Spinal brucellosis in South of Tunisia: review of 32 cases

Koubâa, Makram; Maâloul, I.; Marrakchi, Chakib; Lahiani, D.; Hammami, B.; Mnif, Z.; Mahfoudh, K. Ben; Hammami, Adnane; Jemâa, Mounir Ben

doi:10.1016/j.spinee.2013.09.027

Cited by 46 publications

(58 citation statements)

References 31 publications

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“…In the present study, of the 219 patients with brucellosis, complications were present in 91 (41.6%) patients; the most frequent complication was spondylodiscitis, present in 59 (26.9%) patients. In previous reports, the spondylodiscitis rate in brucellosis was 11.9-39% [17][18][19][20]. Aktug-Demir N et al [21] reported a spondylodiscitis rate of 23.7%, which is similar to our data.…”

Section: Discussionsupporting

confidence: 91%

“…In another study, abscess formation and paravertebral involvement were very high, at rates of 81% and 58.3%, respectively [29]. Kouba M et al [20] found an even higher rate of paravertebral abscess at 65.6% of brucellar spondylodiscitis cases. Kaptan F et al [19] reported that abscess was found in 61.3% of patients with brucellar spondylodiscitis and emphasized the higher sensitivity of MRI to detect abscess.…”

Section: Discussionmentioning

confidence: 88%

“…Our results showed that lumbar involvement was the most frequent site (69.5%) for spondylodiscitis, and one-quarter of spondylodiscitis cases involved the L3-L4 segment. In previous studies, lumbar involvement was reported as 60-78% in patients with brucellar spondylodiscitis [20,29,30]. One of these studies, the most common site was the L4-L5 segment; the level was not specified in the two other studies.…”

Section: Discussionmentioning

confidence: 96%

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Spondylodiscitis: a common complication of brucellosis

Kutlu

Tuzun

et al. 2018

J Infect Dev Ctries

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Introduction: Brucellar spondylodiscitis is a frequent and serious complication of brucellosis. The aim of this study is to describe the brucellosis patients with spondylodiscitis and the predictive factors related to spondylodiscitis in brucellosis. Methodology: Laboratory-confirmed brucellosis patients from a low-to medium-endemic region were enrolled in the study and distributed into two groups. Group I consisted of patients with spondylodiscitis and Group II patients had no complications. Both groups were compared for predictive factors of spondylodiscitis. Results: A total of 219 patients with active brucellosis were included in the study. We determined at least one complication in 91 (41.6%) patients. The most frequent complication was spondylodiscitis [n = 59 patients (26.9 %)]. In univariate analysis, age, time from symptom onset to diagnosis, presence of low back pain, increased levels of erythrocyte sedimentation rate, and alkaline phosphatases were the most significant predictive factors for spondylodiscitis among brucellosis cases. Presence of headache and thrombocytopenia were less frequent in patients with spondylodiscitis when compared to patients without complications (p = 0.024, p = 0.006 respectively). In multivariate analysis, old age (odds ratio [OR] 1,063; 95% confidence interval [CI] 1.026-1.101; p < 0.001), prolonged time between symptoms onset before diagnosis (OR 1.008; 95% CI 1.001-1.016; p = 0.031), and presence of low back pain (OR 12.886;; p < 0.001) were indepedently associated with an increased risk of spondylodiscitis. Conclusions: Spondylodiscitis is the most frequent complication of systemic brucellosis. Patients with low back pain, older age, and longer duration of symptoms should be considered as candidates of potential spondylodiscitis in brucellosis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 96%

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Spondylodiscitis: a common complication of brucellosis

Kutlu

Tuzun

et al. 2018

J Infect Dev Ctries

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“…Koubaa et al reported thirty-two patients with spinal brucellosis during a period of 21 years. Among their patients, paravertebral mass was detected in 65.6% of patients and back pain (100% of patients) was the most common symptom (13). Sanaei-Dashti reported that sacroiliitis is the most common form of the skeletal involvement of brucellosis in adults yet we had no patients with sacroiliitis involvement and most of them showed spondylitis in lumbar vertebra (14).…”

Section: Discussionmentioning

confidence: 93%

“…Bones are normally resistant to infections. However, Brucella infection has aspecial tropism for osteoarticular involvement and osteoarticular brucellosis is the most common localization of active disease (2,3,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Focal osteomyelitis of the vertebrae, tibia and especially the knees has also been reported with brucellosis infection even in the absence of other significant systemic symptoms (1, 4, 12-14).…”

Section: Discussionmentioning

confidence: 99%

Vertebral Osteomyelitis and Paraspinal Abscess Among Patients With Brucellosis

2015

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Background: Brucellosis is a systemic bacterial disease transmitted from animals to humans and involves many organs and tissues. Symptoms of brucellosis are protean and can be similar to many other infectious diseases. None of the symptoms are specific enough to support the clinical diagnosis. The musculoskeletal system is one of the most commonly affected organs. Disease can be present with bursitis, sacroiliitis, peripheral arthritis, osteomyelitis, spondylitis and paraspinal abscess, which among them vertebral osteomyelitis and paraspinal abscess are rare. Objectives: In this study, we aimed to evaluate the prevalence of vertebral osteomyelitis and paraspinal abscess in patients with brucellosis who were admitted to an infectious hospital in Zahedan, Southeastern Iran. Patients and Methods: During 48 months, from December 2008 to October 2012 we evaluated all patients who were referred to infectious clinics (Zahedan, Southeastern Iran) because of fever, myalgia, arthralgia, chronic low back pain, bone pain and had a wright positive test. Blood samples were tested again for 2ME. A titer of more than 1/80 was positive. All patients with low back pain who had a MRI or spine CTScan, which showed a sign of osteomyelitis and/or cold abscess, were included in our study. Results: Among 73 patients with brucellosis (56 males, 17 females; age range 12-69 years), 14 patients (19%; 12 males) had a diagnosis of brucella osteomyelitis. Eleven patients had vertebral osteomyelitis and five showed an abscess next to the involved spine. Patients were treated with a triple regimen including: doxicycline, rifampin and streptomycin, and one patient needed surgery due to pressure effect on the spine. Conclusions: Localized complications of brucellosis such as bone involvement were observed in patients with acute disease or chronic untreated infection. Based on our results, in endemic areas, every patient with low back pain and a positive test for brucella should be evaluated for spinal osteomyelitis.

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