Skeletal brucellosis in Iraqi patients.

Abstract

SUMMARY The clinical features of 21 episodes of skeletal brucellosis in 17 Iraqi patients are reported. Six had monarthritis of a large joint, six had spondylitis, and five had spondarthritis. Brucellosis remains a major health problem in Iraq. The disease is transmitted to man through the ingestion of unpasteurised milk or milk products but can also be acquired through physical contact.Key words: Brucella abortus, monarthritis, spondylitis, spondarthritis. Patients and methods ResultsSeventeen consecutive patients attending our rheumatology clinic with skeletal manifestations considered to be due to brucellosis were studied. In addition to obtaining a history, physical examination, and x rays, the following investigations were performed: haemoglobin and leucocyte count, erythrocyte sedimentation rate (ESR), urine examination, latex fixation test for rheumatoid factor, antistreptolysin 0 titre, antinuclear factor, lupus erythematosus cell preparation, C reactive protein, serum uric acid, rose bengal test using a concentrated suspension of Brucella abortus (Weybridge strain) stained with rose bengal (BioMerieux), and an agglutination test with Brucella abortus antigen (Burroughs-Wellcome). HLA typing was done using the microlymphocytotoxicity technique only for the young patients in the spondylitic and spondarthritic groups. A blood culture for brucella was carried out in 12 patients and synovial fluid culture in three. A tuberculin test was done only in one patient with spondylitis. All cases were followed up for one year. In cases of relapse the ESR, leucocyte count, rose bengal and brucella agglutination tests were performed. The diagnosis of brucellosis was made on the basis of suggestive history in association with the finding of a positive rose bengal screening test and a positive agglutination titre (3,>1/320).

Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations

“…In adults, a recent randomized study suggested an adequate (but not superior) response rate comparable to the WHO-recommended regimens, although the treatment duration was extended [ 46 ]. Past studies have produced contradicting results, with relapse rates ranging from 0% to 30% (TMP-SMX combinations with tetracycline) [ 25 , 47 ].…”

Manifestations articulaires de la brucellose

“…L'atteinte des grosses articulations périphériques représente un fort pourcentage des atteintes ostéoarticulaires de la brucellose, pourcentage qui est néanmoins variable dans les différen-tes séries [15,16,19,20]. L'atteinte articulaire périphérique est la règle chez l'enfant [21,22] et dans la brucellose liée à B. abortus [23].…”

“…L'atteinte de la sacro-iliaque est fréquente et peut représen-ter un quart à la moitié de l'ensemble des atteintes ostéoarticu-laires de la brucellose [16,17,19,20,26,31,32]. À l'inverse, l'atteinte sacro-iliaque est rare chez l'enfant [21,22] et lors des infections à B. abortus ou à B. suis [33].…”

“…En milieu de culture usuel, on a trouvé jusqu'à 60 % de liquides synoviaux positifs [16,34]. On a aussi pu isoler en culture à partir de liquide synovial B. abortus [20] et B. canis [2]. Les cultures de prélève-ments obtenus à partir d'un disque intervertébral infecté par ponction à l'aiguille [52] ou par biopsie chirurgicale, peuvent aussi être positives pour Brucella.…”

Osteomyelitis

“…Die uni-oder bilaterale Sakroileitis ist häufig. Bei den peripheren Arthritiden stehen Hüft-und Kniegelenk im Vordergrund (Al-Rawi et al 1989;Gotuzzo et al 1982). Die sternoklavikuläre Beteiligung ist in Einzelberichten beschrieben worden (Colmenero et al 1991).…”