Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Abstract

Introduction:Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods:Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period . Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

Cervical Spondylitis and Epidural Abscess Caused by Brucellosis: a Case Report and Literature Review

“…7,8 Lumbar spine is frequently affected but involvement of cervical spine is very rare. 9 Colmenero and Solera reported cervical involvement at levels of 1.2% and 2.1%, respectively, in patients under monitoring for brucellosis. 10 The clinical signifi cance of cases of cervical spondylitis and epidural abscess is that the increased neurological complications in such patients have an adverse effect on prognosis.…”

Brucella spondylodiscitis that affected both cervical and lumbar spines: a rare case report from Syria

“…Ana Lebre et al . 12 conducted a retrospective analysis of 54 patients with brucellar spondylodiscitis. Prior to the diagnosis, the symptoms had been present for 5.5 months.…”

“…When compared to our circumstances, neurological deficits (25.9%), fever (46.3%), and pain (98.1%) were the most common signs and symptoms. The lumbar area accounted for 77.7% of the total 12 . Therefore, cervical placement in our patient is considered unusual.…”

Tendências temporais da brucelose humana: estudo comparativo entre Portugal e a União Europeia temporal

“…Em síntese, pode afirmar-se que a brucelose continua a ser uma realidade em Portugal e que estes dados reforçam a necessidade de manter uma vigilância epidemiológica ativa, que permita a deteção precoce de todos os casos de infeção (Pelerito, Cordeiro, Matos, Santos, Soeiro, Santos, et al, 2017;ASAE, 2018). O controlo de animais positivos, para além dos cuidados a ter com os alimentos e o contacto com fontes de contaminação são essenciais para a prevenção da brucelose no ser humano (Corbel, 2006;Lebre, Velez, Seixas et al, 2014;Soares et al, 2015). A brucelose, ainda, é um problema recorrente e, como tal, a adoção de corretas medidas para a manutenção da sanidade animal e da saúde pública são fundamentais.…”

“…Los resultados revelaron que existe una tendencia a la disminución de los casos de brucelosis en Portugal y en la UE en el mismo período y una disminución más acentuada en Portugal. (Memish & Balkhy, 2004;Galińska & Zagórski, 2013;Lebre, Velez, Seixas et al, 2014).…”