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Aljuaid AS, Badirah SB, Abusaeed RI, Almalki AM, Almaghrabi MA, Alzahrani EA, Alhazmi KA, Almaghrabi AA, AlQarni AM, Alghamdi KM. Analysis of antibiotic regimens and outcomes in spinal brucellosis: insights from a retrospective cohort study in Makkah, Saudi Arabia. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:264-273. [PMID: 38974497 PMCID: PMC11224780 DOI: 10.21037/jss-23-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/23/2024] [Indexed: 07/09/2024]
Abstract
Background Brucellosis is a zoonotic disease that is widely spread across the globe, with the number of cases increasing annually. Spinal brucellosis is known to affect about half of patients with brucellosis. Nevertheless, data on the optimal antibiotic regimens for spinal brucellosis are limited. Therefore, this study aims to compare antibiotic treatment regimens for spinal brucellosis at our center in Makkah, Saudi Arabia. Methods This is a retrospective cohort study of an 11-year period from 2010 to 2021 conducted at a single center in Makkah, Saudi Arabia. All patients with spinal brucellosis were included. Patients were excluded if the duration of the received antibiotic regimen or follow-up was poorly documented. Data analysis was conducted using RStudio (R version 4.1.1). Categorical variables of each regimen used by the patients were presented as frequencies and percentages, while numerical variables were summarized using the median and interquartile range (IQR). Results A total of 35 patients were included; the median (IQR) age of the patients was 58.0 (48.0 to 63.0) years. The most frequently reported symptoms upon admission included low back pain (83.3%). The most frequently administered regimen was the combination of streptomycin + doxycycline + rifampicin (SDR) (20 patients, 55.6%), followed by the combination of streptomycin + rifampicin + trimethoprim/sulfamethoxazole (SRT) (eight patients, 22.2%). Overall, out of the total 35 patients who received first-line treatment, only six patients experienced therapy failure. Out of the total six patients who experienced first-line treatment failure with SDR (five patients, 83%) and SDT (one patient, 17%), surgery was indicated for three patients. Surgical intervention was deemed necessary in 12 patients (34%). Three patients chose not to undergo surgical intervention but still showed complete improvement upon completing the treatment duration. One patient experienced a postoperative complication, resulting in paraplegia. Conclusions In this study, we found that among 35 patients, treatment failure was observed only in six patients who received triple therapy. In addition, surgical intervention was indicated in 12 patients; however, three patients refused surgery and improved ultimately after changing or extending the duration of the antibiotic regimen.
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Affiliation(s)
| | - Sara B. Badirah
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | | | | | | | | | | | - Khalid M. Alghamdi
- Department of Orthopedic Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
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Abu Nowar H, Al Dalahmeh A, Alrabadi M, Jabali S, Kakich M, Alqsous N, Adaileh O, Kannan S, Hjazeen A, Alqroom R. Exploring the Complex Landscape of Spine Brucellosis. Cureus 2024; 16:e51761. [PMID: 38318596 PMCID: PMC10843238 DOI: 10.7759/cureus.51761] [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: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Brucellosis is an infectious illness contracted by humans through the consumption of unpasteurized milk and dairy items. Brucella organisms are diminutive, gram-negative, non-motile, and non-spore-forming facultative intracellular, aerobic intracellular coccobacilli residing within the reproductive organs of host animals, leading to conditions such as abortions and sterility. Numerous species of Brucella have been identified, with the following four exhibiting varying degrees of pathogenicity in humans: Brucella melitensis (originating from sheep), Brucella suis (associated with pigs), Brucella abortus (linked to cattle), and Brucella canis (found in dogs). B. melitensis and B. suis demonstrate the highest level of pathogenicity, while B. abortus and B. canis exhibit a more moderate degree of pathogenicity. The illness can progress to systemic involvement, with the musculoskeletal system being particularly susceptible to complications. Spinal epidural abscess is an infrequent complication that may occur during spondylitis caused by Brucella species. Epidural abscesses most commonly affect the lumbar vertebrae, while their involvement in the cervical spine is relatively rare. OBJECTIVE In this review, we explore spine brucellosis, covering its epidemiology, pathogenesis, clinical manifestations, diagnostics, and evolving treatments. We aim to enhance early detection, timely intervention, and patient outcomes. PATIENTS AND METHODS This retrospective chart analysis was conducted by revising all medical files for patients in whom spinal brucellosis was diagnosed and managed. RESULTS This study was conducted at King Hussein Medical Center (KHMC), Jordan, and included a total of 20 patients who were diagnosed with spine brucellosis during the study period. Within the final cohort, 65% of the patients were male (13/20), with an average age at diagnosis of 47.53±14.98 years (ranging from 4 to 61 years). The female group, on the other hand, had an average age at diagnosis of 51.12±15.55 years (ranging from 3 to 58 years). Statistical analysis of the data revealed no significant demographic differences between the two groups. Regarding the co-morbidities, no statistical differences were observed between the two groups. Examining the occupational status of the two groups, no differences were observed. Also, no differences were observed between the two groups regarding the residence place, or the spinal segment involved. CONCLUSION Spine brucellosis, although uncommon, poses a complex clinical challenge. Early diagnosis and a multidisciplinary approach are crucial for effective management. Further research is needed to refine diagnostic tools and treatment guidelines for spine brucellosis.
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Affiliation(s)
- Hussam Abu Nowar
- Neurosurgery, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Alaa Al Dalahmeh
- Neurosurgery, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Maha Alrabadi
- Radiology, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Saif Jabali
- Community Medicine, Queen Rania Medical Center - Royal Medical Services, Amman, JOR
| | - Martin Kakich
- Neurosurgery, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Najib Alqsous
- Psychiatry, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Omar Adaileh
- Radiology, King Hussein Medical Center - Royal Medical Services, Amman, JOR
| | - Soha Kannan
- Directory of Royal Medical Services, King Hussein Medical Center, Amman, JOR
| | - Anees Hjazeen
- Community Health Nursing, Jordanian Royal Medical Services, Amman, JOR
| | - Rami Alqroom
- Neurosurgery, King Hussein Medical Center - Royal Medical Services, Amman, JOR
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Du J, Tao Y, Yang J, Cai J, Zhou H, Zhang R, Hu Y. Case Report: Metagenomic Next-Generation Sequencing Confirmed a Case of Spine Infection with Brucella melitensis in Non-Endemic Area. Infect Drug Resist 2023; 16:7219-7225. [PMID: 38023409 PMCID: PMC10655603 DOI: 10.2147/idr.s436278] [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: 08/22/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Brucellosis is a zoonotic disease caused by Brucella spp., with the highest prevalence found in the northern cities of China. In this case report, we present an occurrence of spinal infection caused by B. melitensis in a 67-year-old man residing in a non-endemic area of southern China. The patient initially presented with chest and back pain, which was not accurately diagnosed and treated at a local hospital. Subsequently, due to worsening pain, he was admitted to our hospital. To determine the cause of the infection, we performed CT-guided aspiration biopsy and collected biopsy tissue for metagenomic next-generation sequencing (mNGS) on the second day of hospitalization. Imaging investigations revealed involvement of the thoracic vertebrae, specifically thoracic 4-7 with the main focus on 5-6, accompanied by stenosis of the intervertebral space. The mNGS results indicated that the spine infection was caused by B. melitensis. The patient's history as a shepherd and a positive Rose Bengal plate test (RBPT) further supported the diagnosis of brucella spondylitis. In order to alleviate pain and restore spinal function, the patient underwent posterior internal fixation of the thoracic spine. Treatment was initiated with cefoperazone/sulbactam, followed by doxycycline. Subsequently, the patient was switched to a combination therapy of rifampicin and doxycycline for a duration of six weeks. The patient responded well to treatment, and his condition remained stable. In conclusion, brucellosis is a common disease that can be easily misdiagnosed. This case report highlights the potential value of mNGS in early and rapid diagnosis. We believe that mNGS can serve as an effective tool to improve the diagnosis of spine infections caused by this pathogen.
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Affiliation(s)
- Jingjing Du
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Yiqing Tao
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Jiaxing Yang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Jiachang Cai
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Hongwei Zhou
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Rong Zhang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
| | - Yanyan Hu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People’s Republic of China
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Papadakis SA, Ampadiotaki MM, Pallis D, Tsivelekas K, Nikolakakos P, Agapitou L, Sapkas G. Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review. J Clin Med 2023; 12:4509. [PMID: 37445544 DOI: 10.3390/jcm12134509] [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: 05/30/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality.
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Affiliation(s)
| | | | - Dimitrios Pallis
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | | | - Petros Nikolakakos
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - Labrini Agapitou
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, 18547 Athens, Greece
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Ali A, Waris A, Khan MA, Asim M, Khan AU, Khan S, Zeb J. Recent advancement, immune responses, and mechanism of action of various vaccines against intracellular bacterial infections. Life Sci 2023; 314:121332. [PMID: 36584914 DOI: 10.1016/j.lfs.2022.121332] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Emerging and re-emerging bacterial infections are a serious threat to human and animal health. Extracellular bacteria are free-living, while facultative intracellular bacteria replicate inside eukaryotic host cells. Many serious human illnesses are now known to be caused by intracellular bacteria such as Salmonella enterica, Escherichia coli, Staphylococcus aureus, Rickettsia massiliae, Chlamydia species, Brucella abortus, Mycobacterium tuberculosis and Listeria monocytogenes, which result in substantial morbidity and mortality. Pathogens like Mycobacterium, Brucella, MRSA, Shigella, Listeria, and Salmonella can infiltrate and persist in mammalian host cells, particularly macrophages, where they proliferate and establish a repository, resulting in chronic and recurrent infections. The current treatment for these bacteria involves the application of narrow-spectrum antibiotics. FDA-approved vaccines against obligate intracellular bacterial infections are lacking. The development of vaccines against intracellular pathogenic bacteria are more difficult because host defense against these bacteria requires the activation of the cell-mediated pathway of the immune system, such as CD8+ T and CD4+ T. However, different types of vaccines, including live, attenuated, subunit, killed whole cell, nano-based and DNA vaccines are currently in clinical trials. Substantial development has been made in various vaccine strategies against intracellular pathogenic bacteria. This review focuses on the mechanism of intracellular bacterial infection, host immune response, and recent advancements in vaccine development strategies against various obligate intracellular bacterial infections.
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Affiliation(s)
- Asmat Ali
- Department of Biotechnology and Genetic Engineering, Hazara University Mansehra, Pakistan
| | - Abdul Waris
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong.
| | - Muhammad Ajmal Khan
- Division of Life Sciences, Center for Cancer Research and State Key Laboratory of Molecular Neurosciences, The Hong Kong University of Science and Technology, Hong Kong
| | - Muhammad Asim
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong
| | - Atta Ullah Khan
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, China
| | - Sahrish Khan
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jehan Zeb
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong
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Ali Adam A, Sheikh Hassan M, Adam Osman A. Spinal brucellosis causing spondylodiscitis. Ann Med Surg (Lond) 2022; 82:104782. [PMID: 36268353 PMCID: PMC9577941 DOI: 10.1016/j.amsu.2022.104782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and Importance: Brucellosis is a common prevalent zoonotic disease in developing countries including Somalia. Brucellosis may affect many organs. However involvement in the spine and paravertebral muscles is common and may lead to diagnostic challenges since it presents with non-specific symptoms. Case presentation Here we report 18-year old male patient who presented with low back pain, low grade fever, difficult voiding and progressive lower extremity weakness for 5 months. The pain was localized to the lumbar vertebra (tender on palpation) and radiating to both lower limbs. There was slight weakness on the left lower limb (muscle power 3+/5). There were no associated sensory symptoms or deep tendon reflex abnormality. But he had mild urine retention. Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis. Rose-Bengal test was positive for brucellosis. A Brucella standard tube agglutination test was positive at a titer of 1:64. Given the test results and the imaging finding, the patient was diagnosed with Spinal brucellosis. He was treated with oral doxycycline (100 mg, two times daily) and Rifampicin (600Mg) orally once daily for 6 months. Streptomycin was added during the first three weeks. The patient had massive improvement after 3 months of treatment, (the patient's symptoms almost disappeared). Clinical discussion Spinal brucellosis is characterized by the involvement of the vertebral column, interspinal spaces, and/or paraspinal areas. Its subacute or chronic forms typically affect the spinal column. Spinal brucellosis may cause Spondylitis, spondylodiscitis or epidural abscess causing spinal compression. This case presented with spondylodiscitis and was successfully treated without the need for surgical intervention. Conclusions Brucella spondylodiscitis, though uncommon and challenging, it should be kept in mind in the differential diagnosis of patients presenting with chronic back pain and lower extremity weakness living in endemic areas like Somalia. The duration of treatments should be prolonged in patients with worse physical condition. Spinal brucellosis is not uncommon cause of spondylodiscitis. Due to its non specific symptoms diagnosis can be challenging. It should be considered in the differential diagnosis especially for patient with chronic back pain living in endemic areas like Somalia. In this paper, we presented the case report of young man with spinal brucellosis who was treated successfully without the need for surgical intervention.
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Wang S, Zhao X, Sun K, Bateer H, Wang W. The Genome Sequence of Brucella abortus vaccine strain A19 provides insights on its virulence attenuation compared to Brucella abortus strain 9-941. Gene 2022; 830:146521. [PMID: 35447245 DOI: 10.1016/j.gene.2022.146521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/20/2021] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brucellosis is a widespread disease that affects animals and humans. The live attenuated Brucella abortus A19 strain is used for vaccination against brucellosis in China. In addition, the main mechanisms supporting the residual toxicity of A19 have not been elucidated. Here, we performed a comprehensive comparative analysis of the genome-wide sequence of A19 against the whole genome sequences of the published virulent reference strain 9-941. The primary objective of this study was to identify candidate virulence genes by systematically comparing the genomic sequences between the two genomes. RESULTS This analysis revealed two deletion regions in the A19 genome, in which all included large fragments of 63 bp, and one of their gene function is related to ABC transporter permease protein. In addition, we have identified minor mutations in important virulence-related genes that can be used to determine the underlying mechanisms of virulence attenuation. The function of its virulence gene covers LysR family transcriptional regulator, outer membrane, MFS transporter and oxidoreductase etc. At the same time, a PCR differential diagnosis method was constructed, which can distinguish A19, S19 and most other commonly used Brucella viruent strains and vaccine strains. CONCLUSION The data may help to provide resources for further detailed analysis of mechanisms for other Brucella vaccines. It laid the foundation for further distinguishing between vaccine immunity and virulent strains infection.
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Affiliation(s)
- Shuyi Wang
- Key Laboratory of Clinical Diagnosis and Treatment Technology in Animal Disease, Ministry of Agriculture/College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia 010018, China; Inner Mongolia Autonomous Region Comprehensive Center for Disease Control and Prevention, Hohhot, Inner Mongolia 010031, China
| | - Xueliang Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling 712100, China
| | - Ke Sun
- Key Laboratory of Clinical Diagnosis and Treatment Technology in Animal Disease, Ministry of Agriculture/College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia 010018, China
| | - Huhe Bateer
- Key Laboratory of Clinical Diagnosis and Treatment Technology in Animal Disease, Ministry of Agriculture/College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia 010018, China
| | - Wenlong Wang
- Key Laboratory of Clinical Diagnosis and Treatment Technology in Animal Disease, Ministry of Agriculture/College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, Inner Mongolia 010018, China.
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Li T, Yu Q, Wang XY, Wu C. A rare case of multi-level Brucella spondylitis combined with incomplete paralysis. Asian J Surg 2022; 45:2349-2350. [PMID: 35610149 DOI: 10.1016/j.asjsur.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tao Li
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China
| | - Qin Yu
- Department of Pathology, The First People's Hospital of Zigong, Sichuan Province, China
| | - Xiang-Yu Wang
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China
| | - Chao Wu
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China.
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Li HK, Du JP, Huang DG, Shan LQ, He BR, Yan L, Zhao QP, Hao DJ. Surgical treatment of the lower cervical brucellosis with osteoporosis in the northwest region of China: review of 22 cases. Am J Transl Res 2022; 14:909-917. [PMID: 35273694 PMCID: PMC8902538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the surgical treatment of patients with cervical brucellosis with osteoporosis over a 4-year period in Northwest China. METHODS From 2013 to 2018, 22 patients (12 males and 10 females) with lower cervical spine brucellosis (C3-C7) underwent anterior lesion debridement, decompression, bone grafting and internal fixation combined with posterior bone graft fusion and internal fixation (ADDF+PIF). The follow-up period averaged 37.4 months (ranging from 24 to 57 months). RESULTS Involvement of 1 vertebra was observed in 3 patients, involvement of 3 vertebrae was observed in 9 patients, and involvement of 3 vertebrae was observed in 10 patients. Before surgery, 1 patient had Frankel grade B, 2 had grade C, 9 had grade D, and 10 had grade E. In the final follow-up, 12 patients had neurological deficits, 10 patients improved by one grade, 6 patients improved by two grades, and the neurological status of 6 patients remained unchanged. In all cases, it was observed that bone fusion required 6.8 months on average. The kyphosis Cobb angle was enhanced from an average of 11.5° preoperatively (range 0°-24°) to 0.13° postoperatively (range 1°-5°), and there was no vital loss of correction in the follow-up. CONCLUSIONS ADDF+PIF is an effective and safe treatment for patients with lower cervical brucellosis with osteoporosis.
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Affiliation(s)
- Hou-Kun Li
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Jin-Peng Du
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Da-Geng Huang
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Le-Qun Shan
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Bao-Rong He
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Liang Yan
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Qing-Peng Zhao
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Ding-Jun Hao
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
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Epidemiology, Clinical and Laboratory Manifestations, and Outcomes of Brucellosis Among 104 Patients in Referral Hospitals of Tehran, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.111546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Brucellosis is the most common zoonotic disease in Iran, imposing a significant financial burden on the healthcare system. The diversity of non-specific clinical manifestations of this disease can lead to misdiagnosis or delayed diagnosis. Therefore, it is important to pay attention to other aspects of this disease. Objectives: This study aimed to determine the epidemiology, clinical and laboratory manifestations, and outcomes of brucellosis. Methods: In this cross-sectional study, brucellosis patients, admitted to three hospitals, affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from April 2015 to September 2020, were examined. The patients' medical records were reviewed for epidemiological, clinical, and laboratory findings. The outcomes of the disease were evaluated by phone calls. Results: Of the 104 patients included in this study, 53.8% were male, and 46.2% were female. The mean age of the patients was 43.07 ± 18.521 years. Unpasteurized dairy consumption and contact with livestock were reported in 60.6 and 27.9% of the patients, respectively. Also, 23.1% of the patients had high-risk occupations. The most common symptoms included fever (80.8%), chills (58.7%), backache (55.8%), and sweating (51%). The most common complication was osteoarticular involvement (21.2%), followed by neurobrucellosis (6.7%). Elevated alkaline phosphatase (89.7%), anemia (67.3%), increased C-reactive protein (57.7%), and increased erythrocyte sedimentation rate (48.1%) were common laboratory findings. The rates of improvement, treatment failure, and relapse were 86.9, 9.1, and 4%, respectively. There was no significant relationship between the rate of improvement and the antibiotic regimen. However, the most common cause of treatment failure was the patient’s poor compliance with treatment. Conclusions: The diversity of non-specific clinical manifestations of brucellosis is a diagnostic challenge. Therefore, physicians must request laboratory tests to evaluate brucellosis after taking a precise epidemiological and clinical history of suspected cases.
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Rizkalla JM, Alhreish K, Syed IY. Spinal Brucellosis: A Case Report and Review of the Literature. J Orthop Case Rep 2021; 11:1-5. [PMID: 34239818 PMCID: PMC8241257 DOI: 10.13107/jocr.2021.v11.i03.2060] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction: The most common location of infection of brucellosis is the musculoskeletal system. It is estimated that the spine is involved in 2–54% of brucellosis infections, with the lumbar spine most commonly affected. We report an uncommon case of brucellar spondylodiscitis, in addition to the pathology, common presentation, and management of spinal brucellosis through additional literature review. Case Report: A 65-year-old Hispanic male presented to an orthopedic spine surgeon with signs and symptoms concerning for metastatic disease to the spine. Investigation revealed that the patient had the rare diagnosis of brucellar spondylodiscitis. This only became apparent after detailed questioning of the patient’s history revealed his employment within a Mexican meat slaughterhouse and a regular consumer of unpasteurized Mexican cheeses. Conclusion: Although uncommon, brucellosis spondylodiscitis should remain as a differential diagnosis in any patient who presents with back pain and fever. Detailed history taking and thorough physical examination remain vital in the work-up of brucellar spondylodiscitis. Understanding the pathology, radiographic findings, and necessary work-up are essential to properly treat this infection.
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Affiliation(s)
- James M Rizkalla
- Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Khalid Alhreish
- Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Ishaq Y Syed
- Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas, United States
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