A case of spondylodiscitis with spinal epidural abscess due to Brucella

Exploring the Complex Landscape of Spine Brucellosis

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.

First case of cervical epidural abscess caused by brucellosis in Saudi Arabia: A case report and literature review

Spinal epidural abscess (SEA) is an extremely rare and disastrous musculoskeletal complication of spondylodiscitis and sacroilitis secondary to brucellosis infection. Few case reports and retrospective studies have been published reporting patients with epidural abscesses mainly lumbar, and thoracic while cervical abscess are rare. Management of spinal epidural abscess due to Brucella species is not standard and remains controversial. To the best of our knowledge this is the first case of brucellar cervical epidural abscess reported in Saudi Arabia. In this paper, we review the literature and report a case of a 67-year-old Saudi gentleman, who presented with fever and back pain. Further evaluation revealed cervical epidural abscess and a positive serology for brucellosis. Following 6 months of antibiotic therapy alone against brucellosis, he showed significant clinical and radiological improvement. Spinal epidural abscess caused by brucellosis is a rare condition, difficult to diagnose, and can be complicated by disastrous neurological or vascular complication if left untreated. Brucellosis must be considered as a possible cause of spinal epidural abscess in patients from endemic area. Hence, early detection and initiation of appropriate medical treatment alone is crucial in preventing permanent neurological complication, and possibly avoid surgical intervention.

Risk factors associated with the presentation of brucellosis in the spine

OBJECTIVE: The aim of this study is to describe the risk factors associated with the presentation of brucellosis on the spine, and determine the strength of association between these factors. METHODS: The medical records of patients with brucellosis on the spine were analyzed and a spreadsheet was created to compile the following data: age, sex, place of origin and residence, risk factors (exposure at work, consumption of unpasteurized products and comorbidities), clinical presentation (lumbar pain, anorexia, headache, myalgia, fatigue, paresthesia, dysesthesia, muscle weakness, weight loss, fever), affected spine level, presence of abscesses, disease duration (acute, subacute, chronic), laboratory studies (erythrocyte sedimentation rate, C-reactive protein, serology, blood culture, Rose Bengal test, histopathological reports), imaging studies (x-rays, MRI, bone gammagraphy), established treatment (medical and/or surgical), therapeutic failure and sequelae. RESULTS: A total of 17 patients, 10 women (58.8%) and seven men (41.2%), were reviewed from January 2007 to January 2011. The group had a mean age of 57.8 years with a standard deviation of +13.91 and age range between 16-74 years. CONCLUSIONS: There is no significant difference between the groups compared with respect to age and sex, however, improvement of the neurological deficit was observed in eight patients who underwent surgical procedure.