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Bilateral knee arthroplasty infection due to Brucella melitensis: a rare pathology?

机译：布鲁氏菌引起的双侧膝关节置换术感染：罕见的病理？

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Brucella infection of prosthetic joints is uncommon. Thirteen cases at the hip or knee have been reported . A stay in an endemic area suggests the diagnosis, which is confirmedby recovery of Brucella in joint specimen cultures. The treatment consists in antibiotics and surgery.A 65-year-old Portuguese woman with a history of bilateral total knee arthroplasty sought medical attention for inflammation of both knees with a discharge to the skin and a low-grade fever of 38 degC. Loosening of the left tibial plateau was noted on radiographs. Laboratory tests showed inflammation (erythrocyte sedimentation rate, 60 mm; and C-reactive protein, 80 mg/L) with normal findings from blood cell counts, renal and hepatic function tests, and serum electrolytes. No microorganisms were identified by microscopic examination or 40-day cultures of the discharges or aspirates. The diagnosis was bilateral knee prosthesis infection by an unidentified microorganism. The prostheses were removed and spacers inserted. Vegetationsfound on the tibial plateaus were sent to the microbiology laboratory, as well as three synovial membrane biopsies from each knee. After 7 days, the synovial membrane specimens grew a gram-negative coccobacillus identified as Brucella melitensis. Rifampin (900 mg/d) and vibramycin (200 mg/d) were given orally for 3 months. When asked about recent trips, the patient reported having traveled about 3 months earlier to Portugal, where she had eaten unpasteurized goat cheese. Penetration of the organism via the gastrointestinal tract followed by hematogenous dissemination was suspected. Knee prostheses were implanted after 6 weeks of antibiotic therapy. One year later, the walking distance was more than 1 km and motion ranges were acceptable (0/0/90 on the right and 0/5/75 on the left). The C-reactive protein level was normal. Follow-up evaluations 5 and 10 years later showed no deterioration in walking performance or motion ranges.
机译：布鲁氏菌人工关节感染并不常见。据报道髋部或膝盖有13例。留在地方病区提示诊断，可通过在联合标本培养物中恢复布鲁氏菌来确诊。该治疗方法包括抗生素和外科手术。一位65岁的葡萄牙妇女有双侧全膝关节置换术史，她因双膝发炎，皮肤排泄和38摄氏度的低烧而寻求医疗护理。 X光片显示左胫骨平台松动。实验室检查显示炎症（红细胞沉降速率为60 mm; C反应蛋白为80 mg / L），血细胞计数，肾脏和肝功能检查以及血清电解质均正常。通过显微镜检查或排放物或吸出物的40天培养未发现微生物。诊断为双侧膝关节假体被未知微生物感染。移除假体并插入垫片。胫骨平台上发现的植被以及每个膝盖的三个滑膜活检被送往微生物学实验室。 7天后，滑膜标本长出革兰氏阴性球菌，被鉴定为布鲁氏菌。口服利福平（900 mg / d）和维布霉素（200 mg / d）3个月。当被问及最近的旅行时，该患者报告说大约三个月前去了葡萄牙，在那里她吃了未经巴氏消毒的山羊奶酪。怀疑该生物体通过胃肠道渗透，然后通过血行性传播。抗生素治疗6周后植入膝关节假体。一年后，步行距离超过1公里，运动范围尚可（右侧为0/0/90，左侧为0/5/75）。 C反应蛋白水平正常。 5年和10年后的跟踪评估显示，步行性能或运动范围没有恶化。

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