abstract

BACKGROUND
Brucella spp. prosthetic joint infections are infrequently reported in the literature, particularly in returning travellers, and optimal treatment is unknown.

METHOD
We 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.

RESULTS
The 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.

CONCLUSIONS
Brucella-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.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 108 Preventive health services. Preventive medicine. Travel Medicine.
WC Communicable Diseases > Infection. Bacterial Infections > Other Bacterial Infections. Zoonotic Bacterial Infections > WC 310 Brucellosis
WE Musculoskeletal System > WE 800 Extremities > WE 870 Knee. Lower leg
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.tmaid.2016.08.010
Depositing User: Rachel Dominguez
Date Deposited: 29 Sep 2016 10:38
Last Modified: 13 Nov 2019 11:22
URI: https://archive.lstmed.ac.uk/id/eprint/6221

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