Retrospective Analysis of Patients Admitted to Physical Medicine and Rehabilitation Outpatient Clinics with Osteoarticular Findings and Diagnosed with Brucellosis

Abstract

Aim: In endemic regions, we aimed to consider Brucella infection in the differential diagnosis of musculoskeletal manifestations and to emphasize the diversity of presentation. Material and Method: Our study has a retrospective design. Between 01.01.2020 and 01.01.2024, patients who applied to the physical therapy and rehabilitation department of a secondstage public hospital located in a region where brucella infection is endemic and were diagnosed with brucellosis with osteoarticular findings were included in our study. Demographic data, complaints at presentation, musculoskeletal examination findings, Brucella serology tests, liver function tests, complete blood counts, sedimentation rate (ESR) and C-reactive protein (CRP) levels, and related musculoskeletal imaging data were recorded. Results: 47 patients were enrolled in the study. 68.1% (32/47) of the patients were male, while 31.9% (15/47) were female. The average age of the patients was 44.43±15.47 years. Joint pain and low back pain were the predominant symptoms observed in the majority of cases; the most common types of involvement were arthralgia (46.8%), sacroiliitis (19.1%), spondylodiscitis (14.9%) and monoarthritis (14.9%). We found elevated CRP in 48.93%, elevated ESR in 27.65%, leukocytosis in 14.89%, leukopenia in 8.51%, anemia in 31.91%, elevated ALT in 12.76% and elevated AST in 10.63%. Conclusion: Brucellosis may present with various musculoskeletal findings. Considering Brucella infection in the differential diagnosis is crucial for preventing potential complications through prompt diagnosis and treatment in patients presenting with musculoskeletal symptoms, particularly in endemic areas.

Keywords

• arthritis
• brucella
• sacroiliitis
• spondylodiscitis

References

1. 1. Qie C, Cui J, Liu Y, Li Y, Wu H, Mi Y. Epidemiological and clinicalcharacteristics of bacteremic brucellosis. Journal of International Medical Research. 2020;48(7):0300060520936829.
2. 2. Di Bonaventura G, Angeletti S, Ianni A, Petitti T, Gherardi G. Microbiological laboratory diagnosis of human brucellosis: an overview. Pathogens. 2021;10(12):1623.
3. 3. Qureshi KA, Parvez A, Fahmy NA, Abdel Hady BH, Kumar S, Ganguly A, et al. Brucellosis: epidemiology, pathogenesis, diagnosis and treatment-a comprehensive review. Annals of Medicine. 2023;55(2):2295398.
4. 4. Yumuk Z, O’Callaghan D. Brucellosis in Turkey –an overview. International Journal of Infectious Diseases. 2012;16(4):e228–e35.
5. 5. Bruselloz Haritası (Türkiye, 2008–2017): T. C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Zoonotik ve Vektörel Hastalıklar Dairesi Başkanlığı;2017 [Erişim tarihi:01. 02. 2024]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/zoonotikve-vektorel-hastaliklar-db/Dokumanlar/Istatistikler/Web_Bruselloz_haritasi.pdf
6. 6. Chang C, Beutler BD, Ulanja MB, Uche C, Zdrnja M. Brucellosis presenting with febrile pancytopenia: an atypical presentation of a common disease and review of brucellosis. Case Reports in Infectious Diseases. 2021;2021.
7. 7. Khaidarova Y, Masoodi M, Kurmanova G, Kulembaeva A, Seizhanova B. Polymorphism of Osteoarticular Manifestation of Brucellosis Infection A Review. Interdisciplinary Approaches to Medicine. 2020;1(1):22–33.
8. 8. Uyar C, Alkan S, Tahmaz A. Research trends and hotspots of osteoarticular involvement in brucellosis. Journal of Zoonotic Diseases. 2022;6(2):69–77.

9. 9. Battikh H, Berriche A, Zayoud R, Ammari L, Abdelmalek R, Kilani B, et al. Clinical and laboratory features of brucellosis in a university hospital in Tunisia. Infectious Diseases Now. 2021;51(6):547–51.
10. 10. Bagheri Nejad R, Krecek RC, Khalaf OH, Hailat N, Arenas-Gamboa AM. Brucellosis in the Middle East: Current situation and a pathway forward. PLoS Neglected Tropical Diseases. 2020;14(5):e0008071.
11. 11. Kavak Ş, Şehmuz K. Evaluation of Bone and Joint Involvement in Patients Followed with the Diagnosis of Brucellosis. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;11(3):279–83.
12. 12. Mehmet F, Ali G, Kemal N, Remzi Ç, Jale S, Bunyamin D, et al. Musculoskeletal involvement in brucellosis in different age groups: a study of 195 cases. Swiss medical weekly. 2002;132(0708):98–104.
13. 13. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World journal of orthopedics. 2019;10(2):54.
14. 14. Rizkalla JM, Alhreish K, Syed IY. Spinal brucellosis: a case report and review of the literature. Journal of orthopaedic case reports. 2021;11(3):1.
15. 15. Kutlu SS, Kutlu M, Tuzun T, Ozdemir K. Spondylodiscitis: a common complication of brucellosis. The Journal of Infection in Developing Countries. 2018;12(07):550–6.
16. 16. Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS neglected tropical diseases. 2019;13(1):e0007112.
17. 17. Gerges S, Khoury A, Hallit S, Hoyek F, Hallit R. Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess: a case report. Journal of Medical Case Reports. 2022;16(1):418.
18. 18. Jahmani R, Obeidat O, Yusef D. Brucella septic hip arthritis:A case report. The American journal of case reports.2021;22:e928592–1.
19. 19. Demir MI, Kader Ç, Çolak NY, Kocabıyık O, Erbay A, Şebnem E. Bruselloz Olgularının Değerlendirilmesi Evaluation of Brucellosis Cases. Bozok Tıp Dergisi. 2017;7(3):47–51.
20. 20. Balın ŞÖ, Tartar AS, Akbulut A. The predictive role of haematological parameters in the diagnosis of osteoarticular brucellosis. African health sciences. 2018;18(4):988–94.
21. 21. Çiftdoğan DY, Aslan S. Osteoarticular involvement of brucellosis in pediatric patients: clinical and laboratory characteristics. The Turkish Journal of Pediatrics. 2020;62(2):199–207.
22. 22. Türkoğlu-Yılmaz E, Arslan Z. Bruselloz Tanılı Hastaların Retrospektif Değerlendirilmesi: Beş Yıllık Deneyim. Klimik Journal/Klimik Dergisi. 2023;36(3).
23. 23. Kış TT, Mehmet K, Şükran K. 111 Bruselloz olgusunun etyoloji, klinik seyir ve komplikasyonlarının değerlendirilmesi;bir retrospektif çalışma. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2020;13(3):339–47.