Vertebral Osteomyelitis and Paraspinal Abscess Among Patients With Brucellosis

Abstract

Background: Brucellosis is a systemic bacterial disease transmitted from animals to humans and involves many organs and tissues. Symptoms of brucellosis are protean and can be similar to many other infectious diseases. None of the symptoms are specific enough to support the clinical diagnosis. The musculoskeletal system is one of the most commonly affected organs. Disease can be present with bursitis, sacroiliitis, peripheral arthritis, osteomyelitis, spondylitis and paraspinal abscess, which among them vertebral osteomyelitis and paraspinal abscess are rare. Objectives: In this study, we aimed to evaluate the prevalence of vertebral osteomyelitis and paraspinal abscess in patients with brucellosis who were admitted to an infectious hospital in Zahedan, Southeastern Iran. Patients and Methods: During 48 months, from December 2008 to October 2012 we evaluated all patients who were referred to infectious clinics (Zahedan, Southeastern Iran) because of fever, myalgia, arthralgia, chronic low back pain, bone pain and had a wright positive test. Blood samples were tested again for 2ME. A titer of more than 1/80 was positive. All patients with low back pain who had a MRI or spine CT-Scan, which showed a sign of osteomyelitis and/or cold abscess, were included in our study. Results: Among 73 patients with brucellosis (56 males, 17 females; age range 12-69 years), 14 patients (19%; 12 males) had a diagnosis of brucella osteomyelitis. Eleven patients had vertebral osteomyelitis and five showed an abscess next to the involved spine. Patients were treated with a triple regimen including: doxicycline, rifampin and streptomycin, and one patient needed surgery due to pressure effect on the spine. Conclusions: Localized complications of brucellosis such as bone involvement were observed in patients with acute disease or chronic untreated infection. Based on our results, in endemic areas, every patient with low back pain and a positive test for brucella should be evaluated for spinal osteomyelitis.