{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:23:49Z","timestamp":1783164229668,"version":"3.54.6"},"reference-count":28,"publisher":"Universa BV","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Orthop Belg"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:p>Brucellosis, caused by a facultative intracellular gram-negative coccobacillus, is one of the most common zoonotic infections worldwide. Very rarely, brucellosis can cause periprosthetic joint infections (PJI). In this case-based literature review, we summarize the current medical literature regarding Brucella PJI, with the aim to raise awareness among clinicians, particularly in non-endemic areas. We report a case of a woman with a 3 weeks history of increasing hip pain, who was eventually diagnosed with Brucella PJI. We searched multiple databases to identify all case reports on Brucella PJI in humans published from February, 1983 to December, 2023. A total of 42 cases from 38 published articles were retrieved and summarized, along with our case. Mean age was 65.5 years, with sex ratio nearly one. Almost all patients presented with local symptoms and 56% with systemic symptoms. Only knee (n=30) and hip (n=13) prosthetic joint were involved. If performed, culture showed positive results on synovial fluid (74%), intra- operative tissue (79%), and\/or blood (38%). Serological confirmation was obtained in 97%. Antimicrobial treatment consisted of a combination of doxycycline and rifampin in most cases, with in nearly half of the cases the addition of an aminoglycoside. The majority of patients (n=24) were surgically treated with a two stage exchange arthroplasty; although other options were successful as well. Brucella PJI is a rare but potentially severe manifestation of brucellosis. Brucella PJI must be considered in patients from endemic areas, especially when another causative agent has not been isolated. If culture results remain negative, PCR or serology should be performed. To date, there is no uniform recommendation for the duration of antimicrobial therapy nor the preferred surgical procedure. Relapse is possible even with adequate therapy.<\/jats:p>","DOI":"10.52628\/90.4.13281","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:37:30Z","timestamp":1737977850000},"page":"759-767","source":"Crossref","is-referenced-by-count":3,"title":["Brucella melitensis periprosthetic joint infection:"],"prefix":"10.52628","volume":"90","author":[{"given":"L","family":"VANDENBERK","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.F.","family":"VLES","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"DERDELINCKX","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"GHIJSELINGS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"DEPYPERE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"VAN DEN HOUT","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"HENCKAERTS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27062","published-online":{"date-parts":[[2025,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Pappas, G., Akritidis, N., Bosilkovski, M., & Tsianos, E. (2005). Brucellosis. The New England journal of medicine, 352(22), 2325\u20132336. https:\/\/doi.org\/10.1056\/NEJMra050570","DOI":"10.1056\/nejmra050570"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Pappas, G., Papadimitriou, P., Akritidis, N., Christou, L., & Tsianos, E. V. (2006). The new global map of human brucellosis. The Lancet. Infectious diseases, 6(2), 91\u201399. https:\/\/doi.org\/10.1016\/S1473-3099(06)70382-6","DOI":"10.1016\/s1473-3099(06)70382-6"},{"key":"ref2","unstructured":"Control of Neglected Tropical Diseases (NTD). (2006, 15 juni). Brucellosis in humans and animals. https:\/\/www.who.int\/publications\/i\/item\/9789241547130"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Whatmore, A. M., Koylass, M. S., Muchowski, J., Edwards-Smallbone, J., Gopaul, K. K., & Perrett, L. L. (2016). Extended Multilocus Sequence Analysis to Describe the Global Population Structure of the Genus Brucella: Phylogeography and Relationship to Biovars. Frontiers in microbiology, 7, 2049. https:\/\/doi.org\/10.3389\/fmicb.2016.02049","DOI":"10.3389\/fmicb.2016.02049"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Shakir R. (2021). Brucellosis. Journal of the neurological sciences, 420, 117280. https:\/\/doi.org\/10.1016\/j.jns.2020.117280","DOI":"10.1016\/j.jns.2020.117280"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Bosilkovski, M., Krteva, L., Dimzova, M., Vidinic, I., Sopova, Z., & Spasovska, K. (2010). Human brucellosis in Macedonia - 10 years of clinical experience in endemic region. Croatian medical journal, 51(4), 327\u2013336. https:\/\/doi.org\/10.3325\/cmj.2010.51.327","DOI":"10.3325\/cmj.2010.51.327"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Zheng, R., Xie, S., Lu, X., Sun, L., Zhou, Y., Zhang, Y., & Wang, K. (2018). A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China. BioMed research international, 2018, 5712920. https:\/\/doi.org\/10.1155\/2018\/5712920","DOI":"10.1155\/2018\/5712920"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Franco, M. P., Mulder, M., Gilman, R. H., & Smits, H. L. (2007). Human brucellosis. The Lancet. Infectious diseases, 7(12), 775\u2013786. https:\/\/doi.org\/10.1016\/S1473-3099(07)70286-4","DOI":"10.1016\/s1473-3099(07)70286-4"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Roop, R. M., 2nd, Gaines, J. M., Anderson, E. S., Caswell, C. C., & Martin, D. W. (2009). Survival of the fittest: how Brucella strains adapt to their intracellular niche in the host. Medical microbiology and immunology, 198(4), 221\u2013238. https:\/\/doi.org\/10.1007\/s00430-009-0123-8","DOI":"10.1007\/s00430-009-0123-8"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Bosilkovski, M., Krteva, L., Dimzova, M., & Kondova, I. (2007). Brucellosis in 418 patients from the Balkan Peninsula: exposure-related differences in clinical manifestations, laboratory test results, and therapy outcome. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 11(4), 342\u2013347. https:\/\/doi.org\/10.1016\/j.ijid.2006.10.002","DOI":"10.1016\/j.ijid.2006.10.002"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Yagupsky, P., Morata, P., & Colmenero, J. D. (2019). Laboratory Diagnosis of Human Brucellosis. Clinical microbiology reviews, 33(1), e00073-19. https:\/\/doi.org\/10.1128\/CMR.00073-19","DOI":"10.1128\/cmr.00073-19"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Memish, Z. A., Almuneef, M., Mah, M. W., Qassem, L. A., & Osoba, A. O. (2002). Comparison of the Brucella Standard Agglutination Test with the ELISA IgG and IgM in patients with Brucella bacteremia. Diagnostic microbiology and infectious disease, 44(2), 129\u2013132. https:\/\/doi.org\/10.1016\/ s0732-8893(02)00426-1","DOI":"10.1016\/s0732-8893(02)00426-1"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Ruiz-Mesa, J. D., S\u00e1nchez-Gonzalez, J., Reguera, J. M., Mart\u00edn, L., Lopez-Palmero, S., & Colmenero, J. D. (2005). Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 11(3), 221\u2013 225. https:\/\/doi.org\/10.1111\/j.1469- 0691.2004.01063.x","DOI":"10.1111\/j.1469-0691.2004.01063.x"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Christoforidou, S., Kyritsi, M., Boukouvala, E., Ekateriniadou, L., Zdragas, A., Samouris, G., & Hadjichristodoulou, C. (2020). Identification of Brucella spp. isolates and discrimination from the FACULTY OF MEDICINE 18 vaccine strain Rev.1 by MALDI-TOF mass spectrometry. Molecular and cellular probes, 51, 101533. https:\/\/doi.org\/10.1016\/j.mcp.2020.101533","DOI":"10.1016\/j.mcp.2020.101533"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Dematheis, F., Walter, M. C., Lang, D., Antwerpen, M., Scholz, H. C., Pfalzgraf, M. T., Mantel, E., Hinz, C., W\u00f6lfel, R., & Zange, S. (2022). Machine Learning Algorithms for Classification of MALDITOF MS Spectra from Phylogenetically Closely Related Species Brucella melitensis, Brucella abortus and Brucella suis. Microorganisms, 10(8), 1658. https:\/\/doi.org\/10.3390\/microorganisms10081658","DOI":"10.3390\/microorganisms10081658"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Godefroid, M., Svensson, M. V., Cambier, P., Uzureau, S., Mirabella, A., De Bolle, X., Van Cutsem, P., Widmalm, G., & Letesson, J. J. (2010). Brucella melitensis 16M produces a mannan and other extracellular matrix components typical of a biofilm. FEMS immunology and medical microbiology, 59(3), 364\u2013377. https:\/\/doi.org\/10.1111\/j.1574-695X.2010.00689.x","DOI":"10.1111\/j.1574-695x.2010.00689.x"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Almir\u00f3n, M. A., Roset, M. S., & Sanjuan, N. (2013). The Aggregation of Brucella abortus Occurs Under Microaerobic Conditions and Promotes Desiccation Tolerance and Biofilm Formation. The open microbiology journal, 7, 87\u201391. https:\/\/doi.org\/10.2174\/1874285801307010087","DOI":"10.2174\/1874285801307010087"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Izakovicova, P., Borens, O., & Trampuz, A. (2019). Periprosthetic joint infection: current concepts and outlook. EFORT open reviews, 4(7), 482\u2013494. https:\/\/doi.org\/10.1302\/2058- 5241.4.180092","DOI":"10.1302\/2058-5241.4.180092"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Cair\u00f3, M., Calbo, E., G\u00f3mez, L., Matamala, A., Asunci\u00f3n, J., Cuchi, E., & Garau, J. (2006). Foreignbody osteoarticular infection by Brucella melitensis: A report of three cases. The Journal of bone and joint surgery. American volume, 88(1), 202\u2013204. https:\/\/doi.org\/10.2106\/JBJS.D.02656","DOI":"10.2106\/00004623-200601000-00025"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Farmer, K. W., Hammond, J. W., Queale, W. S., Keyurapan, E., & McFarland, E. G. (2007). Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clinical orthopaedics and related research, 455, 183\u2013189. https:\/\/doi.org\/10.1097\/01.blo.0000238839.26423.8d","DOI":"10.1097\/01.blo.0000238839.26423.8d"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Esmaeilnejad-Ganji, S. M., & Esmaeilnejad-Ganji, S. M. R. (2019). Osteoarticular manifestations of human brucellosis: A review. World journal of orthopedics, 10(2), 54\u201362. https:\/\/doi.org\/10.5312\/wjo.v10.i2.54","DOI":"10.5312\/wjo.v10.i2.54"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Lowe, C. F., Showler, A. J., Perera, S., McIntyre, S., Qureshi, R., Patel, S. N., Allen, V., Devlin, H. R., & Muller, M. P. (2015). Hospital-associated transmission of Brucella melitensis outside the laboratory. Emerging infectious diseases, 21(1), 150\u2013152. https:\/\/doi.org\/10.3201\/eid2101.141247","DOI":"10.3201\/eid2101.141247"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Wang, Y., Wang, Z., Zhang, Y., Bai, L., Zhao, Y., Liu, C., Ma, A., & Yu, H. (2014). Polymerase chain reaction-based assays for the diagnosis of human brucellosis. Annals of clinical microbiology and antimicrobials, 13, 31. https:\/\/doi.org\/10.1186\/s12941-014-0031-7","DOI":"10.1186\/s12941-014-0031-7"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Ariza, J., Corredoira, J., Pallares, R., Viladrich, P. F., Rufi, G., Pujol, M., & Gudiol, F. (1995). Characteristics of and risk factors for relapse of brucellosis in humans. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 20(5), 1241\u20131249. https:\/\/doi.org\/10.1093\/clinids\/20.5.1241","DOI":"10.1093\/clinids\/20.5.1241"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Ruiz-Iban, M. A., Crespo, P., Diaz-Peletier, R., Rozado, A. M., & Lopez-Pardo, A. (2006). Total hip arthroplasty infected by Brucella: a report of two cases. Journal of orthopaedic surgery (Hong Kong), 14(1), 99\u2013103. https:\/\/doi.org\/10.1177\/230949900601400122","DOI":"10.1177\/230949900601400122"},{"key":"ref25","unstructured":"Sesli \u00c7etin, E., Kaya, S., Atay, T., Demirci, M., & Yorganc\u0131gil, H. (2008). Brucellar Prosthetic Arthritis of the Knee Detected with the Use of Blood Culture System For the Culture of Synovial Fluid. F\u0131rat T\u0131p Derg, 153-155."},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Balkhair, A., Al Maskari, S., Ibrahim, S., Al Busaidi, I., Al Amin, M., & Ba Taher, H. (2019). Brucella Periprosthetic Joint Infection Involving Bilateral Knees with Negative Synovial Fluid AlphaDefensin. Case reports in infectious diseases, 2019, 9423946. https:\/\/doi.org\/10.1155\/2019\/9423946","DOI":"10.1155\/2019\/9423946"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Qasim, S. N., Swann, A., & Ashford, R. (2017). The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement - a literature review. SICOT-J, 3, 2. https:\/\/doi.org\/10.1051\/sicotj\/2016038","DOI":"10.1051\/sicotj\/2016038"}],"container-title":["Acta Orthopaedica Belgica"],"original-title":[],"deposited":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:37:35Z","timestamp":1737977855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.actaorthopaedica.be\/archive\/volume-90\/issue-4\/reviews\/brucella-melitensis-periprosthetic-joint-infection-\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,1]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.52628\/90.4.13281","relation":{},"ISSN":["0001-6462"],"issn-type":[{"value":"0001-6462","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}