Osteoarticular Involvement among Brucellosis Cases in Konya City

Year 2015, , 483 - 494, 30.09.2015

Hale Özden , Turhan Togan

https://doi.org/10.17826/cutf.42511

Cited By: 2

Abstract

Purpose: Brucellosis is a systemic disease that can affect many organs and tissues. Musculoskeletal system is one of the most commonly affected systems. Disease may present itself with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis or osteomyelitis. The objective of the present study was to determine the frequency, types and clinical features of osteoarticular involvement among cases with brucellosis in Konya city and to establish the differences between patients with and without osteoarticular involvement. Material and Methods: Three hundred and sixteen patients with Brucellosis who presented between June 2003 and June 2014 were included in the study. Brucellosis was diagnosed by positive Brucella Standard Agglutination Test (1/160 titer) and/or growth of Brucella spp. in blood culture addition to the presence of clinical signs and findings. Diagnosis of osteoarticular system complications was established by physical examination and radiological findings obtained by diagnostic imaging tools. Magnetic resonance images of the thoracic, lumbar or sacral vertebrae were acquired in patients with back pain, low back pain and sacro-iliac joint pain. Results: Osteoarticular involvement was noted in 129 patients (40.8%) (females: 52% and males: 48%). The most common route of transmission was employment in farming and/or consumption of un-pasteurized milk or dairy products, especially fresh cheese, in 97 (75%) cases. Mean age was 4618 years. Sacroiliitis was the most frequent osteoarticular involvement (n: 68, 52.7%), 70.5% of which were bilateral. Sacroiliitis was followed by spondylodiscitis in 35 (38.7%), peripheral arthritis in 20 (15.5%), bursitis in 1 (0.8%) cases. Patients with osteoarticular involvement received medical treatment for at least three months. Discussion: Ratio and anatomical region of osteoarticular involvement in brucellosis shows variability among areas. In the present study, we demonstrated that sacroiliitis was the most common form in Konya city. This disease should be included in differential diagnosis in patients with symptoms of sacroiliitis, spondylodiscitis or those with articular pain.

Keywords

Brucellosis, osteoarticular involvement

Konya İlinde Osteoartiküler Tutulumlu Bruselloz Olguları

Abstract

Giriş: Bruselloz birçok organ ve dokuyu tutabilen sistemik bir infeksiyondur. En sık etkilenen sistemlerden biri kasiskelet sistemidir. Hastalık sakroiliit, periferik artrit, spondilit, paraspinal apse, bursit, osteomyelit gibi tablolarla ortaya çıkabilmektedir. Çalışmamızın amacı Konya ilinde brusellozlu olgularda osteoartiküler tutulumun oranlarını, tiplerini, klinik özelliklerini değerlendirmek ve osteoartiküler tutulumu olmayan grupla aradaki farkları belirlemektir. Materyal ve Metod: Çalışmamıza Haziran 2003–Haziran 2014 tarihleri arasında bruselloz tanısı ile başvuran 316 hasta alındı. Bruselloz tanısı uygun klinik belirti ve bulguların varlığında, pozitif Brucella Standart Tüp Aglutinasyon testi (1/160 titre) ve/veya kan kültüründe Brucella spp. bakterisinin üremiş olması ile konuldu. Osteoartiküler sistem komplikasyonlarının tanısı uygun fizik muayene bulguları varlığında radyolojik tanı yöntemleri ile saptanan bulgulara göre konuldu. Bel ağrısı, sakroiliak eklem ağrısı ve sırt ağrısı olan olgularda lomber vertebra, sakral vertebra veya torakal vertebra magnetik rezonans inceleme tetkikleri yapıldı. Bulgular: 129 hastada (%40,8) osteoartiküler tutulum gözlendi. (%52 kadın, %48 erkek). En sık bulaş yolu olarak, 97 (%75) olguda hayvancılıkla uğraşma ve/veya pastörize edilmemiş süt ve süt ürünleri tüketimi öyküsü- özellikle taze peynir- mevcuttu. Ortalama yaş 4618 yıldı. En sık osteoartiküler tutulum olarak sakroiliit saptandı. (n: 68, %52,7). Sakroiliitlerin %70,5’i bilateraldi. Sakroiliiti takiben, spondilodiskit 50 (%38,7), periferik artrit 20 (%15,5), bursit 1 (%0,8) olguda saptandı. Osteoartiküler tutulumu olan olgulara en az üç ay medikal tedavi verildi. Sonuç: Brusellozda osteoartiküler tutulum oranları ve tutulum yerleri bölgeden bölgeye farklılık gösterebilmektedir. Çalışmamızda Konya ilinde en sık tutulumun sakroiliit olduğunu gösterdik. Bu hastalık sakroiliit ve spondilodiskit semptomları ya da eklem ağrıları olan olgularda ayırıcı tanıda mutlaka yer almalıdır.

Keywords

Bruselloz, osteoartiküler tututlum

References

• Young EJ. Brucella species, In: Mandell GL, Bennet JE, Dolin R (eds). Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone, Philadelphia. 2010:2921-5.
• Doganay M, Meşe EA. Bruselloz, In: Willke Topcu A,
• Soyletir G, Doganay M. Enfeksiyon Hastalıkları ve Mikrobiyolojisi. 3rded. Nobel Tıp Kitabevleri, Istanbul. 2008:897-909.
• Taşova Y, Saltoğlu N, Şahin G, Aksu HZS.
• Osteoarthicular involvement of brucellosis in Turkey. Clin Rheumatol. 1999;18:214-9.
• Geyik MF, Gür A, Nas K, Çevik R, Saraç J, Dikici B,
• Ayaz C. Musculoskeletal involvement in brucellosis in different age groups: a study of 195 cases. Swiss Med Wkly. 2002;132:98-105.
• Aydin M, Yapar Fuat A, Savas L et al. Scintigraphic findings in osteoarticular brucellosis. Nucl Med Commun. 2005;26:639-47.
• Gonzalez –Gay MA, Garcia-Parrua C, Ibanez D, Garcia-Pais MJ. Osteoarthicular complications of brucellosis in an Atlantic area of Spain. J Rheumatol. 1999:26:141-5.
• Madkour MM, Sharif HS, Abed MY, Al-Fayez MA. brucellosis: Osteoarticular results of bone Brucellar spondylitis and
• Colmenero JD, Reguera JM, Fernandez-Nebro A, Cabera –Franquelo F. Osteoarticular complications of brucellosis. Ann Rheum Dis. 1991;50:23-6.
• Colmenero JD, Reguera JM, Martos F, Sanchez-de- Mora D, Delgado M, Causse M, et al. Complications associated with Brucella melitensis infection: a study 530 cases. Medicine (Baltimore). 1996;75:195-211.
• Hashemi SY, Keramat F, Ranjbar M, Mamani M, Jamal-Omidi Farzam complications of brucellosis in Hamedan, an endemic area in the west of Iran. Int J Infect Dis. 2007;11:496- 500. S. Osteoarticular
• Crosby E, Liosa L, Miro Queseda M, Carillo P, Gottuzzo E. Hematologic changes in brucellosis. J Infect Dis. 1984;150:419-24.
• Buchanan TM, Faber LC, Feldman RA. Brucellosis in the United States, 1960-1972. An abattoir- associated disease. Part I. Clinical features and therapy. Medicine (Baltimore). 1974;53:403-13.
• Gur A, Geyik MF, Dikici B, Nas K, Cevik R, Sarac J, Hosoglu S Complications of Brucellosis in different age groups: A study of 283 cases in Southeastern Anatolia of Turkey. Yonsei Medical Journal. 2003;44:33-44.
• Bosilkovski M, Krteva L, Caparoska S, Maija D. Osteoarticular involvement in brucellosis: study of 196 cases in the republic. Croatian Med J. 2004;45:727-33.
• Demiroglu YZ, Turunc T, Aliskan H, Colakoglu S, Arslan H. Brucellosis: Retrospective evaluation of the clinical, laboratory and epidemiological features of 151 cases. Mikrobiyol Bul. 2007;41:517-27.
• Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I, Yalcintas D. Epidemiologic, clinical and imaginig findings in brucellosis patients with Roentgenol. 2006;187:873-80. AJR Am J
• El-Desouki M. Skeletal brucellosis: assessment with bone scintigraphy. Radiology. 1991;181:415-8.
• Buzgan T, Karahocagil MK , Irmak H, Baran AI, Karsen manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14:e469-78. doi: 10.1016/j.ijid.2009.06.031. Epub 2009 Nov 11.
• Andriopoulos P, Tsironi M, Deftereos S, Aessopos A, Assimakopoulos
• presentation, diagnosis, and treatment of 144 cases. International 2007;11:52-7. Acute brucellosis: Journal Infectious diseases.
• Moussa AR, Muhtaseb SA, Almudallal DS, Khodeir SM, Marafie AA. Osteoarticular complications of brucellosis: a study of 169 cases. Rev Infect Dis. 1987;9:531-43.
• Weil Y, Mattan Y, Liebegall M, Rahav G. Brucella prosthetic joint infection: a report of 3 cases and a review of the literature. Clin Infect Dis. 2003;36:81-6.
• Corderro-Sanchez M, Alvarez-Ruiz S, Lopez-Ochoa J, Garcia-Talavera JR. Scintigraphic evaluation of lumbosacral pain in brucellosis. Arthritis Rheum. 1990;33:1052-5.
• Bodur H, Erbay A, Colpan A, Akinci E. Brucellar spondylitis. Rheumatol Int. 2004;24:221-6.
• Gundes SG, Gundes H, Sarlak A, Willke A. Primary brucellar psoas abscess: presentation of a rare case of psoas abscess caused by Brucella melitensis without any osteoarticular involvement. Int J Clin Pract Suppl. 2005;147:67-8.