BRUSELLOZDA OSTEOARTİKÜLER TUTULUMU OLAN HASTALARIN DEĞERLENDİRİLMESİ

Öz

Bruselloz, ülkemizde önemini koruyan bir zoonozdur. Bu çalışmada bruselloz tanılı hastaların klinik ve laboratuvar bulgularının değerlendirilmesi, osteoartiküler tutulumu olan ve olmayan hastaların karşılaştırılması amaçlanmıştır. Çalışmaya 1 Ocak 2020 1 Haziran 2022 tarihleri arasında hastanemiz Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Bölümü’nde bruselloz tanısı alan 350 hasta dahil edildi. Bruselloz tanısında klinik belirti ve bulguları olan hastalarda Rose Bengal testi ve Brucella standart tüp aglütinasyon testi (≥1/160) kullanıldı. Osteoartiküler sistem tutulumu olup olmamasına göre hastalar iki gruba ayrıldı. Osteoartiküler sistem tutulumu fizik muayene ve radyolojik görüntülemelere göre belirlendi. Çalışmaya dahil edilen 350 hastanın 115'inde (%32.9) osteoartiküler tutulum tespit edildi. En sık osteoartiküler tutulum olarak sakroileit saptandı (%18). Sakroileiti takiben spondilodiskit (%13.4), epidural apse (%4.9) ve periferik artrit (%3.4) görüldü. Osteoartiküler tutulumu olan hastalar yaş ortalaması 50.8±14.1 olup, tutulum olmayan hastalara göre daha yüksekti (p<0.001). Bel ağrısı ve kalça ağrısı da osteoartiküler tutulumu olan hastalarda daha sık gözlendi (sırasıyla p<0.001, p=0.003). Laboratuvar parametrelerinden lökopeni (<4000/mL) ve trombositopeni (150000/mL), osteoartiküler tutulum olmayan hastalarda daha sık görüldü (sırasıyla p=0.035, p=0.049). Osteoartiküler tutulumu olan olgulara en az üç ay medikal tedavi verildi. Bu bulgular, brusellozun osteoartiküler komplikasyonlarının yönetimi ve tedavisi açısından klinisyenlere kılavuzluk etmektedir. Bölgemizde endemik olan bu hastalık için özellikle bel ve kalça ağrısı olan hastalarda osteoartiküler bruselloz ayırıcı tanıda akla gelmelidir.

Anahtar Kelimeler

• Bruselloz
• Brucella
• osteoartiküler tutulum
• sakroileit

EVALUATION OF PATIENTS WITH OSTOEARTICULAR INVOLVEMENT IN BRUCELLOSIS

Öz

Brucellosis is a zoonosis that remains important in our country. The aim of this study was to evaluate the clinical and laboratory findings of patients with brucellosis and to compare patients with and without osteoarticular involvement. The study included 350 patients diagnosed with brucellosis between January 1, 2020 and June 1, 2022 in the Infectious Diseases and Clinical Microbiology Department of our hospital. Diagnosis was based on the Rose Bengal test and the Brucella standard tube agglutination test (≥1/160) in symptomatic individuals. Patients were divided into two groups based on the presence or absence of osteoarticular involvement as determined by physical examination and radiographic assessments. Osteoarticular involvement was noted in 115 (32.9%) of the 350 patients. The most common osteoarticular involvement was sacroiliitis (18%). Sacroiliitis was followed by spondylodiscitis (13.4%), epidural abscess (4.9%), and peripheral arthritis (3.4%). The average age of the patients with osteoarticular involvement was 50.8±14.1 years, which was higher than that of the patients without osteoarticular involvement (p<0.001). Low back pain and hip pain had a higher prevalence in patients with osteoarticular involvement (p<0.001 and p=0.003, respectively). Among laboratory parameters, leukopenia (<4.000/ml) and thrombocytopenia (150.000/ml) occurred more frequently in patients without osteoarticular involvement (p=0.035 and p=0.049, respectively). Patients with osteoarticular involvement received medical treatment for at least three months. These results provide physicians with valuable insights to guide management and therapeutic strategies for osteoarticular complications associated with brucellosis. Osteoarticular brucellosis must be considered in the differential diagnosis, particularly in individuals with low back and hip pain in regions where this disease is endemic.

Anahtar Kelimeler

• Brucellosis
• Brucella
• osteoarticular involvement
• sacroiliitis

Kaynakça

1. 1.Adesokan HK, Alabi PI, Ogundipe MA. Prevalence and predictors of risk factors for Brucellosis transmission by meat handlers and traditional healers' risk practices in Ibadan, Nigeria. J Prev Med Hyg. 2016;57(3):164-71.
2. 2. Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS Negl Trop Dis. 2019;13(1):e0007112. https://doi.org/10.1371/journal.pntd.0007112
3. 3. Ariza J, Corredoira J, Pallares R, et al. Characteristics of and risk factors for relapse of brucellosis in humans. Clin Infect Dis. 1995;20(5):1241-249. https://doi.org/10.1093/clinids/20.5.1241
4. 4. Aydin M, Fuat Yapar A, Savas L, ve ark. Scintigraphic findings in osteoarticular brucellosis. Nucl Med Commun. 2005;26(7):639-47. https://doi.org/10.1097/01.mnm.0000167651.52724.68
5. 5. Aygen B, Doğanay M, Sümerkan B, Yıldız O, Kayabaş Ü. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Médecine Et Maladies Infectieuses. 2002;32(9):485-93. https://doi.org/10.1016/S0399-077X(02)00403-1
6. 6. Bal A, Gürçay E, Ünlüsoy D, Çınar C, Çakcı A. Brusellozda Kas İskelet Sistemi Komplikasyonları. Balkan Medical Journal. 2008;2008(1):20-5.
7. 7. Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61(6):e26-46. https://doi.org/10.1093/cid/civ482
8. 8. Berrocal A, Gotuzzo E, Calvo A, Carrillo C, Castañeda O, Alarcón GS. Sternoclavicular brucellar arthritis: a report of 7 cases and a review of the literature. J Rheumatol. 1993;20(7):1184-6.

9. 9. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45(6):727-33.
10. 10. Boyaci A, Boyaci N, Tutoglu A, Dokumaci DS. Spinal epidural abscess in brucellosis. BMJ Case Rep. 2013. https://doi.org/10.1136/bcr-2013-200946
11. 11. Brucellosis Reference Guide: Exposures, Testing, and Prevention. Centers for Disease Control and Prevention, https://www.cdc.gov/brucellosis/pdf/brucellosi-reference-guide.pdf (erişim tarihi: 19.11.2024)
12. 12. Chelli Bouaziz M, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol. 2008;37(9):785-90. https://doi.org/10.1007/s00256-007-0371-x
13. 13. D'Anastasio R, Staniscia T, Milia ML, Manzoli L, Capasso L. Origin, evolution and paleoepidemiology of brucellosis. Epidemiol Infect. 2011;139(1):149-56. https://doi.org/10.1017/S095026881000097X
14. 14. Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(12):e1929. https://doi.org/10.1371/journal.pntd.0001929
15. 15. Demiroğlu YZ, Turunç T, Alişkan H, Colakoğlu S, Arslan H. Brucellosis: retrospective evaluation of the clinical, laboratory and epidemiological features of 151 cases. Mikrobiyol Bul. 2007;41(4):517-27.
16. 16. Doğanay M, Alp Meşe E. Bruselloz. In: Wilke T, Söyletir G, Doğanay M, editors. İnfeksiyon Hastalıkları ve Mikrobiyolojisi. İstanbul: Nobel Tıp Kitapevleri; 2008, p. 897-909.
17. 17. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: A review. World J Orthop. 2019;10(2):54-62. https://doi.org/10.5312/wjo.v10.i2.54
18. 18. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7(12):775-86. https://doi.org/10.1016/S1473-3099(07)70286-4
19. 19. Gür A, Geyik MF, Dikici B, ve ark. Complications of brucellosis in different age groups: a study of 283 cases in southeastern Anatolia of Turkey. Yonsei Med J. 2003;44(1):33-44. https://doi.org/10.3349/ymj.2003.44.1.33
20. 20. Hasanjani Roushan MR, Ebrahimpour S, Moulana Z. Different Clinical Presentations of Brucellosis. Jundishapur J Microbiol. 2016;9(4):e33765. https://doi.org/10.5812/jjm.33765
21. 21. Hashemi SH, Keramat F, Ranjbar M, Mamani M, Farzam A, Jamal-Omidi S. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. Int J Infect Dis. 2007;11(6):496-500. https://doi.org/10.1016/j.ijid.2007.01.008
22. 22. Hayoun M, Muco E, Shorman M. Brucellosis, StatPearls Publishing LLC, https://www.ncbi.nlm.nih.gov/books/NBK441831/ (erişim tarihi: 9.12.2024)
23. 23. Jin M, Fan Z, Gao R, Li X, Gao Z, Wang Z. Research progress on complications of Brucellosis. Front Cell Infect Microbiol. 2023;13:1136674. https://doi.org/10.3389/fcimb.2023.1136674
24. 24. Kayaaslan, B, Bastug A, Aydin E, ve ark. A long-term survey of brucellosis: Is there any marker to predict the complicated cases? Infectious Diseases. 2015;48(3):215–21. https://doi.org/10.3109/23744235.2015.1107187
25. 25. O'Callaghan D. Human brucellosis: recent advances and future challenges. Infect Dis Poverty. 2020;9(1):101. https://doi.org/10.1186/s40249-020-00715-1
26. 26. Özden H, Togan T. Osteoarticular Involvement among Brucellosis Cases in Konya City. Cukurova Medical Journal. 2015;40(3):483-94. https://doi.org/10.17826/cutf.42511
27. 27. Özger HS, Karasahin Ö, Yıldız Y, Dizbay M. Brusellozda Osteoartiküler Organ Tutulumu ve Yetersiz Tedavinin Relaps ile İlişkisi. Mediterr J Infect Microb Antimicrob. 2020;9(1):1-7. https://doi.org/10.4274/mjima.galenos.2020.2020.1
28. 28. Pourbagher A, Pourbagher MA, Savas L, et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. AJR Am J Roentgenol. 2006;187(4):873-80. https://doi.org/10.2214/AJR.05.1088
29. 29. Taşova Y, Saltoğlu N, Sahin G, Aksu HS. Osteoarthricular involvement of brucellosis in Turkey. Clin Rheumatol. 1999;18(3):214-9. https://doi.org/10.1007/s100670050087
30. 30. Unuvar GK, Kilic AU, Doganay M. Current therapeutic strategy in osteoarticular brucellosis. North Clin Istanb. 2019;6(4):415-20. https://doi.org/10.14744/nci.2019.05658
31. 31. Z, Abdollahi A, Ziaee V, Domiraei Z, et al. Prevalence of positive autoimmune biomarkers in the brucellosis patients. Clin Rheumatol. 2016;35(10):2573-8. https://doi.org/10.1007/s10067-016-3171-7
32. 32. Zormpala A, Skopelitis E, Thanos L, Artinopoulos C, Kordossis T, Sipsas NV. An unusual case of brucellar spondylitis involving both the cervical and lumbar spine. Clin Imaging. 2000;24(5):273-75. https://doi.org/10.1016/s0899-7071(00)00226-6