Hip arthritis in brucellosis: a study of 33 cases in the Republic of Macedonia (FYROM)

Abstract

Prospectively were studied clinical characteristics, diagnostic tools and outcome in 33 patients with hip arthritis during brucellosis that were treated at the clinic for infectious diseases in Skopje, Republic of Macedonia (FYROM). Thirty-six hip involvements were noted. The patient's age was mean (SD) 23.7 (19.9) years, 18 were male. Twenty-one of them acquired the disease through direct contact with infected animals. In five patients, hip arthritis was the unique manifestation of the disease. Concomitant affection of other osteoarticular localisation was found in 18 patients. The diagnosis of hip arthritis was achieved using radionuclide bone scan and ultrasound examination in 17 and 16 cases, respectively. During the follow-up period, six relapses, three therapeutic failures and one sequela were noted. Brucellar aetiology should be considered in all patients from endemic areas, who have manifest symptoms of hip joint involvement.

Human Brucellosis in Macedonia – 10 Years of Clinical Experience in Endemic Region

“…It has been recognized that brucellosis duration without adequate treatment is directly correlated with the complication rate and unfavorable outcome (41). A long period of symptomatic disease before therapeutic intervention was significantly more frequent in patients with brucellar spondylitis than in patients without spondylitis (12,48). The percentage of relapses among patients suffering from the disease for more than a month before therapy was higher than that among patients suffering from the disease for less than a month (29).…”

“…In our study, twothirds of the enrolled patients had focal manifestations and osteoarticular forms predominated, similar to other reports (1,15,20,28,44). The wide variation in the frequencies of clinical manifestations may reflect the characteristics of the examined population, the nature of the causative agent, geographic variations of the disease, the stage of disease, the diversity of case definition criteria, the diagnostic procedures, and the type of study (retrospective or prospective) (12).…”

“…If a focal form of the disease was suspected after clinical examination, further investigations were performed, such as x-rays, electrocardiography, ultrasound investigations, lumbar puncture, radionuclide bone scan, computerized tomography, magnetic resonance imaging, and electromyography. Osteoarticular involvement was considered to be present if there were any inflammatory signs in peripheral osteoarticular locations (swelling, pain, functional disability, heat, and redness of the joints), or inflammatory pain in deep osteoarticular locations concurrently with pathologic findings on x-rays, radionuclide bone scans, computerized tomography, or magnetic resonance imaging (12). Orchitis and epididymitis were diagnosed by the presence of swelling and tenderness of the testis and epididymis, respectively.…”

Comparisons of brucellosis between human and veterinary medicine

“…The most common osteoarthricular malady reported is peripheral arthritis, typically affecting a single joint [9,40]. Only, 9% of peripheral arthritis cases are found bilaterally or are considered polyarthritis [40].…”

“…Not surprisingly, those presenting with osteoarthricular brucellosis are more likely to have an elevated erythrocyte sedimentation rate than those without osteoarthricular brucellosis. However, there appears to be no statistical difference between groups with regard to C-reactive protein [40]. Therapeutic failure is three-times higher in osteoarthricular brucellosis compared to brucellosis cases without osteoarthricular complaints [40,43,44].…”