Foreign-Body Osteoarticular Infection by Brucella melitensis: A Report of Three Cases

Abstract

B rucellosis, a zoonosis, is an important cause of human disease in many parts of the world. Brucellae are small, gram-negative nonsporulating rods or coccobacilli that are transmitted from infected animals, mainly cattle and other domesticated ruminants (e.g., camels). Brucellae are shed in the feces, milk, and urine of infected animals and are transmitted to humans through the ingestion of contaminated dairy products or through the inhalation of aerosolized infected fecal particles. They can also be directly transmitted through wounds in exposed individuals such as farmers, veterinarians, and laboratory workers. Travelers usually acquire the infection after consuming contaminated foods. Dairy products, especially soft cheeses, unpasteurized milk, and ice cream, are the most frequently implicated sources. Various Brucella species can produce human disease, including Brucella melitensis, Brucella abortus, Brucella suis, and, rarely, Brucella canis. Brucella melitensis is, by far, the most common cause of human disease and is mainly acquired from sheep, goats, and camels. In Spain, where brucellosis is still present in some rural communities, 861 new cases were diagnosed in 20021. Brucella melitensis was the main causative agent; Brucella abortus and Brucella suis rarely cause disease in swine and cattle in our environment. The most common clinical features of human brucellosis are undulant fever, sweats, arthromyalgias, lymphadenopathy, and hepatosplenomegaly2. Focal infection can be life-threatening when the heart or the central nervous system is involved. However, bone and joint infections are the most common localized sites and account for up to 85% of these cases3,4. Brucella melitensis infection around medical implants has rarely been described in patients with mechanical heart valves5-13, pacemakers14, and breast implants15. We describe the cases of three patients with Brucella melitensis infection around an orthopaedic medical implant, and we also …