Spinal brucellosis: a review
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REVIEW ARTICLE
Spinal brucellosis: a review Mouna Chelli Bouaziz & Mohamed Fethi Ladeb & Mohamed Chakroun & Skander Chaabane
Received: 8 May 2007 / Revised: 5 July 2007 / Accepted: 7 August 2007 / Published online: 26 October 2007 # ISS 2007
Abstract Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East. It is a systemic infection, caused by facultative intra-cellular bacteria of the genus Brucella, that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, followed by the sacroiliac joints. The aim of this study was to assess the clinical, biological and imaging features of spinal brucellosis.
products. Farmers and veterinary surgery operators are the mainly targeted occupational group. Laboratory workers processing specimens are also vulnerable [2]. The brucellian infection mainly affects organs rich in mononuclear phagocytes, such as the liver, the spleen, the lymph nodes and the bone marrow [6]. The aim of imaging in spinal brucellosis is to allow an early diagnosis and a precise assessment of the extent of the disease, so that possible neurological complications may be detected.
Keywords Brucella . Infection . Spine . Radiograph . CT . MRI
Spine involvement and clinical features
Introduction A common zoonosis to many parts of the world, brucellosis remains a major public health problem, mainly in the Mediterranean region and in the Middle East and parts of central and south America [1]. The disease affects mainly young and middle-aged adults, infants and elderly patients being less vulnerable [2]. Four species are responsible for brucellosis in humans: Brucella abortus, Brucella suis, Brucella canis and Brucella melitensis, the latter being the most virulent and invasive [3, 4]. Brucella organisms are shed in the excreta (urine, stool, milk and products of conception) of infected animals [5–7]. The disease is often the result of direct human direct contact with infected animals or ingestion of infected dairy M. Chelli Bouaziz (*) : M. F. Ladeb : M. Chakroun : S. Chaabane Department of Radiology, Institut M T Kassab d’orthopédie, 2010 Ksar Said, Tunisia e-mail: [email protected]
The spectrum of musculoskeletal manifestations of brucellosis includes sacroiliitis, spondylitis, arthritis, osteomyelitis, tenosynovitis and bursitis. The type of skeletal involvement depends on the patient’s age [4]. The spine is the targeted site in the elderly, while the sacroiliac joints and knee arthritis predominate in children and young adults. The relationship between osteoarticular complications and Brucella species is not clear. Osteoarticular complications may have a genetic predisposition, as recent data suggest an association with HLA-B39 [8]. The sacroiliac (SI) joints are the most commonly reported extraspinal site of involvement. Sacroillitis is more commonly seen in acute brucellosis and may be associated with spinal brucellosis. Patients may present with hip or low back pain, potentially del
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