Imagine a surgeon, mid-operation, unknowingly contracting a rare and dangerous infection from their patient. This isn't a scene from a medical thriller, but a real-life scenario highlighted by a recent report of Brucella melitensis transmission during spinal surgery. While such cases are thankfully uncommon, they serve as a stark reminder of the hidden risks healthcare workers face.
In a recent publication, I. Potparić and colleagues detailed the transmission of Brucella melitensis to an orthopedic surgeon during the irrigation of a spinal infection (1). Though rare, instances of B. melitensis transmission from patients to surgical staff have been documented (1–5).
Brucellae are notorious for their low infectious dose—as few as 100 bacteria can cause infection. These bacteria can enter the body through the respiratory tract or conjunctivae, making them a leading cause of laboratory-acquired infections (2). Interestingly, while unseeded biological specimens are generally considered low-risk due to the low concentration of brucellae in body fluids and tissues, the danger escalates dramatically once these specimens are cultured. This is why handling presumptive Brucella cultures requires the strict use of biological safety cabinets (2).
But here's where it gets controversial: Despite these risks, physicians treating brucellosis patients are not typically considered at higher risk, as person-to-person transmission is extremely rare (3,4). However, the reported cases of intraoperative transmission share striking similarities. Often, brucellosis in the patient goes unrecognized, even when they hail from endemic regions (1–4). High-risk procedures like unprotected bone drilling, irrigation, or aspiration of respiratory secretions (1,3,4) create opportunities for exposure, especially when they generate aerosol clouds or involve significant spillage of blood or amniotic fluid (3,4). Compounding the issue, medical staff sometimes neglect to wear essential protective gear like face masks or goggles (2).
And this is the part most people miss: All five published cases of intraoperative transmission occurred in non-endemic countries with advanced medical and diagnostic capabilities. Conversely, reports from developing nations, where brucellosis is rampant, are conspicuously absent. We speculate that this disparity stems from inadequate epidemiological surveillance, underreporting, and the assumption that infections are acquired outside hospital settings.
This raises a thought-provoking question: Are we underestimating the true prevalence of intraoperative brucellosis transmission, particularly in regions where the disease is endemic?
What do you think? Could better surveillance and reporting in developing countries reveal a more widespread issue? Share your thoughts in the comments below.
References:
1. Potparić I, Bošnjak K, Avberšek J, et al. Investigation of possible intraoperative transmission of Brucella melitensis, Slovenia. Emerg Infect Dis. 2025;31:2034–7.
2. Lowe CF, Showler AJ, Perera S, et al. Hospital-associated transmission of Brucella melitensis outside the laboratory. Emerg Infect Dis. 2015;21:150–2.
3. Mesner O, Riesenberg K, Biliar N, et al. The many faces of human-to-human transmission of brucellosis: congenital infection and outbreak of nosocomial disease related to an unrecognized clinical case. Clin Infect Dis. 2007;45:e135–40.
4. Poulou A, Markou F, Xipolitos I, Skandalakis PN. A rare case of Brucella melitensis infection in an obstetrician during the delivery of a transplacentally infected infant. J Infect. 2006;53:e39–41.
5. Kiel FW, Khan MY. Brucellosis among hospital employees in Saudi Arabia. Infect Control Hosp Epidemiol. 1993;14:268–72.
Suggested Citation: Yagupsky P. Intraoperative transmission of Brucellae. Emerg Infect Dis. 2025 Dec [date cited]. https://doi.org/10.3201/eid3112.251518
Disclaimer: The views expressed herein do not necessarily reflect those of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Trade names are used solely for identification purposes and do not imply endorsement.
