Update on treatment options for spinal brucellosis

Ulu-Kılıç, Ayşegül; Karakaş, Ahmet; Erdem, Hakan; Türker, T.; İnal, Ayşe Seza; Ak, Özlem; Turan, Hale; Kazak, Esra; İnan, Asuman; Duygu, Fazılet; Demiraslan, Hayati; Kader, Çiğdem; Şener, Ahmet; Dayan, Serkan; Deveci, Özcan; Tekin, Recep; Saltoğlu, Neşe; Aydın, Mehmet Faruk; Horasan, Elif Şahin; Gül, Hanefi Cem; Ceylan, Burcu; Kadanalı, Ayten; Karabay, Oğuz; Karagöz, Gül; Kayabaş, Üner; Turhan, Vedat; Engin, Derya Öztürk; Gülsün, Serda; Elaldı, Nazif; Alabay, Selma

doi:10.1111/1469-0691.12351

Cited by 98 publications

(76 citation statements)

References 21 publications

(39 reference statements)

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“…In brucellosis, the spinal column can be affected at any level, whereas lumbar spine is the most common site, particularly the L4-L5 segment [28]. 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.…”

Section: Discussionmentioning

confidence: 59%

“…In our study, even a minor delay (45 days vs. 30 days) in diagnosis was an important predictive factor of spondylodiscitis in brucellosis patients. Although previous studies reported longer delays in diagnosis, even minor delays can be significant in the development of complications [13,20,28,32]. Therefore, in older patients and in patients who have back pain, earlier diagnosis and treatment of brucellosis may prevent complications like spondylodiscitis.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Spondylodiscitis: a common complication of brucellosis

Kutlu

Tuzun

et al. 2018

J Infect Dev Ctries

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“…The skeletal system is commonly involved in brucellosis, however most important clinical involvement is spondylitis which is seen in 6-58% of cases due to Brucella species [2,3] . Brucellosis is diagnosed definitively via isolation of Brucella species from blood or tissue samples in a laboratory, however, isolation of bacteria is not always possible [4] .…”

Section: Dear Editormentioning

confidence: 99%

“…UluKilic et al [3] compared five major combination regimens (doxycycline, rifampicin, and streptomycin; doxycycline, rifampicin, and gentamicin; doxycycline and rifampicin; doxycycline and streptomycin; doxycycline, rifampicin, and ciprofloxacin) and they concluded that there was no difference between these combinations. There is no certain length of the treatment period, and the final criterion was an improvement in radiological findings.…”

Section: Dear Editormentioning

confidence: 99%

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

Karagöz¹,

İrvem²,

Çomoğlu³

et al. 2018

mjima

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Dear Editor,Brucella species can cause a zoonotic infection brucellosis which may affect multiple tissues in the body including musculoskeletal system. Vertebral brucellosis is relatively common in the patients who have musculoskeletal involvement and should be diagnosed rapidly in the endemic regions. Early diagnosis and appropriate antimicrobial therapy combined with surgery are associated with an excellent prognosis; otherwise, delay in diagnosis increases the rate of morbidity and mortality [1] . Isolation of the microorganism from the tissue sample establishes the definite diagnosis and this is also necessary for the differential diagnosis. In this paper we aim to report a patient who presented to our clinic with spondylodiscitis and epidural abscess due to brucellosis.A 46-year-old female patient admitted to our setting with fever for 4 months, chills, and sweating which was exaggerated at night. She also had complaints of lower back pain lasting 2.5 months in addition to fatigue, lack of appetite, and weight loss. She had history of stockbreeding and ate unpasteurized dairy products. On physical examination, her body temperature was 37.5 °C, pain with local pressure was detected on the lumbar vertebrae, and her motor deficit grade was 2/5. The rest of general and neurological examinations were normal. The patient's laboratory test results were as follows: white blood cell count: 4590/mm 3 ; hemoglobin: 9.6 g/dL; hematocrit: 29.2%; erythrocyte sedimentation rate: 95 mm/h; C-reactive protein: 5.9 mg/L (normal, 0 to 0.8 mg/L); and a normal other blood biochemistry profile. The total serum protein, albumin, and globulin were also normal. There was no reversal of the albumin/ globulin ratio, and the Rose Bengal test was positive. The Wright agglutination test for Brucella was also positive at a titer of 1/2560. However, the patient was not tested by the 2-mercaptoethanol. Magnetic resonance imaging (MRI) of the spine was consistent with the diagnosis of spondylodiscitis. The height of the Intervertebral disc between L5-S1vertebrae was decreased in addition to signal abnormality on the vertebral corpus and vertebral endplates in MRI (Figure 1, 2). An epidural abscess, 54x22 mm in size, extending from the posterior of the L5 and S1 vertebrae to the paravertebral space and an abscess, 3x2 cm in size, on the anterior prevertebral space were identified. Upon laminectomy, a purulent epidural and prevertebral mass were evacuated. After decompression, the motor deficit was improved and the pain was relieved. On the Gram stain of the Anahtar Kelimeler: Bakteriyel enfeksiyonlar, Bruselloz, tedavi, epidural apse, dekompresyon cerrahisi

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“…Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis (2), (3) . Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus.…”

Section: A Case Of Brucellar Spondylitis With Lumbar Spondylolisthesismentioning

confidence: 99%

A case of brucellar spondylitis with lumbar spondylolisthesis

Zhang

Zhao

2017

Rev. Soc. Bras. Med. Trop.

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A 46-year-old man was hospitalized with a 6-month history of severe low back pain in addition to weight loss, fatigue, and intermittent febrile symptoms for the past 4 weeks. Physical examination revealed painful and restricted low back movement. His temperature was 37.5℃. Laboratory values were as follows: white blood cell count: 9,600/mm 3 , hemoglobin: 13.5g/dl, erythrocyte sedimentation rate: 45mm/h, and C-reactive protein: 58mg/L. The Rose-Bengal test was (++), and the Brucella agglutination test was positive with a titer of 1:320. Computed FIGURE A -CT revealed intervertebral destruction and narrowing at L4-5, and I° lumbar spondylolisthesis with posterior displacement (arrow in FIGURE A-a). There was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes (arrow in FIGURE A-b). MRI revealed L4-5 intervertebral disc tissues, and the L4-5 vertebral bodies were hypointense, heterogeneous, and heterogeneous on T1WI, T2WI and STIR images, respectively (arrow in FIGURE A-c). CT: computed tomography; MRI: magnetic resonance imaging; T1WI: T1 weighted imaging; T2WI: T2 weighted imaging; STIR: Short time inversion recovery. tomography (CT) revealed intervertebral destruction and narrowing at L4-5 and I° l umbar spondylolisthesis with posterior displacement (1) . There was i sthmic spondylolisthesis, and there was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes ( Figure A and Figure B). Magnetic resonance imaging (MRI) showed signs compatible with osteomyelitis of the L4 and L5 vertebral bodies with accompanying discitis. L4-5 intervertebral disc tissues were hypointense, heterogeneous, 875Zhang Q et al. -Brucellar lumbar spondylolisthesis and heterogeneous on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), and S hort time inversion recovery (STIR) MRI images, respectively ( Figure A and Figure C). Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis (2),(3) . Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus. Giemsa staining showed positive Brucella (Figure B). On the control X-ray after surgery, the intervertebral height had been restored, and the lumbar spondylolisthesis was reduced ( Figure C).

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Update on treatment options for spinal brucellosis

Cited by 98 publications

References 21 publications

Spondylodiscitis: a common complication of brucellosis

Spondylodiscitis: a common complication of brucellosis

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

A case of brucellar spondylitis with lumbar spondylolisthesis

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