République Tunisienne  
Ministère de l'Agriculture, des Ressources Hydrauliques et de la Pêche

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Spinal brucellosis in South of Tunisia- review of 32   cases > Description

 
Date de publication 2014 

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Spinal brucellosis in South of Tunisia- review of 32   cases
Auteur   Makram Koubaa, Imed Maaloul, Chakib Marrakchi, Dorra Lahiani, Boussaima Hammami, Zeinab Mnif, Kaireddine Ben ahfoudh, Adnane Hammami, Mounir Ben Jemaa
Mots clés  Brucellosis; Brucellar spondylitis; Antibiotic therapy; Magnetic resonance imaging; Computed tomography
Résumé  

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 51615.85 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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