Hip osteoarticular complication due to delay in diagnosis and treatment of brucellar hip arthritis: two cases report. BMC Infect Dis. 2019;19:412. [PMID: 31088383 PMCID: PMC6518787 DOI: 10.1186/s12879-019-4045-9]

Establishment of an A/T-Rich Specifically MGB Probe digital droplet PCR Assays Based on SNP for Brucella wild strains and vaccine strains

In recent years, immunization with the S2 live-attenuated vaccine has been recognized as the most economical and effective strategy for preventing brucellosis in Inner Mongolia, China. However, there are still challenges related to vaccine toxicity and the inability to distinguish between vaccine immunization and natural infection. Therefore, in this study, we developed a digital droplet polymerase chain reaction (ddPCR) assay based on single-nucleotide polymorphism (SNP) loci to identify wild Brucella strains and S2 vaccine strains. The assay demonstrated excellent linearity (R2> 0.99) with a lower detection limit of 10 copies/µL for both wild and vaccine strains. Additionally, the ddPCR assay outperformed the real-time fluorescent quantitative PCR (qPCR) assay in screening 50 clinical samples. We have established an effective and highly sensitive ddPCR assay for Brucella, providing an efficient method for detecting and differentiating wild strains of Brucella from the S2 vaccine strain.

Femoral Head Avascular Necrosis Due to Brucella Infection: A Case Report

Brucellosis remains a widespread disease in endemic regions worldwide and is not adequately controlled. It is a common zoonotic disease worldwide, a systemic infection, and a major health problem in endemic countries. Femoral head avascular necrosis (FHAVN) as a consequence of brucellosis is exceedingly unusual and has seldom been recorded. The case reports a 21-year-old female patient was hospitalized due to severe pain in both lower limbs, particularly in the anterior portion of the hip joint, accompanied by a low-grade fever persisting for six months. Movement of the right hip was painful, and the patient limped at the beginning of walking after a few steps. Rheumatoid factor and antinuclear antibody test results were negative. The right hip joint was aspirated, and a small quantity of fluid was sent for Gram staining and culture. Synovial joint fluid culture confirmed Brucella abortus infection after four weeks. The source of infection in the present case was the consumption of raw milk. Based on laboratory tests and radiographic images, FHAVN was diagnosed. Owing to misdiagnosis, she had not received standard treatment for brucellosis in the previous months. The patient was diagnosed early, and she was in the third stage. After the patient received medical treatment, the left and right hip joints partly recovered. The right hip joint required replacement; however, the patient refused. Attending physicians should consider brucellosis as an alternative to arthritis for hip joint pain in Brucella-endemic locations. Medication-based therapy may be effective for early avascular necrosis, emphasizing the need for early diagnosis and treatment.

Clinical efficacy of arthroscopy combined with irrigation and drainage in the treatment of brucellosis of the hip

PURPOSE

To evaluate the short-term clinical efficacy of hip arthroscopy combined with catheter irrigation and drainage in the treatment of brucellosis of the hip.

METHODS

From 2015 to 2020, 11 patients with a diagnosis of brucellosis-induced unilateral hip joint arthritis were treated with arthroscopic debridement and lesion synovectomy. Catheterization was performed during the operation, and normal saline lavage was continued after the operation. A regimen of doxycycline plus rifampicin, plus a third-generation cephalosporin in cases of refractory infections, were used for three months.

RESULTS

The rate of positive synovial bacterial culture during the operation was 91% (10/11). Postoperative pathological examination of 11 patients showed purulent arthritis; this result combined with the disease history led to the diagnosis of all patients with brucellosis of the hip. All patients were followed up for more than 24 months. From three months after surgery to the last follow-up, both ESR and CPR were within the normal range, but the VAS score decreased significantly (P < 0.05), and the mHHS and HOS-ADL scores increased significantly (P < 0.01). Compared with that on preoperative imaging, the measurement of the hip joint space on imaging at the last follow-up showed no significant change (P > 0.01).

CONCLUSION

Arthroscopic treatment of brucellosis in the hip joint not only preserves the joint fluid and lesion tissue for a clear diagnosis but also allows thorough removal of the infected and injured tissue during surgery. Hip arthroscopy combined with postoperative tube irrigation and drainage is an effective method for the diagnosis and treatment of brucellosis in the hip joint.

Rapidly progressive femoral head necrosis due to post-traumatic Brucella hip infection: a case report

Brucellosis is a common zoonotic infectious disease worldwide that can affect almost all organs in the human body. Osteonecrosis of the femoral head has numerous possible causes. Patients usually experience movement disorders, severe pain, and an extremely high disability rate. We herein describe a 32-year-old male farmer living in Shanxi, China who accidentally injured his right hip while working. After 1 month of rest, the pain in the right hip was relieved, and the patient began to walk again. However, after 2 months of walking, he developed aggravated pain and claudication in the right lower limb. Examination revealed shortening of the right lower limb. We carried out a comprehensive and systematic examination and performed total hip arthroplasty. Hip trauma with Brucella infection may progress to osteonecrosis of the femoral head in a short period of time without typical symptoms of Brucella infection. Systematic examination and treatment should be performed at an early stage to prevent the eventual deterioration of the disease and serious complications that are difficult to treat.

Atypical presentation of shoulder brucellosis misdiagnosed as subacromial bursitis: A case report

BACKGROUND

Brucella infections in the shoulder joint are uncommon, and few have been reported in the literature.

CASE SUMMARY

A 26-year-old male was admitted to our hospital with complaint of recurrent pain and limited movement of the right shoulder. The patient reported the pain to have first occurred as an isolated event 6 mo previously and to have reoccurred 5 mo later, when it was accompanied by limited movement of the shoulder. Findings from physical examination and magnetic resonance imaging (referred to as MRI) suggested the diagnosis of subacromial bursitis, and diagnostic paracentesis and arthroscopic debridement were performed. Surprisingly, synovial fluid culture detected brucella, and the finding was confirmed by mass spectrometry of a colony sample. The diagnosis was corrected to brucellosis of the shoulder joint, and antibiotic drug treatment (oral rifampicin and doxycycline) was administrated for 6 wk. The 4-mo postoperative follow-up examination (MRI) yielded normal findings. The 2-year follow-up showed no signs of recurrence.

CONCLUSION

This rare case of brucellosis infection in shoulder highlights the importance of increasing awareness to help avoid misdiagnosis.

Investigation of the Sensitivity and Specificity of Laboratory Tests Used in Differential Diagnosis of Childhood Brucellosis

Objectives 

Childhood brucellosis is a common public health problem in developing countries. The diagnosis of brucellosis based on nonspecific symptoms is an ongoing problem for physicians, especially in endemic areas. In this study, it is aimed to discuss the efficacy of frequently used test methods in the differential diagnosis of brucellosis.

Methods

The records of 332 patients admitted to pediatric clinic on suspicion of brucellosis were retrospectively analyzed. Patients with brucellosis were included in the positive group (n = 262) and those without brucellosis were included in the negative group (n = 70).

Results

 As a result of biochemical analysis of the cases, median alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) values were significantly higher in the positive group than that in the negative group (p<0.05). There was no significant difference between median white blood cell, neutrophil, lymphocyte, neutrophil to lymphocyte ratio, hemoglobin, and platelet values between groups (p>0.05). Receiver operating curves were plotted to compare predictive values of CRP (area under curve (AUC): 0.635, p= 0.001), ESR(AUC:0.701, p<0.001), AST(AUC: 0.595, p=0.015), ALT(AUC:0.604, p=0.007), and GGT(AUC:0.593, p=0.016) in 332 patients with suspected brucellosis.

Conclusions

Increased levels of AST, ALT, GGT, CRP, and ESR may have a complementary role in the differential diagnosis of childhood brucellosis. However, all of these markers should be evaluated with clinical findings due to their low specificity and sensitivity.