Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report
Abstract Background Brucellosis is an endemic systemic infectious disease, the most common complication is bone and joint involvement. Sacroiliac joint and spinal joint are the most frequently involved sites in adults, but knee joint infection is rare, and acute infectious knee arthritis complicated...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-022-07392-5 |
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| author | Jie Wang Qiang Zhang |
| author_facet | Jie Wang Qiang Zhang |
| author_sort | Jie Wang |
| collection | DOAJ |
| description | Abstract Background Brucellosis is an endemic systemic infectious disease, the most common complication is bone and joint involvement. Sacroiliac joint and spinal joint are the most frequently involved sites in adults, but knee joint infection is rare, and acute infectious knee arthritis complicated by acute osteomyelitis is even extremely uncommon in adults. Here, we report two cases of acute septic knee arthritis complicated by acute osteomyelitis caused by Brucella melitensis (B. melitensis). Case presentation Both patients had a history of traveling in animal husbandry areas within three months. On clinical examination, their right knee joint was tender, swollen, had limited movement and an effusion was present. Imaging examination showed effusion and synovial thickening of the right knee joint, as well as subchondral bone edema of the distal femur and proximal tibia. Laboratory examination showed that the serum agglutination test (SAT) in both patients were positive (1: 640 and 1: 320) without leukocytosis, although the proportion of lymphocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly increased. Both patients underwent knee joint aspiration. Real-time polymerase chain reaction (Real-time PCR) analysis of synovial fluid showed that there was B. melitensis, and blood bacterial culture was negative. We determined that two patients had acute brucellosis knee arthritis complicated by acute osteomyelitis. Antibiotic treatment was given during hospitalization consisting of doxycycline (0.1 g po bid) and rifampicin (0.6 g po qd) for six weeks, and the changes of inflammatory indexes were closely monitored. At discharge, the symptoms had completely resolved, imaging abnormalities disappeared, and inflammatory indexes returned to normal. There was no recurrence of the disease at 1-year follow-up. Conclusion Acute brucellosis knee arthritis complicated by acute osteomyelitis is a rare but serious complication of brucellosis in adults. There is no obvious specificity of clinical manifestation and imaging examination. Early diagnosis and treatment can prevent the occurrence of knee joint deformity and even pathological fracture. Clinicians should fully consider the possibility of brucellosis where the travel or occupational history is suggestive. |
| first_indexed | 2024-12-12T16:02:34Z |
| format | Article |
| id | doaj.art-e4a22fe3777c465da59e62d996bac490 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T16:02:34Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-e4a22fe3777c465da59e62d996bac4902022-12-22T00:19:23ZengBMCBMC Infectious Diseases1471-23342022-05-012211610.1186/s12879-022-07392-5Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases reportJie Wang0Qiang Zhang1Department of Orthopedics, Beijing Ditan Hospital, Capital Medical UniversityDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical UniversityAbstract Background Brucellosis is an endemic systemic infectious disease, the most common complication is bone and joint involvement. Sacroiliac joint and spinal joint are the most frequently involved sites in adults, but knee joint infection is rare, and acute infectious knee arthritis complicated by acute osteomyelitis is even extremely uncommon in adults. Here, we report two cases of acute septic knee arthritis complicated by acute osteomyelitis caused by Brucella melitensis (B. melitensis). Case presentation Both patients had a history of traveling in animal husbandry areas within three months. On clinical examination, their right knee joint was tender, swollen, had limited movement and an effusion was present. Imaging examination showed effusion and synovial thickening of the right knee joint, as well as subchondral bone edema of the distal femur and proximal tibia. Laboratory examination showed that the serum agglutination test (SAT) in both patients were positive (1: 640 and 1: 320) without leukocytosis, although the proportion of lymphocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly increased. Both patients underwent knee joint aspiration. Real-time polymerase chain reaction (Real-time PCR) analysis of synovial fluid showed that there was B. melitensis, and blood bacterial culture was negative. We determined that two patients had acute brucellosis knee arthritis complicated by acute osteomyelitis. Antibiotic treatment was given during hospitalization consisting of doxycycline (0.1 g po bid) and rifampicin (0.6 g po qd) for six weeks, and the changes of inflammatory indexes were closely monitored. At discharge, the symptoms had completely resolved, imaging abnormalities disappeared, and inflammatory indexes returned to normal. There was no recurrence of the disease at 1-year follow-up. Conclusion Acute brucellosis knee arthritis complicated by acute osteomyelitis is a rare but serious complication of brucellosis in adults. There is no obvious specificity of clinical manifestation and imaging examination. Early diagnosis and treatment can prevent the occurrence of knee joint deformity and even pathological fracture. Clinicians should fully consider the possibility of brucellosis where the travel or occupational history is suggestive.https://doi.org/10.1186/s12879-022-07392-5BrucellosisSeptic knee arthritisAcute osteomyelitisSynovitis |
| spellingShingle | Jie Wang Qiang Zhang Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report BMC Infectious Diseases Brucellosis Septic knee arthritis Acute osteomyelitis Synovitis |
| title | Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report |
| title_full | Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report |
| title_fullStr | Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report |
| title_full_unstemmed | Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report |
| title_short | Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report |
| title_sort | early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis two cases report |
| topic | Brucellosis Septic knee arthritis Acute osteomyelitis Synovitis |
| url | https://doi.org/10.1186/s12879-022-07392-5 |
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