Polymorphism Of Osteoarticular Manifestation Of Brucellosis Infection. A Review

Abstract

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Kazakhstan remains among the most disadvantaged territories of brucellosis from Commonwealth of Independent States countries. The involvement of the musculoskeletal system is one of the most common systemic manifestations in brucellosis infection. The frequency of osteoarticular involvement of brucellosis varies between 10% and 85%. Osteoarticular involvement includes spondylitis, sacroiliitis, osteomyelitis, peripheral arthritis, bursitis, and tenosynovitis. Sacroiliitis is the most common osteoarticular finding in adults. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely even in presence of low index of suspicion, especially in endemic areas. According to studies, when diagnosed with chronic brucellosis, the results of serological studies were unreliable: the result of the standard agglutination test (SAT)-Wright's reaction was negative in 32.7% of cases in patients with chronic brucellosis. 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. For instance, 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.