Musculoskeletal Brucellosis

Abstract

Brucellosis is a zoonosis of worldwide distribution caused by small gram-negative nonencapsulated coccobacilli of the genus Brucella. It is characterized by a granulomatous reaction in the reticuloendothelial system. Because it affects several organs and tissues, it may have various clinical manifestations. Musculoskeletal involvement is one of the most common locations, and the frequency of bone and joint (osteoarticular) involvement of brucellosis varies between 10% and 85%. Osteoarticular involvement includes spondylitis, sacroiliitis, osteomyelitis, peripheral arthritis, bursitis, and tenosynovitis. The most common osteoarticular finding in children is monoarticular arthritis, mostly located in the knees and hips; whereas in adults, sacroiliitis is the most frequent. Imaging studies, including radiography, computed tomography (CT), magnetic resonance (MR) imaging, and bone scintigraphy, have been used for diagnosis. Radiography is limited to evaluating the focal form of spinal brucellosis and advanced disease at the joints. CT and bone scintigraphy have limited value because of their inadequate soft tissue resolution. MR imaging is the method of choice to assess the extent of disease and follow up the treatment response. However, MR imaging has a low specificity to predict the exact cause of an osteoarticular lesion, and in case of arthralgia or symptoms of osteomyelitis or spondylodiscitis, the index of suspicion should be high in regions where the disease is endemic.

Clinical and Diagnostic Aspects of Brucellosis and Antimicrobial Susceptibility of <i>Brucella</i> Isolates in Hamedan, Iran

“…According to various studies, the frequency of osteoarticular complications has been reported in 10 to 80 % of patients (14,15). In a previous study in our region, the frequency of osteoarticular complications was 28.5%, of which 75.7% cases were of sacroiliitis (16).…”

Brucella spondylodiscitis: Multifocal involvement in thoracic and lumbar areas; a rare case

“…The optimal treatment duration has not been clearly established, but at least three to 6-months of treatment is recommended. 2,4 Nevertheless, there is not any standard therapy for osteoarticuler brucellosis. 1,19 In the early phases of the disease, medical treatment could be efficient but in older patients (50-60 years old) it might not provide satisfactory results.…”

“…Osteoarticular involvement in brucellosis is most commonly encountered as followings: spondylitis, sacroiliitis, osteomyelitis, peripheral arthritis, bursitis, and tenosynovitis. 2 Spinal infection due to brucellosis causes morbidity resulting from infectious disease in the infested regions of the world and particularly in the rural areas including our country. 3 Spondylodiscitis is most commonly seen in the lumbar, cervical and thoracic regions, respectively.…”

Brusellar Spondilodiskit: Olgu Sunumu

“…Spondilit, sakroileit, osteomiyelit, periferal artrit, bursit ve tenosinovit olarak karşımıza çıkabilir. Erişkinlerde en sık sakroileit veya spondilodiskitin, çocuklarda ise en sık monoartiküler artritin (özellikle diz ve kalçada) görüldüğü bildirilmiştir ancak bizim hastamızda spondilodiskit şeklinde tutulum olmuştur (2). Bazı yayınlarda brusellar osteoartiküler komplikasyonların genetik predispozisyonla (HLA-B39 gibi) ilişkili olabileceği belirtilmiş olsa da çoğu çalışmada HLA gruplarıyla ilişki bulunamamıştır (1,3).…”

“…Osteoartikuler bruselloz periferik artrit, sakroileit, spondilit, tenosinovit, bursit ve osteomyelit şeklinde ortaya çıkabilmektedir (2). Burada ateş, bel ağrısı ve skolyoz ile gelen bir hastada klinik şüphe, prozon fenomeninin akla gelmesi ve manyetik rezonans görüntüleme yöntemi ile tanı alan brusellar spondilodiskitli bir olgu sunulmuştur.…”