Osteoarticular manifestations of human brucellosis: A review

Abstract

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Serum changes of PYD, C2C and OC among male brucellosis patients at early period

“…Human brucellosis can cause serious complications. A considerable number of brucellosis patients with musculoskeletal changes who had rst been referred to rheumatologists and orthopedists may have suffered longer diagnostic delays or even misdiagnoses so, early diagnosis is necessary to avoid these problems [7,13].…”

“…These musculoskeletal changes can lead patients to initially visit general practitioners, and ultimately rheumatology and or orthopedic specialists. Because of variable clinical features and lack of speci c symptoms, it may delay diagnosis of musculoskeletal changes and relaive drug therapy [7]. Due to musculoskeletal changes irreversible, so, it is very necessary to prevent musculoskeletal changes of human brucellosis at the early period.…”

Approaching ancient disease from a One Health perspective: Interdisciplinary review for the investigation of zoonotic brucellosis

“…Vertebral destruction is usually less severe in brucellosis than in tuberculosis (Chelli Bouaziz, Ladeb, Chakroun, & Chaabane, ). In addition, clinical manifestations vary with age of the individual: monoarthritis of knee and hip in children, sacroiliitis in children and young adults, and spondylitis in older adults (Chelli Bouaziz et al, ; Esmaeilnejad‐Ganji & Esmaeilnejad‐Ganji, ). Thus, diseases included in the differential diagnosis may differ depending on age of the individual and osseous elements affected.…”

“…Thus, for adults, methods of age estimation other than that of auricular surface morphology should be used in cases of suspected brucellosis. Skeletal region targeted varies with the age‐at‐death of the individual observed: peripheral arthritis and sacroiliitis in children and young adults and spondyloarthropathy in older adults (Chelli Bouaziz et al, ; Esmaeilnejad‐Ganji & Esmaeilnejad‐Ganji, ) although length of chronic infection may also play a part in the predominance of spinal changes in older individuals. In his macroscopic analysis of vertebral lesions from medieval Wharram Percy, England, Mays () takes a conservative approach, suggesting that without at least two categories of evidence (one being biomolecular), diagnosis must be tentative.…”

Serum changes in pyridinoline, type II collagen cleavage neoepitope and osteocalcin in early stage male brucellosis patients

“…As musculoskeletal changes progress, patients tend to initially visit a general practitioner and ultimately consult a rheumatologist and orthopedic specialists. However, due to variable clinical features and the lack of specific symptoms, obtaining a diagnosis and the necessary drug therapy tends to be delayed 7 , making an early diagnosis imperative to minimizing the musculoskeletal changes associated with brucellosis.…”