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Rezaei Shahrabi A, Moradkasani S, Goodarzi F, Beig M, Sholeh M. Prevalence of Brucella melitensis and Brucella abortus tetracyclines resistance: A systematic review and meta-analysis. Microb Pathog 2023; 183:106321. [PMID: 37673354 DOI: 10.1016/j.micpath.2023.106321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Brucellosis is a zoonotic disease that can be transmitted from animals to humans. Brucellosis is caused by bacteria of the genus Brucella, which are typically transmitted through contact with infected animals, unpasteurized dairy products, or airborne pathogens. Tetracyclines (tetracycline and doxycycline) are antibiotics commonly used to treat brucellosis; however, antibiotic resistance has become a major concern. This study assessed the worldwide prevalence of tetracycline-resistant Brucella isolates. METHODS A systematic search was conducted in Scopus, PubMed, Web of Science, and EMBASE using relevant keywords and Medical Subject Headings (MeSH) terms until August 13, 2022, to identify relevant studies for meta-analysis. A random effects model was used to estimate the proportion of resistance. Meta-regression analysis, subgroup analysis, and examination of outliers and influential studies were also performed. RESULTS The prevalence rates of resistance to tetracycline and doxycycline were estimated to be 0.017 (95% confidence interval [CI], 0.009-0.035) and 0.017 (95%CI, 0.011-0.026), respectively, based on 51 studies conducted from 1983 to 2020. Both drugs showed increasing resistance over time (tetracycline: r = 0.077, P = 0.012; doxycycline: r = 0.059, P = 0.026). CONCLUSION The prevalence of tetracycline and doxycycline resistance in Brucella was low (1.7%) but increased over time. This increase in tetracycline and doxycycline resistance highlights the need for further research to understand resistance mechanisms and develop more effective treatments.
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Affiliation(s)
| | | | - Forough Goodarzi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Sholeh
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
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Jeyaraman N, Jeyaraman M, Nallakumarasamy A, K S, Adhikari S, Rijal R, Asija A, Sedhai YR, Sah S, Mohanty A, Bonilla-Aldana DK, Sah R. A proposed management classification for spinal brucellosis from India. Travel Med Infect Dis 2023; 54:102614. [PMID: 37392982 DOI: 10.1016/j.tmaid.2023.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION The myriad presentation of osteoarticular brucellosis make the patient seek the help of general practitioners, orthopaedic and rheumatology specialists. Moreover, the lack of disease-specific symptomatology is the leading cause of the delay in diagnosing osteoarticular brucellosis. Given the increasing number of spinal brucellosis cases across the country, no literature is presented on the systematic management of spinal brucellosis. However, with our experience, we formulated a classification for managing spinal brucellosis. METHODS A single-centred prospective observational study was conducted with 25 confirmed cases of spinal brucellosis. Patients were analysed and graded clinically, serologically, and radiologically and were managed with antibiotics for 10-12 weeks, and if necessary, stabilisation and fusion were done based on the treatment classification devised. All patients were followed up to ensure disease clearance at serial follow-up with relevant investigations. RESULTS The mean age of the study participants was 52.16 ± 12.53 years. According to spondylodiscitis severity code (SSC) grading, four patients belong to grades 1, 12 to grade 2 and 9 to grade 3 at presentation. Erythrocyte sedimentation rate (p = 0.02), c-reactive protein (p < 0.001), Brucella agglutination titers (p < 0.001), and radiological outcomes improved statistically by six months. The treatment duration was individualised according to the patient's response to the treatment, with a mean time of 11.42 ± 2.66 weeks. The mean follow-up period was 14.42 ± 8 months. CONCLUSION High index of suspicion of patients from endemic regions, proper clinical assessment, serological evaluation, radiological assessment, appropriate decision-making (medical/surgical) in treatment, and regular follow-up were the key to successful comprehensive management of spinal brucellosis.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Chengalpet, 603108, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Shanmugapriya K
- Department of Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600095, Tamil Nadu, India
| | | | - Rishikesh Rijal
- Department of Gastroenterology, University of Louisville, Kentucky, USA
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, 442001, India; SR Sanjeevani Hospital Kalyanpur-10, Siraha, Nepal
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, 273008, Uttar Pradesh, India
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, 46000, Nepal; Department of Clinical Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411000, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
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Akkoc G, Tekerek S. Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases. Pediatr Infect Dis J 2023; 42:381-388. [PMID: 36795549 DOI: 10.1097/inf.0000000000003844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUNDS Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement. METHODS This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey. RESULTS A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement. CONCLUSION A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.
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Affiliation(s)
- Gulsen Akkoc
- From the Department of Pediatric Infectious Disease, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Pediatric Infectious Disease, University of Health Sciences, Haseki Training and Research Hospital Istanbul, Istanbul, Turkey
| | - Serhat Tekerek
- Department of Radiology, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Radiology, University of Health Sciences Antalya Research and Training Hospital Antalya, Antalya, Turkey
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The Development of Diagnostic and Vaccine Strategies for Early Detection and Control of Human Brucellosis, Particularly in Endemic Areas. Vaccines (Basel) 2023; 11:vaccines11030654. [PMID: 36992237 DOI: 10.3390/vaccines11030654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Brucellosis is considered one of the most serious zoonotic diseases worldwide. This disease affects both human and animal health, in addition to being one of the most widespread zoonotic illnesses in the Middle East and Northern Africa. Human brucellosis generally presents in a diverse and non-specific manner, making laboratory confirmation of the diagnosis critical to the patient’s recovery. A coordinated strategy for diagnosing and controlling brucellosis throughout the Middle East is required, as this disease cannot be known to occur without reliable microbiological, molecular, and epidemiological evidence. Consequently, the current review focuses on the current and emerging microbiological diagnostic tools for the early detection and control of human brucellosis. Laboratory assays such as culturing, serology, and molecular analysis can frequently be used to diagnose brucellosis. Although serological markers and nucleic acid amplification techniques are extremely sensitive, and extensive experience has been gained with these techniques in the laboratory diagnosis of brucellosis, a culture is still considered to be the “gold standard” due to the importance of this aspect of public health and clinical care. In endemic regions, however, serological tests remain the primary method of diagnosis due to their low cost, user-friendliness, and strong ability to provide a negative prediction, so they are commonly used. A nucleic acid amplification assay, which is highly sensitive, specific, and safe, is capable of enabling rapid disease diagnosis. Patients who have reportedly fully healed may continue to have positive molecular test results for a long time. Therefore, cultures and serological methods will continue to be the main tools for diagnosing and following up on human brucellosis for as long as no commercial tests or studies demonstrate adequate interlaboratory reproducibility. As there is no approved vaccine that prevents human brucellosis, vaccination-based control of animal brucellosis has become an important part of the management of human brucellosis. Over the past few decades, several studies have been conducted to develop Brucella vaccines, but the problem of controlling brucellosis in both humans and animals remains challenging. Therefore, this review also aims to present an updated overview of the different types of brucellosis vaccines that are currently available.
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Kraft DC, Naeem M, Mansour J, Beal MA, Bailey TC, Bhalla S. Body Imaging of Bacterial and Parasitic Zoonoses: Keys to Diagnosis. Radiographics 2023; 43:e220092. [PMID: 36729948 DOI: 10.1148/rg.220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zoonotic infections, which are transmitted from animals to humans, have been a substantial source of human disease since antiquity. As the human population continues to grow and human influence on the planet expands, humans frequently encounter both domestic and wild animals. This has only increased as deforestation, urbanization, agriculture, habitat fragmentation, outdoor recreation, and international travel evolve in modern society, all of which have resulted in the emergence and reemergence of zoonotic infections. Zoonotic infections pose a diagnostic challenge because of their nonspecific clinical manifestations and the need for specialized testing procedures to confirm these diagnoses. Affected patients often undergo imaging during their evaluation, and a radiologist familiar with the specific and often subtle imaging patterns of these infections can add important clinical value. The authors review the multimodality thoracic, abdominal, and musculoskeletal imaging findings of zoonotic bacterial (eg, Bartonella henselae, Pasteurella multocida, Francisella tularensis, Coxiella burnetii, and Brucella species), spirochetal (eg, Leptospira species), and parasitic (eg, Echinococcus, Paragonimus, Toxocara, and Dirofilaria species) infections that are among the more commonly encountered zoonoses in the United States. Relevant clinical, epidemiologic, and pathophysiologic clues such as exposure history, occupational risk factors, and organism life cycles are also reviewed. Although many of the imaging findings of zoonotic infections overlap with those of nonzoonotic infections, granulomatous diseases, and malignancies, radiologists' familiarity with the imaging patterns can aid in the differential diagnosis in a patient with a suspected or unsuspected zoonotic infection. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- David C Kraft
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Muhammad Naeem
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Joseph Mansour
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Michael A Beal
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Thomas C Bailey
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Sanjeev Bhalla
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
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Spinal Infections. Neuroimaging Clin N Am 2023; 33:167-183. [DOI: 10.1016/j.nic.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Muacevic A, Adler JR. Role of Surgery in Brucella Spondylodiscitis: An Evaluation of 28 Patients. Cureus 2023; 15:e33542. [PMID: 36632375 PMCID: PMC9829415 DOI: 10.7759/cureus.33542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Background A limited number of studies are available in the literature on the surgical treatment of brucellosis-related spondylodiscitis. This study aimed to define and discuss the role of surgery in brucellosis-related spondylodiscitis. Methodology A total of 28 patients who underwent surgical treatment due to brucellosis-related spondylodiscitis between February 2021 and August 2022 were included in this study. Medical records, radiological images, and laboratory data were collected. Surgical results were evaluated according to the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, clinical findings, postoperative radiological imaging findings, and complications were evaluated. Results In total, 16 of the patients included in the study were male and 12 were female, with a mean age of 56.4 ± 7.2 years. The mean follow-up duration was 11.8 ± 5.4 months. Brucellosis involvement was in the lumbosacral region in all patients. Overall, 21 patients had a neurological deficit in the preoperative period. Posterior stabilization and fusion were done in 20 (71.4%) patients, while simple laminectomy (decompression) and debridement were done in eight (28.6%) patients. There was a decrease in the pain in the lower back and leg in all patients in the postoperative period. Neurological recovery was achieved in 18 patients with a neurological deficit. Two patients underwent wound drainage in the postoperative period. The patient who had morbid obesity and comorbidities died in the postoperative period. ESR and CRP levels returned to normal at the end of the six-month follow-up. There was a significant recovery in VAS and ODI scores (p < 0.05). In total, 24 (85.4%) patients were considered fully recovered both radiologically and clinically at the end of the follow-up. Conclusions Although long-term and specific antibiotic treatment constitute the main treatment in brucellosis-related spondylodiscitis, debridement, decompression, and stabilization (when required) of infection with a focus on neurological deficits and instability formation and non-stop severe pain are effective and safe treatment options.
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OGUL Y, AYYILDIZ VA, GÜZEL M, AKPINAR O, ORHAN H. Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1112409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
ABSTRACT
Objective: Musculoskeletal involvement in brucellosis is very important. This study aimed to evaluate the magnetic resonance imaging (MRI) findings and hematological parameters as a predictive value for the diagnosis of musculoskeletal brucellosis.
Methods: This prospective case-control study was conducted between June 2011 and November 2019 in a university hospital. Ninety-nine patients with the confirmed diagnosis of brucellosis without musculoskeletal involvement and forty-three brucellosis patients with musculoskeletal involvement were examined. The hematological, biochemical parameters, and radiological imaging findings of both groups were recorded. These parameters were statistically compared between the two groups.
Results: The mean age of the patients (non-involvement group) and musculoskeletal involvement groups was 44.04 ± 23.11 and 37.92 ± 24.80 years, respectively (P = 0.062). C-reactive protein (CRP) and alkaline phosphatase (ALP) levels were significantly higher in the musculoskeletal involvement group (P < 0.05). The lower lymphocyte level was statistically significant in this group. Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 70% and 65% for ALP, 77% and 58% for CRP, 83% and 45% for lymphopenia, respectively. There was no statistically significant difference between the two groups in terms of the other hematological and biochemical parameters. Spondylodiscitis (34.8%) was the most common MRI finding in patients with musculoskeletal involvement.
Conclusions: Our study results show that CRP, ALP, and lymphopenia can be used as valuable markers in the preliminary diagnosis of musculoskeletal brucellosis.
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Affiliation(s)
| | | | | | - Orhan AKPINAR
- SÜLEYMAN DEMİREL ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ
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Gerges S, Khoury A, Hallit S, Hoyek F, Hallit R. Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess: a case report. J Med Case Rep 2022; 16:418. [PMID: 36329543 PMCID: PMC9631603 DOI: 10.1186/s13256-022-03544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Human brucellosis is the most frequently contracted zoonotic infection worldwide. Although being an old disease that carries minimal risks of mortality, it remains a source of considerable sequelae and disability. However, noncontiguous multifocal spinal involvement is an exceptional presentation of brucellosis; additionally, an associated paravertebral abscess is extremely rare. Case presentation This paper focuses on a 67-year-old Lebanese woman with noncontiguous multifocal Brucella spondylodiscitis, involving the T12–L1 and L3–L4 segments, with paravertebral abscess formation. She presented with a 3-week history of acute severe lumbar back pain, radiating to the lower extremities and associated with impaired mobility and lower extremity weakness. The patient complained of night sweating but had no fever. No lymphadenopathy, hepatomegaly, or splenomegaly could be observed. She had painful percussion of the lumbar spine, painful passive mobilization, and paravertebral tenderness, yet her neurological examination was completely normal. BrucellaCapt test was positive at a titer of 1/5120 (reference range 1/180). The patient was treated with an inpatient regimen for 2 weeks, which was followed by an outpatient oral antibiotic regimen with doxycycline, rifampin, and ciprofloxacin to complete a total treatment duration of 3 months. Magnetic resonance imaging was performed at the end of the treatment and showed a complete resolution of the paravertebral abscess. Conclusion Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess is an extremely rare presentation. It may be effectively managed by antibiotic therapy, without surgery or drainage, in the absence of neurological complications. Nonetheless, the principal challenge to an efficient management is establishing the diagnosis of Brucella in the first place. In endemic countries, a strong suspicion of spinal involvement of brucellosis should be elicited in front of back pain presentations—even in the absence of fever and other related symptoms.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | | | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Fadi Hoyek
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.,Department of Orthopedics, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Department of Infectious Disease, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon. .,Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon.
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The role of shoulder arthroplasty after chronic brucellosis of glenohumeral joint septic arthritis. A case report and literature reviews. Int J Surg Case Rep 2022; 97:107467. [PMID: 35952568 PMCID: PMC9403336 DOI: 10.1016/j.ijscr.2022.107467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The main socioeconomic area in Thailand has been the agricultural endemic area, where brucellosis infection, one of the bacterial infectious diseases has been an overlooked diagnose. PRESENTATION OF CASE A 50-year-old Thai woman was admitted to the hospital with pain and limited motion in her left shoulder. These symptoms have been prolonging with progressive clinical for two years. The physical examination revealed stiffness in all directions. The glenohumeral joint appeared to be narrowing on radiographic evaluation. The multiple loculate mass and septic glenohumeral joint arthritis were seen by magnetic resonance imaging (MRI). Furthermore, the Brucellosis investigation specificity was Brucella IgM/IgG positive. This patient was treated with a combination of surgery and oral antimicrobial medication. We decided to perform a total shoulder arthroplasty because the patient was still in pain and stiff from secondary arthritis. DISCUSSION As a result of the late treatment for osteoarticular involvement, secondary osteoarthritis develops until leading to significant cartilage loss. Therefore, even medical treatment and surgical debridement, the patient still suffers from secondary osteoarthritis, which causes pain and limited activity. The arthroplasty treatment method plays a role in the treatment of function following secondary osteoarthritis infection. CONCLUSION The role of arthroplasty was selected in the treatment of brucellosis osteoarticular involvement, which is an uncommon and difficult to identify condition that can lead to maltreatment. So that this case report offers the treatment option if the patient was not responsible for the medical and surgical debridement therapy with secondary osteoarthritis at the glenohumeral joint, even though the brucellosis infection condition had completely resolved.
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Wareth G, Dadar M, Ali H, Hamdy MER, Al-Talhy AM, Elkharsawi AR, Tawab AAAE, Neubauer H. The perspective of antibiotic therapeutic challenges of brucellosis in the Middle East and North African (MENA) countries: Current situation and therapeutic management. Transbound Emerg Dis 2022; 69:e1253-e1268. [PMID: 35244335 DOI: 10.1111/tbed.14502] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Brucellosis is among the most prevalent zoonotic infections in Middle Eastern and North African (MENA) countries, critically impacting human and animal health. A comprehensive review of studies on antibiotic susceptibility and therapeutic regimes for brucellosis in ruminants and humans in the MENA region was conducted to evaluate the current therapeutic management in this region. Different scientific databases were searched for peer-reviewed original English articles published from January 1989 to February 2021. Reports from research organizations and health authorities have been taken into consideration. Brucella melitensis and Brucella abortus have been reported from the majority of MENA countries, suggesting a massive prevalence particularly of B. melitensis across these countries. Several sporadic cases of brucellosis relapse, therapeutic failure, and antibiotic resistance of animal and human isolates have been reported from the MENA region. However, several studies proved that brucellae are still in-vitro susceptible to the majority of antibiotic compounds and combinations in current recommended WHO treatment regimens, e.g. levofloxacin, tetracyclines, doxycycline, streptomycin, ciprofloxacin, chloramphenicol, gentamicin, tigecycline, and trimethoprim/sulfamethoxazole. The current review presents an overview on resistance development of brucellae and highlights the current knowledge on effective antibiotics regimens for treating human brucellosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, Jena, 07743, Germany.,Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Benha University, Moshtohor, 13736, Egypt
| | - Maryam Dadar
- Department of Brucellosis, Razi Vaccine and Serum Research Institute, Agricultural Research, Education, and Extension Organization, Karaj, Iran
| | - Haytham Ali
- Department of Animal and Veterinary Sciences, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman.,Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud E R Hamdy
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo, 12618, Egypt
| | | | - Ahmed R Elkharsawi
- Jena University Hospital, Department of Gastroenterology, Hepatology and Infectious diseases, Am Klinikum 1, Jena, 07747, Germany
| | - Ashraf A Abd El Tawab
- Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Benha University, Moshtohor, 13736, Egypt
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, Jena, 07743, Germany
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Vlok M, Buckley HR, Domett K, Willis A, Tromp M, Trinh HH, Minh TT, Mai Huong NT, Nguyen LC, Matsumura H, Huu NT, Oxenham MF. Hydatid disease (Echinococcosis granulosis) diagnosis from skeletal osteolytic lesions in an early seventh-millennium BP forager community from preagricultural northern Vietnam. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:100-115. [PMID: 36787713 DOI: 10.1002/ajpa.24435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Con Co Ngua is a complex, sedentary forager site from northern Vietnam dating to the early seventh millennium BP. Prior research identified a calcified Echinococcus granulosis cyst, which causes hydatid disease. Osteolytic lesions consistent with hydatid disease were also present in this individual and others. Hydatid disease is observed in high frequencies in pastoralists, and its presence in a hunter-gatherer community raises questions regarding human-animal interaction prior to farming. The objective of this article is to identify and describe the epidemiology of hydatid disease in the human skeletal assemblage at Con Co Ngua. MATERIALS AND METHODS One hundred and fifty-five individuals were macroscopically assessed for lesions. Of these, eight individuals were radiographed. Hydatid disease was diagnosed using a new threshold criteria protocol derived from clinical literature, which prioritizes lesions specific to the parasite. RESULTS Twenty-two individuals (14.2%) presented with osteolytic lesions consistent with hydatid disease, affecting the distal humerus, proximal femur and forearm, and pelvis. Seven individuals radiographed (4.5%) had multilocular cystic lesions strongly diagnostic for hydatid disease. All probable cases had lesions of the distal humerus. The remaining lesions were macroscopically identical to those radiographed and were considered possible cases. DISCUSSION While hydatid disease has previously been found in pre-agricultural communities, the high prevalence at Con Co Ngua is non-incidental. We propose that the presence of wild canids and management of wild buffalo and deer increased the risk of disease transmission. These findings further reveal subsistence complexity among hunter-gatherers living millennia prior to the adoption of farming in Southeast Asia.
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Affiliation(s)
- Melandri Vlok
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Hallie R Buckley
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Kate Domett
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Anna Willis
- College of Arts, Society & Education, James Cook University, Townsville, Australia
| | - Monica Tromp
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,School of Social Sciences, University of Otago, Dunedin, New Zealand.,Department of Archaeology, Max Planck Institute for the Science of Human History, Jena, Germany
| | | | | | | | | | | | | | - Marc F Oxenham
- School of Archaeology and Anthropology, The Australian National University, Canberra, Australia.,Department of Archaeology, University of Aberdeen, Scotland, UK
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13
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Escauriaza L, Reeve L, Hahn H, Granger N, Vandenberghe H. Brucella Canis
discospondylitis in a dog imported into the United Kingdom from Romania. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Lizzie Reeve
- Neurology, Highcroft Veterinary Referrals, Neurology Bristol UK
| | - Harriet Hahn
- Neurology, Highcroft Veterinary Referrals, Neurology Bristol UK
| | - Nicolas Granger
- Neurology, Highcroft Veterinary Referrals, Neurology Bristol UK
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14
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Al Nokhatha S, AlKindi F, Al Yassi S, Hashmey R. Musculoskeletal Brucellosis in Adults in the United Arab Emirates: A Retrospective Study. EUROPEAN MEDICAL JOURNAL 2021. [DOI: 10.33590/emj/20-00271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Brucellosis is a zoonotic infection caused by the aerobic Gram-negative bacteria coccobacilli, and is considered a public health problem in the Mediterranean region and Arabian Peninsula. This paper studied the clinical characteristics of musculoskeletal brucellosis and the outcomes of treatment in Al Ain City, United Arab Emirates.
Method: A retrospective chart review study was conducted at Tawam Hospital over seven years: January 2009–January 2016. Risk factors for brucellosis, musculoskeletal (MSK) manifestations, duration of Brucella infection (acute, subacute, chronic), and treatment were studied.
Results: A total of 99 patients were diagnosed with brucellosis during the study period; the mean age was 44 years, the majority were males (71%), and the male to female ratio was 3:1. The most common risk factor for Brucella infection in the cohort was drinking raw milk (43.4%). Fever was the most common presenting symptoms (93%), followed by arthralgia, fatigue, and loss of appetite in 35, 21, and 14%, respectively. The clinical manifestations of brucellosis in the cohort were MSK involvement (30%), hepatitis (17%), epididymo-orchitis (2%), and endocarditis (1%). Thirty percent of patients (n=30) had MSK-specific symptoms and only one-third (n=10) had confirmatory positive radiographic findings. The majority of patients had lumbar and sacroiliac joint involvement. Most of the patients received antibiotics for a 4–8-week duration and the overall relapse rate of Brucella infection was 10%.
Conclusion: This study demonstrates that MSK involvement is a common manifestation in brucellosis, occurring in one-third of the cases. The index of suspicion should be high in brucellosis-endemic countries for early recognition and treatment.
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Affiliation(s)
| | - Fatima AlKindi
- Division of General Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Shaima Al Yassi
- Division of General Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Rayhan Hashmey
- Division of Infectious Diseases, Tawam Hospital, Al Ain, United Arab Emirates
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15
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Zhang H, Xie S, Wang Y, Zhao X, Yi J, Wang Z, Liu Q, Deng X, Li B, Cui B, Wang Y, Chen C. A case report of endocarditis and spondylitis caused by Brucella melitensis biovar 3. BMC Infect Dis 2021; 21:460. [PMID: 34016047 PMCID: PMC8139066 DOI: 10.1186/s12879-021-06142-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background This case report describes the clinical process of a shepherd who suffered brucellosis-related endocarditis (BE) and spondylitis (BS) and was infected with Brucella melitensis biovar 3 (B. melitensis biovar 3). Case presentation A 55-year-old male patient was admitted to The First Affiliated Hospital of Shihezi University on October 11, 2018, due to over 3 months of intermittent fever, back pain, and heart trouble. The Rose Bengal Plate test was positive, the standard agglutination test titer for brucellosis was 1/800, and the blood culture was positive for B. melitensis biovar 3. Three instances of transthoracic echocardiography examination at days 1, 25, and 376 after admission to the hospital and magnetic resonance imaging (MRI) and computed tomography (CT) checks at days 5 and 38 revealed that the size of the vegetation on the posterior leaflet of the mitral valve increased from 0.71.4cm to 1.21.5cm and that the left atrium and ventricle were enlarged. The MRI and CT results showed hyperplasia of the second and third vertebra, a cold abscess formed on both sides of the psoas major muscles, and the vertebra hyperplasia became aggravated at a later time point. The patients situation deteriorated, and heart failure was discovered on October 22, 2019. At the moment of submission of this manuscript, the patient remains in bed at home because of severe debility caused by brucellosis. Conclusions This is the first reported case of endocarditis combined with spondylitis caused by B. melitensis biovar 3 in a shepherd. Brucellosis infection can cause work-power losses because of misdiagnosis or a lack of proper treatment. Early diagnosis and treatment are essential for a successful outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06142-3.
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Affiliation(s)
- Huan Zhang
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Songsong Xie
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, Shihezi City, 832000, Xinjiang, China.,The First Affiliated Hospital of Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Yueli Wang
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Xiaoli Zhao
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Jihai Yi
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Zhen Wang
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Qi Liu
- The First Affiliated Hospital of Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Xiaoyu Deng
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Bingjie Li
- The First Affiliated Hospital of Shihezi University, Shihezi City, 832000, Xinjiang, China
| | - Buyun Cui
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, 100050, China
| | - Yuanzhi Wang
- School of Medicine, Shihezi University, Shihezi City, 832000, Xinjiang, China.
| | - Chuangfu Chen
- School of Animal Science and Technology, Shihezi University, Shihezi City, 832000, Xinjiang, China.
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16
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Piao D, Li Z, Yang X, Tian G, Zhao H, Jiang H. Emerging Brucellosis Outbreaks Associated with Unpasteurized Milk in China. China CDC Wkly 2020; 2:888-890. [PMID: 34594793 PMCID: PMC8393127 DOI: 10.46234/ccdcw2020.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Dongri Piao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaowen Yang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guozhong Tian
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hai Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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17
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Bialer MG, Sycz G, Muñoz González F, Ferrero MC, Baldi PC, Zorreguieta A. Adhesins of Brucella: Their Roles in the Interaction with the Host. Pathogens 2020; 9:E942. [PMID: 33198223 PMCID: PMC7697752 DOI: 10.3390/pathogens9110942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 01/30/2023] Open
Abstract
A central aspect of Brucella pathogenicity is its ability to invade, survive, and replicate in diverse phagocytic and non-phagocytic cell types, leading to chronic infections and chronic inflammatory phenomena. Adhesion to the target cell is a critical first step in the invasion process. Several Brucella adhesins have been shown to mediate adhesion to cells, extracellular matrix components (ECM), or both. These include the sialic acid-binding proteins SP29 and SP41 (binding to erythrocytes and epithelial cells, respectively), the BigA and BigB proteins that contain an Ig-like domain (binding to cell adhesion molecules in epithelial cells), the monomeric autotransporters BmaA, BmaB, and BmaC (binding to ECM components, epithelial cells, osteoblasts, synoviocytes, and trophoblasts), the trimeric autotransporters BtaE and BtaF (binding to ECM components and epithelial cells) and Bp26 (binding to ECM components). An in vivo role has also been shown for the trimeric autotransporters, as deletion mutants display decreased colonization after oral and/or respiratory infection in mice, and it has also been suggested for BigA and BigB. Several adhesins have shown unipolar localization, suggesting that Brucella would express an adhesive pole. Adhesin-based vaccines may be useful to prevent brucellosis, as intranasal immunization in mice with BtaF conferred high levels of protection against oral challenge with B. suis.
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Affiliation(s)
- Magalí G. Bialer
- Fundación Instituto Leloir (FIL), IIBBA (CONICET-FIL), Buenos Aires 1405, Argentina; (M.G.B.); (G.S.)
| | - Gabriela Sycz
- Fundación Instituto Leloir (FIL), IIBBA (CONICET-FIL), Buenos Aires 1405, Argentina; (M.G.B.); (G.S.)
| | - Florencia Muñoz González
- Cátedra de Inmunología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina; (F.M.G.); (M.C.F.)
- Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Mariana C. Ferrero
- Cátedra de Inmunología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina; (F.M.G.); (M.C.F.)
- Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Pablo C. Baldi
- Cátedra de Inmunología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires 1113, Argentina; (F.M.G.); (M.C.F.)
- Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-Universidad de Buenos Aires, Buenos Aires 1113, Argentina
| | - Angeles Zorreguieta
- Fundación Instituto Leloir (FIL), IIBBA (CONICET-FIL), Buenos Aires 1405, Argentina; (M.G.B.); (G.S.)
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
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18
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Fan Z, Yang Y, Li D, Fei Q. A rare lumbar pyogenic spondylodiscitis caused by staphylococcus caprae with initial misdiagnosis: case report and literature review. BMC Surg 2020; 20:200. [PMID: 32928168 PMCID: PMC7491161 DOI: 10.1186/s12893-020-00860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Staphylococcus caprae (Sc) is an uncommon causative organism for human. Lumbar pyogenic spondylodiscitis (LPS) of Sc is extremely rare and only a few cases have been reported. As far as we know, there is no specific literature on the diagnosis and treatment for LPS of Sc with L5 nerve root irritation. Case presentation A 65-year-old male patient complained of chronic low back pain for 10 years, acute worsening with radiating pain to left lower extremity over a month. Physical examination revealed tenderness point on his low back, 3/5 dorsiflexor strength in his left 1st toe and decreased sensation of pin prick over the left lateral shank and medial dorsal foot. The individual was initially misdiagnosed with lumbar disc herniation (LDH) without further examination in outpatient, which was then found to be LPS of Sc with L5 nerve root irritation after admission to our hospital. Magnetic resonance images (MRI) of lumbar spine exhibited inflammation signal at L4-L5 level of the vertebral body and disc with hypointense on T1-weighted images (T1-WI) and hyperintense on T2-weighted images (T2-WI). The causative organism was confirmed by the culture of irrigation fluid obtained from L5 vertebrae by needle puncture. After systemic conservative treatment including using sensitive antimicrobial agents and immobilization, the rare infection was finally cured. The patient also showed a satisfactory recovery during the 36-month follow-up period. Conclusions Confirming the diagnosis and identifying the causative organism as soon as possible is the key point for the treatment of LPS. LPS of Sc causing nerve root irritation is rare but curable with early diagnosis and proper therapy. The culture of irrigation fluid obtained from vertebrae by needle puncture may be an effective and sensitive attempt for potential infection of spine to identify the causative organism at early stage of the disease.
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Affiliation(s)
- Zihan Fan
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
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19
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Adetunji SA, Ramirez G, Ficht AR, Perez L, Foster MJ, Arenas-Gamboa AM. Building the Evidence Base for the Prevention of Raw Milk-Acquired Brucellosis: A Systematic Review. Front Public Health 2020; 8:76. [PMID: 32232023 PMCID: PMC7082743 DOI: 10.3389/fpubh.2020.00076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The scientific evidence of the health risks associated with the consumption of raw milk has been known for a long time. However, less clear is the impact of acquiring infectious diseases from raw milk consumption in the United States (US) due to incomplete reporting of cases and the complex factors associated with the sale and consumption of raw milk. Investigations of this current study focused on human brucellosis, one of the infectious diseases commonly acquired through the consumption of raw milk and milk products, and which continues to be a public health threat worldwide. Methodology: A qualitative systematic review of the sources of opinions that contribute to the increased trend of raw milk sales and consumption in the US was conducted. Results: Interestingly, opinions about the sale of raw milk and/or the benefits arising from its consumption varied by US region, with the proportion of messages supporting raw milk consumption being highest in the Northeast compared to other US regions. Several evidence gaps and factors that possibly contribute to the increased prevalence of raw milk-acquired brucellosis were identified including inadequate monitoring of the raw milk sales process and lack of approved diagnostic methods for validating the safety of raw milk for human consumption. Conclusions: The unavailability of data specifying brucellosis cases acquired from raw milk consumption have precluded the direct association between raw milk and increased brucellosis prevalence in the United States. Nevertheless, the evidence gaps identified in this study demonstrate the need for intensified surveillance of raw-milk acquired infectious diseases including human brucellosis; establishment of safety and quality control measures for the process of selling raw milk; and design of an effective strategy for the prevention of raw milk-acquired infectious diseases including brucellosis. Overall, for the first time, this study has not only shown the gaps in evidence that require future investigations, but also, variations in the perception of raw milk consumption that may impact disease acquisition in different US regions.
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Affiliation(s)
- Shakirat A Adetunji
- Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States
| | - Gilbert Ramirez
- School of Public Health, Texas A&M University, College Station, TX, United States
| | - Allison R Ficht
- College of Medicine, Texas A&M University Health Science Center, Bryan, TX, United States
| | - Ligia Perez
- Department of Student Life Studies, Texas A&M University, College Station, TX, United States
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States
| | - Angela M Arenas-Gamboa
- Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States
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20
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Sardana R, Vaish A, Merh A, Butta H, Vaishya R, Mendiratta L. Knee and the farm animals: An unusual presentation of Brucella melitensis masquerading as tuberculosis. Indian J Med Microbiol 2019; 37:123-126. [PMID: 31424024 DOI: 10.4103/ijmm.ijmm_19_213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In many developed countries, brucellosis has been successfully eradicated. However, brucellosis, with its myriad presentations, continues to be a clinical and diagnostic challenge in primarily agrarian countries such as India. We present a case of a rare manifestation of brucellosis i.e., septic arthritis of the knee joint associated with a lytic lesion of the proximal tibia. The patient belonged to a Brucella endemic country, and clinical features were of chronic reactive knee arthritis with synovial hypertrophy and effusion. Advanced diagnostic methods played a pivotal role in excluding the diagnosis of tuberculosis, and thus unnecessary administration of antitubercular therapy and initiating focused narrowed anti-Brucella management, achieving the goal of antimicrobial stewardship also.
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Affiliation(s)
- Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aditya Merh
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Hena Butta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Leena Mendiratta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
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21
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Brucellosis as a rare cause of olecranon bursitis: case-based review. Rheumatol Int 2019; 39:2185-2187. [PMID: 31388750 DOI: 10.1007/s00296-019-04414-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
A 51-year-old man shepherd presented with mild pain and swelling of the right posterior aspect of his right elbow. In ultrasonography, the affected bursal space had swelling and effusion. Moreover, the aspiration of the affected bursa revealed an inflammatory profile. Brucella melitensis was detected in aspirated fluid and blood cultures. The serum agglutination test (SAT) and 2-mercaptoethanol test for brucellosis were also positive. Therefore, the diagnosis of brucellar olecranon was confirmed. Treatment was initiated using gentamicin for the first 7 days and doxycycline plus rifampicin for 2 months. After treatment, all clinical signs and symptoms were resolved. No relapse was seen after 1 year of the completion of treatment. Clinicians should pay attention to the symptoms of olecranon brucellar bursitis that is similar to that of pyogenic bursitis.
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22
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Arslan A, Çavuş G, Bilgin E, Ökten Aİ, Gezercan Y, Atmiş A, Çelik Ü. Brucella Case That Led to Atlantoaxial Spinal Instability in Childhood. World Neurosurg 2019; 131:108-111. [PMID: 31323407 DOI: 10.1016/j.wneu.2019.07.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atlantoaxial subluxation caused by Brucella infection is rarely seen in children. CASE DESCRIPTION C1-C2 dislocation, erosion in the odontoid bone, and compression to the brainstem were detected on cervical computed tomography and magnetic resonance imaging in a 6-year-old patient who suffered neck pain, deviation to the right in the neck, fever, and pain in his extremities. He was hospitalized in the Clinic of Pediatric Infectious Diseases. Positive Brucella agglutination tests were obtained, so C1-C2 stabilization and fusion were performed. Antibrucellosis antibiotic treatment was administered for 6 months. It was suggested that the dislocation was related to odontoid erosion and laxity of the atlantoaxial ligamentous structures during Brucella infection. CONCLUSIONS Atlantoaxial dislocation and instability develops secondarily to paravertebral abscesses, only rarely. Like brucellosis of childhood, granulomatous infectious diseases rarely cause atlantoaxial subluxation or dislocation. Torticollis and neck pains should be taken seriously for the purpose of early diagnosis of patients at risk in endemic regions. Stabilization and fusion should be performed when instability is detected, and these patients should be assessed with both pediatric infectious diseases and neurosurgery clinics. Our case is the first one in the literature in which atlantoaxial instability developed due to Brucella infection and stabilization was performed.
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Affiliation(s)
- Ali Arslan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Gökhan Çavuş
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey.
| | - Emre Bilgin
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali İhsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Anıl Atmiş
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
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23
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Bosilkovski M, Siskova D, Spasovska K, Vidinic I, Dimzova M. The influence of illness duration before diagnosis on clinical characteristics and outcome in human brucellosis. Trop Doct 2019; 49:177-181. [PMID: 31060447 DOI: 10.1177/0049475519846422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study assesses the influence of illness duration before establishing the diagnosis of brucellosis and initiating therapy on patients' main clinical characteristics and outcome in an endemic area. The medical files of 297 patients with brucellosis were retrospectively analysed. They were divided into four groups according to illness duration before initiating therapy: <10 days; 11-30 days; 31-90 days; and >90 days. There were significant differences in the occurrences of fever (P = 0.019), focal forms (P = 0.026), spondylitis (P = 0.034) and therapeutic failures (P = 0.006) between the groups. Duration of >30 days before treatment initiation is responsible for more serious clinical presentation and outcome, whereas illness duration of >90 days further worsens the clinical progression in human brucellosis.
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Affiliation(s)
- Mile Bosilkovski
- 1 Specialist in Infectious Diseases, University Hospital for Infectious Diseases and Febrile Conditions, Medical Faculty, Skopje, Republic of North Macedonia
| | - Dijana Siskova
- 2 Specialist in Infectious Diseases, Department for Infectious Diseases, Medical Center Shtip, Republic of North Macedonia
| | - Katerina Spasovska
- 1 Specialist in Infectious Diseases, University Hospital for Infectious Diseases and Febrile Conditions, Medical Faculty, Skopje, Republic of North Macedonia
| | - Ivan Vidinic
- 1 Specialist in Infectious Diseases, University Hospital for Infectious Diseases and Febrile Conditions, Medical Faculty, Skopje, Republic of North Macedonia
| | - Marija Dimzova
- 1 Specialist in Infectious Diseases, University Hospital for Infectious Diseases and Febrile Conditions, Medical Faculty, Skopje, Republic of North Macedonia
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Gentilini MV, Giambartolomei GH, Delpino MV. Adrenal Steroids Modulate Fibroblast-Like Synoviocytes Response During B. abortus Infection. Front Endocrinol (Lausanne) 2019; 10:722. [PMID: 31695682 PMCID: PMC6817619 DOI: 10.3389/fendo.2019.00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 01/18/2023] Open
Abstract
Brucella abortus stimulates an inflammatory immune response that stimulates the endocrine system, inducing the secretion of dehydroepiandrosterone (DHEA) and cortisol. In humans, the active disease is generally present as osteoarticular brucellosis. In previous studies we showed that B. abortus infection of synoviocytes creates a proinflammatory microenvironment. We proposed to determine the role of cortisol and DHEA on synoviocytes and infiltrating monocytes during B. abortus infection. Cortisol inhibited IL-6, IL-8, MCP-1, and MMP-2 secretion induced by B. abortus infection in synovial fibroblast. Cortisol-mediated MMP-2 inhibition during B. abortus infection was reversed by IL-6. DHEA inhibited B. abortus-induced RANKL up-regulation in synovial fibroblast through estrogen receptor (ER). B. abortus infection did not modulate glucocorticoid receptor (GR) expression. Cell responses to cortisol also depended on its intracellular bioavailability, according to the activity of the isoenzymes 11β-hydroxysteroid dehydrogenase (HSD) type-1 and 11β-HSD2 (which are involved in cortisone-cortisol interconversion). B. abortus infection did not modify 11β-HSD1 expression and GRα/β ratio in the presence or absence of adrenal steroids. Supernatants from B. abortus-infected monocytes induced 11β-HSD1 in synovial cells. Administration of cortisone was capable of inhibiting the secretion of RANKL by synoviocytes mimicking cortisol's effect. These results go along with previous observations that highlighted the ability of synovial tissue to secrete active steroids, making it an intracrine tissue. This is the first study that contributes to the knowledge of the consequence of adrenal steroids on synoviocytes in the context of a bacterial infection.
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Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS Negl Trop Dis 2019; 13:e0007112. [PMID: 30657765 PMCID: PMC6355028 DOI: 10.1371/journal.pntd.0007112] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/31/2019] [Accepted: 12/26/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Infection of bones and joints remains one of the most commonly described complications of brucellosis in humans and is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. We aimed to systematically review the literature and perform a meta-analysis to estimate the global prevalence of osteoarticular brucellosis (OAB). METHODOLOGY Major bibliographic databases were searched using keywords and suitable combinations. All studies reporting the incidence and clinical manifestations of osteoarticular brucellosis in humans, and demonstrated by two or more diagnostic methods (bacteriological, molecular, serological, and/or radiographic) were included. Random model was used, and statistical significance was set at 0.05. PRINCIPAL FINDINGS A total of 56 studies met the inclusion criteria and were included in the systematic review and meta-analysis. There was an evidence of geographical variation in the prevalence of osteoarticular disease with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Thus, brucellosis patients have at least a 27% chance of developing osteoarticular disease. CONCLUSIONS The prevalence of OAB is not dependent on the endemicity of brucellosis in a particular region. Hence, further research should investigate the potential mechanisms of OAB, as well as the influence of age, gender, and other socioeconomic factor variations in its global prevalence, as this may provide insight into associated exposure risks and management of the disease.
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Affiliation(s)
- Shakirat A. Adetunji
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, United States of America
| | - Gilbert Ramirez
- School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Margaret J. Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas, United States of America
| | - Angela M. Arenas-Gamboa
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, United States of America
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Caspase-1 and Caspase-11 Mediate Pyroptosis, Inflammation, and Control of Brucella Joint Infection. Infect Immun 2018; 86:IAI.00361-18. [PMID: 29941463 DOI: 10.1128/iai.00361-18] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
Brucellosis, caused by the intracellular bacterial pathogen Brucella, is a zoonotic disease for which arthritis is the most common focal complication in humans. Here we investigated the role of inflammasomes and their effectors, including interleukin-1 (IL-1), IL-18, and pyroptosis, on inflammation and control of infection during Brucella-induced arthritis. Early in infection, both caspase-1 and caspase-11 were found to initiate joint inflammation and proinflammatory cytokine production. However, by 1 week postinfection, caspase-1 and caspase-11 also contributed to control of Brucella joint infection. Inflammasome-dependent restriction of Brucella joint burdens did not require AIM2 (absent in melanoma 2) or NLRP3 (NLR family, pyrin domain containing 3). IL-1R had a modest effect on Brucella-induced joint swelling, but mice lacking IL-1R were not impaired in their ability to control infection of the joint by Brucella In contrast, IL-18 contributed to the initiation of joint swelling and control of joint Brucella infection. Caspase1/11-dependent cell death was observed in vivo, and in vitro studies demonstrated that both caspase-1 and caspase-11 induce pyroptosis, which limited Brucella infection in macrophages. Brucella lipopolysaccharide alone was also able to induce caspase-11-dependent pyroptosis. Collectively, these data demonstrate that inflammasomes induce inflammation in an IL-18-dependent manner and that inflammasome-dependent IL-18 and pyroptosis restrict Brucella infection.
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Gentilini MV, Pesce Viglietti AI, Arriola Benitez PC, Iglesias Molli AE, Cerrone GE, Giambartolomei GH, Delpino MV. Inhibition of Osteoblast Function by Brucella abortus is Reversed by Dehydroepiandrosterone and Involves ERK1/2 and Estrogen Receptor. Front Immunol 2018; 9:88. [PMID: 29434601 PMCID: PMC5790783 DOI: 10.3389/fimmu.2018.00088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/11/2018] [Indexed: 01/18/2023] Open
Abstract
Brucella abortus induces an inflammatory response that stimulates the endocrine system resulting in the secretion of cortisol and dehydroepiandrosterone (DHEA). Osteoarticular brucellosis is the most common presentation of the active disease in humans, and we have previously demonstrated that B. abortus infection inhibits osteoblast function. We aimed to evaluate the role of cortisol and DHEA on osteoblast during B. abortus infection. B. abortus infection induces apoptosis and inhibits osteoblast function. DHEA treatment reversed the effect of B. abortus infection on osteoblast by increasing their proliferation, inhibiting osteoblast apoptosis, and reversing the inhibitory effect of B. abortus on osteoblast differentiation and function. By contrast, cortisol increased the effect of B. abortus infection. Cortisol regulates target genes by binding to the glucocorticoid receptor (GR). B. abortus infection inhibited GRα expression. Cell responses to cortisol not only depend on GR expression but also on its intracellular bioavailability, that is, dependent on the activity of the isoenzymes 11β-hydroxysteroid dehydrogenase (HSD) type-1, 11β-HSD2 (which convert cortisone to cortisol and vice versa, respectively). Alterations in the expression of these isoenzymes in bone cells are associated with bone loss. B. abortus infection increased 11β-HSD1 expression but had no effect on 11β-HSD2. DHEA reversed the inhibitory effect induced by B. abortus infection on osteoblast matrix deposition in an estrogen receptor- and ERK1/2-dependent manner. We conclude that DHEA intervention improves osteoblast function during B. abortus infection making it a potential candidate to ameliorate the osteoarticular symptoms of brucellosis.
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Affiliation(s)
- María Virginia Gentilini
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ayelén Ivana Pesce Viglietti
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Andrea Elena Iglesias Molli
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gloria Edith Cerrone
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - María Victoria Delpino
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), CONICET, Universidad de Buenos Aires, Buenos Aires, Argentina
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Qiao P, Zhao P, Gao Y, Bai Y, Niu G. Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis. Chin J Cancer Res 2018; 30:425-431. [PMID: 30210222 PMCID: PMC6129564 DOI: 10.21147/j.issn.1000-9604.2018.04.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases. Methods Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each) received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.
Results For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the Ktrans values (median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and 0.317±0.005 min–1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min–1; the Ve values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differences were statistically significant (two-sided P<0.05).
Conclusions The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.
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Affiliation(s)
- Pengfei Qiao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Pengfei Zhao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yang Gao
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yuzhen Bai
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Guangming Niu
- Department of Magnetic Resonance Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
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Afrasiabian S, Mohsenpour B, Ghaderi E, Nadri S, Hajibagheri K. Does Helicobacter pylori Infection Play a Role in Susceptibility to Brucellosis? Jpn J Infect Dis 2017; 70:672-674. [PMID: 28890508 DOI: 10.7883/yoken.jjid.2017.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Brucellosis is endemic in Iran. Several studies have shown that brucellosis is associated with other infectious diseases. This study aimed to determine the relationship between Helicobacter pylori (HP) and brucellosis. In this case-control study, 100 patients with brucellosis as cases and 200 participants without brucellosis as controls were evaluated. To compare the prevalence of HP in the 2 groups, odds ratios and confidence intervals for every variable were analyzed using logistic regression models after adjustment for confounding factors. The results obtained in patients with brucellosis showed that fever, sweating, and joint pain were the most prevalent clinical symptoms. In addition, compared with the control group, there was a significant relationship between the IgM antibody to HP and brucellosis infection (estimated odds ratio 2.74; 95% CI: 1.5-4.9) (p = 0.001). Acute infection with HP was associated with brucellosis and increased the risk of brucellosis infection.
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Affiliation(s)
| | | | - Ebrahim Ghaderi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences.,Epidemiology and Biostatistics Department, School of Medicine, Kurdistan University of Medical Sciences
| | - Sara Nadri
- Student Research Committee, Kurdistan University of Medical Sciences
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Shen L, Jiang C, Jiang R, Fang W, Feng Q, Wang L, Wu C, Ma Z. Diagnosis and classification in MRI of brucellar spondylitis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abulizi Y, Liang WD, Muheremu A, Maimaiti M, Sheng WB. Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis. BMC Surg 2017; 17:82. [PMID: 28705257 PMCID: PMC5513084 DOI: 10.1186/s12893-017-0279-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/07/2017] [Indexed: 12/18/2022] Open
Abstract
Background Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis. Methods From February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria. Results The mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months’ follow-up. VAS and ODI scores were significantly improved (P < 0.05). According to JOA score, surgical improvement was excellent in 22 cases (68.8%), good in 9 cases (28.1%), moderate in 1 case (3.1%) at the last follow-up. Conclusions Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation is an effective and safe approach for lumbosacral brucellosis.
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Affiliation(s)
- Yakefu Abulizi
- Department of spine surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Wei-Dong Liang
- Department of spine surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Aikeremujiang Muheremu
- Department of spine surgery, Sixth's Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, 830002, China
| | - Maierdan Maimaiti
- Department of spine surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Wei-Bin Sheng
- Department of spine surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China.
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Arslan Gülen T, İmre A, Sarı AS. Dizin Brusellar Septik Monoartriti: Kronik Brusellozun bir Sonucu mu? ANKARA MEDICAL JOURNAL 2017. [DOI: 10.17098/amj.323180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sparacello VS, Roberts CA, Kerudin A, Müller R. A 6500-year-old Middle Neolithic child from Pollera Cave (Liguria, Italy) with probable multifocal osteoarticular tuberculosis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 17:67-74. [PMID: 28521913 DOI: 10.1016/j.ijpp.2017.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 06/07/2023]
Abstract
Clear skeletal evidence of prehistoric tuberculosis (TB) is rare, especially in children. We describe and differentially diagnose the pathological changes displayed by a five-year-old child, Pollera 21 (PO21) dated to the Middle Neolithic of Liguria (Italy), or 5740±30 BP (Beta-409341; 6635-6453cal BP, 2σ, OxCal 4.2). PO21 shows a number of osteoarticular lesions, mainly of a lytic nature with very little bone proliferation: the vertebral column, the shoulder and pelvic girdles, and the ribcage are involved. Given the nature and pattern of the lesions, we propose a diagnosis of multifocal (or multiple) bone TB. Attempts to detect TB aDNA through molecular analysis gave negative results, but this alone is not sufficient to prove that PO21 was not infected with TB. The lesions observed in PO21 share similarities with other published evidence, such as spinal and joint involvement, and disseminated cyst-like lesions. Conversely, PO21 does not show diffuse bone deposition, such as hypertrophic osteoarthropathy (HOA) or endocranial modifications such as serpens endocrania symmetrica (SES). PO21 adds to our knowledge of patterns of TB manifestation in archaeological skeletal remains, which is especially important considering the variability in types and patterns of osteoarticular lesions seen today in people with TB.
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Affiliation(s)
- Vitale S Sparacello
- Department of Archaeology, Durham University, Durham DH1 3LE, United Kingdom; UMR5199 PACEA, Univ. Bordeaux, Batiment B8, Avenue Geoffroy Saint Hilaire, CS 50023, 33615, Pessac Cedex, France.
| | - Charlotte A Roberts
- Department of Archaeology, Durham University, Durham DH1 3LE, United Kingdom
| | - Ammielle Kerudin
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, 131 Princess Street, Manchester M1 7DN, United Kingdom
| | - Romy Müller
- Manchester Institute of Biotechnology, Faculty of Life Sciences, The University of Manchester, 131 Princess Street, Manchester M1 7DN, United Kingdom
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A Rare Form of Brucella Bursitis with Negative Serology: A Case Report and Literature Review. Case Rep Infect Dis 2017; 2017:9802532. [PMID: 28337351 PMCID: PMC5346395 DOI: 10.1155/2017/9802532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/19/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023] Open
Abstract
Brucellosis is still endemic in certain parts of the world including the Mediterranean, the Middle East, Latin America, and African regions. Osteoarticular manifestations are common presenting features. Brucellosis presenting as prepatellar bursitis has already been reported. We present a case of seronegative olecranon bursitis with positive blood and aspirate cultures. The patient improved remarkably by treatment with streptomycin and doxycycline with no evidence or relapse.
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Rhodes HM, Williams DN, Hansen GT. Invasive human brucellosis infection in travelers to and immigrants from the Horn of Africa related to the consumption of raw camel milk. Travel Med Infect Dis 2016; 14:255-60. [DOI: 10.1016/j.tmaid.2016.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
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Gheita TA, Sayed S, Azkalany GS, El Fishawy HS, Aboul-Ezz MA, Shaaban MH, Bassyouni RH. Subclinical sacroiliitis in brucellosis. Clinical presentation and MRI findings. Z Rheumatol 2016; 74:240-5. [PMID: 25090956 DOI: 10.1007/s00393-014-1465-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this work was to detect subclinical sacroiliac joint involvement in patients with brucellosis and study their clinical and laboratory features. PATIENTS AND METHODS The study included 100 brucellosis patients being followed-up in the Gastroenterology and Hepatology Unit, Theodor Bilharz Research Institute and Cairo University outpatient clinics. A thorough history, physical examination, routine laboratory tests, and abdominal ultrasound were obtained for all patients. Extended rheumatological examination was performed including clinical testing for sacroiliitis and enthesitis. None of the patients reported a history of back pain or any symptoms suggestive of sacroiliitis during the course of the infection. Plain x-ray and MRI scan of the sacroiliac joints were performed for all patients. RESULTS Asymptomatic sacroiliitis was present in 24 % of the brucellosis patients; none of the patients had tenderness over their spine with preserved lumbar spine mobility. Sacroiliitis was mainly unilateral being bilateral in 20.83 %. There was an obvious relationship with animal contact and occupation of the patients. Osteoarticular involvement was common (67 %) including arthralgias, arthritis, myalgias, spondylitis, enthesitis and bursitis, being clearly higher in those with sacroiliitis. The MRI scan showed blurring of the margins in 66.67 %, widening in 25 %, narrowing in 54.17 %, erosions in 20.83 %, and sclerosis in 12.5 %. CONCLUSION Osteoarticular manifestations of brucellosis are prevalent and subclinical sacroiliitis is evident, a finding that may classify these patients as having brucellar spondyloarthropathy (BSA). Referring brucellosis patients for rheumatological assessment has the advantage of early assessment of asymptomatic cases with sacroiliitis which is commonly overlooked.
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Affiliation(s)
- T A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt,
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Aouad P, Serhal A, Bleibel L, Haidar M, Mohanna A. Brucella osteomyelitis of the pubic bones. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Imaging of Hip Pain: From Radiography to Cross-Sectional Imaging Techniques. Radiol Res Pract 2016; 2016:6369237. [PMID: 26885391 PMCID: PMC4738697 DOI: 10.1155/2016/6369237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/17/2015] [Accepted: 12/20/2015] [Indexed: 12/16/2022] Open
Abstract
Hip pain can have multiple causes, including intra-articular, juxta-articular, and referred pain, mainly from spine or sacroiliac joints. In this review, we discuss the causes of intra-articular hip pain from childhood to adulthood and the role of the appropriate imaging techniques according to clinical suspicion and age of the patient. Stress is put on the findings of radiographs, currently considered the first imaging technique, not only in older people with degenerative disease but also in young people without osteoarthritis. In this case plain radiography allows categorization of the hip as normal or dysplastic or with impingement signs, pincer, cam, or a combination of both.
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Mawer DPC, McGann PH, Sandoe JAT, Emerton M, Beeching NJ, Wilcox MH. Prepatellar bursitis: a rare manifestation of chronic brucellosis. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Damian P. C. Mawer
- Department of Microbiology, Leeds General Infirmary, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK
| | - P. Hugh McGann
- Department of Infection and Travel Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Jonathan A. T. Sandoe
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK
- Department of Microbiology, Leeds General Infirmary, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK
| | - Mark Emerton
- Department of Orthopaedics, Chapel Allerton Hospital, Chapeltown Rd, Leeds LS7 4SA, UK
| | - Nicholas J. Beeching
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Mark H. Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK
- Department of Microbiology, Leeds General Infirmary, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK
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Marquez J, Espinoza LR. Infectious arthritis II. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report. J Med Case Rep 2014; 8:367. [PMID: 25394500 PMCID: PMC4234531 DOI: 10.1186/1752-1947-8-367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/01/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Brucellosis is a systemic infectious disease which is still a challenging medical problem in rural areas such as northern China. It rarely occurs in urban areas such as Shenzhen in southern China. Osteoarticular involvements are frequently seen in brucellosis, and rarely is arthritis the only clinical presentation. We report a case of hip septic arthritis caused by Brucella melitensis in an urban area of Shenzhen, China. CASE PRESENTATION A 29-year-old Chinese woman, Han ethnical group presented to our hospital with left hip pain persisting for one month. She had a history of contact with goats one month before admission. Her clinical examination showed marked tenderness and limited movement of her left hip. Further imaging showed effusion of her left hip joint. Inflammatory markers including erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were raised. Our clinical diagnosis was septic arthritis of the left hip. A left hip arthroscopy was performed and the culture was positive for Brucella melitensis. She returned to normal activity after completing a standard antibiotic regimen, including gentamicin at 120mg daily for 2 weeks, doxycycline at 100mg daily and rifampicin at 450mg for a total of 12 weeks. CONCLUSIONS Brucellosis is endemic in some rural areas of China, but rare in urban areas such as Shenzhen in southern China. However, more cases will be expected in urban areas due to increasing migration within China. Physicians should consider brucellosis as one of the differential diagnosis of arthritis. Early surgical intervention is recommended to prevent further joint destruction.
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Affiliation(s)
| | | | | | | | | | - Frankie Leung
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong, China.
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Momjian R, George M. Atypical imaging features of tuberculous spondylitis: case report with literature review. J Radiol Case Rep 2014; 8:1-14. [PMID: 25926906 PMCID: PMC4394978 DOI: 10.3941/jrcr.v8i11.2309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis.
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Affiliation(s)
- Rita Momjian
- Department of Radiology, Khoula Hospital, Muscat, Sultanate of Oman
| | - Mina George
- Department of Histopathology, Khoula Hospital, Muscat, Sultanate of Oman
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Koubaa M, Maaloul I, Marrakchi C, Lahiani D, Hammami B, Mnif Z, Ben Mahfoudh K, Hammami A, Ben Jemaa M. Spinal brucellosis in South of Tunisia: review of 32 cases. Spine J 2014; 14:1538-44. [PMID: 24331843 DOI: 10.1016/j.spinee.2013.09.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 08/31/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
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.
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Affiliation(s)
- Makram Koubaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
| | - Imed Maaloul
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Chakib Marrakchi
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Dorra Lahiani
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Boussaima Hammami
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Zeinab Mnif
- Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Kaireddine Ben Mahfoudh
- Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Adnane Hammami
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Mounir Ben Jemaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
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Gokhan A, Turkeyler IH, Babacan T, Pehlivan Y, Dag MS, Bosnak VK, Namiduru M, Kisacik B, Onat AM. The antibodies cyclic citrullinated peptides (anti-CCP) positivity could be a promising marker in brucellosis patients presented with peripheric arthritis. Mod Rheumatol 2014; 24:182-7. [PMID: 24261776 DOI: 10.3109/14397595.2013.854053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The anti-cyclic citrullinated peptide (anti-CCP) enzyme-linked immunosorbent assay has a high sensitivity and specificity for rheumatoid arthritis (RA). It has been used in especially early diagnosis of RA, and used to discriminate from other forms of arthritis. Anti-CCP positivity is unknown in brucellosis presented with peripheric arthritis (BPA), like other rheumatic diseases. The objective of this study was to investigate the positivity of anti-CCP in patients with BPA in contrast to the patients with RA and healthy controls. Additionally, we have aimed to monitor changes of anti-CCP levels following the brucellosis treatment. METHODS The study group consisted of 137 subjects. 62 brucellosis patients presented with peripheric arthritis. Additionally, 33 RA patients and 42 healthy subjects selected as control groups. The anti-CCP, rheumatoid factor and anti-nuclear antibody levels of the subjects were measured. RESULTS Concerning the 62 BPA, 20 % (13 patients) of them had elevated anti-CCP levels. On the other side, of the 33 RA patients, 78.78 % (26 patients) of them had increased anti-CCP levels. Only one healthy subject's anti-CCP level was positive. There was statistically significant difference among the groups. After brucellosis treatment, monitorisation of the 13 patients with BPA who have the positive anti-CCP levels, were challengingly interesting because none of the patients had positive anti-CCP levels. CONCLUSIONS Anti-CCP may be positive marker in the diagnosis of BPA but clinicians need to be careful during the follow up period because it may turn into normal ranges. Additionally, patients presented with peripheric arthritis and anti-CCP positivity need to be evaluated also for the differential diagnosis of BPA.
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Affiliation(s)
- Azize Gokhan
- Departments of Infectious Diseases, Gaziantep University, Faculty of Medicine , Gaziantep , Turkey
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Taif S, Alrawi A. Spinal brucellosis: a forgotten cause of chronic back pain. BMJ Case Rep 2014; 2014:bcr-2014-205816. [PMID: 24990853 DOI: 10.1136/bcr-2014-205816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sawsan Taif
- Department of Radiology, Khoula Hospital, Muscat, Oman
| | - Asif Alrawi
- Department of Orthopedics, Khoula Hospital, Muscat, Oman
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Yang X, Zhang Q, Guo X. Value of magnetic resonance imaging in brucellar spondylodiscitis. Radiol Med 2014; 119:928-933. [PMID: 24862632 DOI: 10.1007/s11547-014-0416-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/05/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate magnetic resonance (MR) imaging in patients with brucellar spondylodiscitis. MATERIALS AND METHODS Sixty-three patients with spondylodiscitis were diagnosed based on positive clinical findings, ≥1/160 titres of brucella agglutination tests and/or positive blood cultures. MR imaging was performed in all of the patients with spondylodiscitis. Signal changes and enhancement of vertebral bodies, involvement of paravertebral soft tissues and epidural spaces, nerve root and cord compression and abscess formation were assessed. RESULTS Of 63 patients with spinal brucellosis, eight had thoracic, 35 had lumbar, ten had cervical vertebral, seven had both thoracic and lumbar, and three had both lumbar and sacral vertebral involvement. Thirteen patients had cord compression and six had root compression. Four patients had facet-joint involvement, and one had erector spinae muscle involvement. Twenty-four had intervertebral disc narrowing. Seventeen patients were in the acute stage, 32 in the subacute stage and 14 in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. CONCLUSION Brucella is still a public health problem in endemic areas. MR imaging is a highly sensitive and noninvasive imaging technique which should be first choice of imaging in the early diagnosis of spondylodiscitis.
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Affiliation(s)
- Xiaohui Yang
- Department of Radiology, Yuncheng Central Hospital, Yuncheng, 044000, Shanxi, China
| | - Qin Zhang
- Department of Orthopaedics, Yuncheng Central Hospital, Yuncheng, 044000, Shanxi, China.
| | - Xinghua Guo
- Department of Radiology, Yuncheng Central Hospital, Yuncheng, 044000, Shanxi, China
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Serum annexin A2 levels in acute brucellosis and brucellar spondylodiscitis. Eur J Clin Microbiol Infect Dis 2014; 33:1855-9. [DOI: 10.1007/s10096-014-2155-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/05/2014] [Indexed: 11/27/2022]
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Magnetic resonance imaging findings of musculoskeletal brucellosis. Clin Imaging 2014; 38:719-23. [PMID: 24849195 DOI: 10.1016/j.clinimag.2014.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/18/2014] [Accepted: 04/14/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis. MATERIALS AND METHODS Sixty-eight among 304 patients with musculoskeletal brucellosis, aged 12-82 years (average, 50.2 years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitis-spondylodiscitis, and peripheral arthritis. RESULTS Brucella serum agglutination test was >1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%). CONCLUSION Brucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas.
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Darton Y, Richard I, Truc MC. Osteomyelitis variolosa: A probable mediaeval case combined with unilateral sacroiliitis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2013; 3:288-293. [PMID: 29539566 DOI: 10.1016/j.ijpp.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 05/25/2023]
Abstract
Osteoarticular sequelae of smallpox (osteomyelitis variolosa) are uncommon today. Such lesions may be observed occasionally, however, in countries where the disease has been endemic. Without other forms of documentation, it is possible to suggest a diagnosis of smallpox in ancient skeletal remains and thus make a significant contribution to understanding the history of this disease. We have examined a subadult male (Skeleton 833), 15-17 years old at the time of death, who presents bilateral bone manifestations of the elbows suggestive of smallpox. No other bone is similarly affected. In addition, he presents a left sacroiliitis deemed to be a brucellar manifestation. Skeleton 833 is one of at least 730 individuals from an exhaustive excavation of a mediaeval necropolis at Pont-sur-Seine (Aube, north-eastern France). Radiocarbon dating of his bones yields a date of between AD 1022 and 1155 (calibrated), thus apparently the oldest case described to date. The other published cases correspond to more recent periods with a well established historical context. We argue that this example of osteomyelitis variolosa.
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Affiliation(s)
- Yves Darton
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély - SJA3, 24, avenue des Diables Bleus, 06357 Nice cedex 4, France.
| | - Isabelle Richard
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély - SJA3, 24, avenue des Diables Bleus, 06357 Nice cedex 4, France; INRAP Grand Est Nord, 12, rue de Méric, 57063 Metz cedex 2, France
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Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demiraslan H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydın M, Horasan ES, Gul HC, Ceylan B, Kadanalı A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldı N, Alabay S. Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2013; 20:O75-82. [PMID: 24118178 DOI: 10.1111/1469-0691.12351] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/26/2013] [Accepted: 07/27/2013] [Indexed: 12/14/2022]
Abstract
We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.
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Affiliation(s)
- A Ulu-Kilic
- Department of Infectious Disease and Clinical Microbiology (IDCM), Erciyes University School of Medicine, Kayseri, Turkey
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