Makram Koubaa1, Imed Maaloul2, Chakib Marrakchi2, Dorra Lahiani2, Boussaima Hammami2, Zeinab Mnif3, Kaireddine Ben Mahfoudh3, Adnane Hammami4, Mounir Ben Jemaa2. 1. Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia. Electronic address: makram.koubaa@gmail.com. 2. Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia. 3. Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia. 4. Department of Microbiology, Habib Bourguiba University Hospital, Sfax 3029, Tunisia.
Abstract
BACKGROUND CONTEXT: Brucellosis remains an important economic and public health problem in some parts of the world. The spine is the most common site of musculoskeletal involvement of brucellosis. PURPOSE: Assess the clinical, laboratory, radiological findings, and outcomes of vertebral involvement in brucellosis. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Thirty-two patients with spinal brucellosis during a period of 21 years (1990-2010) were included. OUTCOME MEASURES: Clinical and radiological improvement. METHODS: Diagnosis made on clinical presentation, laboratory findings, radiographic evidence, and the Brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp were isolated in the blood or sample cultures. RESULTS: The mean age of patients was 51±15.85 years (23 males, 9 females; age range, 19-74 years). The median diagnostic delay was 3 months. Back or neck pain (100% of patients), fever (78%), and sweats (68.6%) were the most common symptoms. Cultures of blood specimens from five patients (15.6%) were positive for Brucella melitensis. Four patients (12.5%) had motor weakness or paralysis. Magnetic resonance imaging was performed in 24 (75%) cases. Paravertebral masses, epidural masses, and psoas abscesses were detected in 65.6%, 59.4%, and 28.1% of patients, respectively. The lumbar vertebra was the most frequently involved region with the rate of 68.7%, followed by thoracal (18.7%), cervical (6.3%), lumbosacral (6.3%), and thoracolumbar (3.1%) segments. The duration of antimicrobial therapy of brucellosis (median, 6 months; range, 3-13 months) varied according to clinical response and the presence of epidural and paravertebral masses. There were no deaths or severe sequelae in this study. CONCLUSIONS: Brucellar spondylitis should be considered in patients with back pain and fever in endemic areas. A high index of suspicion and clinical, laboratory, and radiological examinations help to confirm the diagnosis of vertebral involvement.
BACKGROUND CONTEXT: Brucellosis remains an important economic and public health problem in some parts of the world. The spine is the most common site of musculoskeletal involvement of brucellosis. PURPOSE: Assess the clinical, laboratory, radiological findings, and outcomes of vertebral involvement in brucellosis. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Thirty-two patients with spinal brucellosis during a period of 21 years (1990-2010) were included. OUTCOME MEASURES: Clinical and radiological improvement. METHODS: Diagnosis made on clinical presentation, laboratory findings, radiographic evidence, and the Brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp were isolated in the blood or sample cultures. RESULTS: The mean age of patients was 51±15.85 years (23 males, 9 females; age range, 19-74 years). The median diagnostic delay was 3 months. Back or neck pain (100% of patients), fever (78%), and sweats (68.6%) were the most common symptoms. Cultures of blood specimens from five patients (15.6%) were positive for Brucella melitensis. Four patients (12.5%) had motor weakness or paralysis. Magnetic resonance imaging was performed in 24 (75%) cases. Paravertebral masses, epidural masses, and psoas abscesses were detected in 65.6%, 59.4%, and 28.1% of patients, respectively. The lumbar vertebra was the most frequently involved region with the rate of 68.7%, followed by thoracal (18.7%), cervical (6.3%), lumbosacral (6.3%), and thoracolumbar (3.1%) segments. The duration of antimicrobial therapy of brucellosis (median, 6 months; range, 3-13 months) varied according to clinical response and the presence of epidural and paravertebral masses. There were no deaths or severe sequelae in this study. CONCLUSIONS:Brucellar spondylitis should be considered in patients with back pain and fever in endemic areas. A high index of suspicion and clinical, laboratory, and radiological examinations help to confirm the diagnosis of vertebral involvement.
Authors: Jason F Talbott; Vinil N Shah; Alina Uzelac; Jared Narvid; Rebecca A Dumont; Cynthia T Chin; David M Wilson Journal: Semin Ultrasound CT MR Date: 2018-09-26 Impact factor: 1.875
Authors: Elena Lazzeri; Alessandro Bozzao; Maria Adriana Cataldo; Nicola Petrosillo; Luigi Manfrè; Andrej Trampuz; Alberto Signore; Mario Muto Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-09 Impact factor: 9.236