Background Brucellosis is frequent in Mediterranean countries such as Tunisia. This disease is characterized by osteoarticular manifestations and may involve the spine.
Objectives To study epidemiological, clinical features and radiological findings of patients with brucellar spondylodiscitis.
Methods We studied retrospectively medical records of twelve patients with brucellar spondylodiscitis, recruited among 103 patients with SPD hospitalized in the department of rheumatology between 2001 and 2012.
Results They were 6 men and 6 women. Mean age was 55 years (range 33 to 79 years). Predisposing factors were noted in 2 cases: diabetes mellitus and cirrhosis. The following symptoms were observed: inflammatory back pain (12 cases), sciatalgia with neurological signs (4 cases), weight loss (11 cases), fever (9 cases) and sweating (n=7). One patient had symptoms of spinal cord compression. Mean symptoms duration was about 3,6 months (range 1,5-6 months). Unpasteurized milk consumption or cattle breeding were found in 8 cases. C Reactive protein level was increased in 8 cases. Lymphopenia was noted in 4 cases. Wright serology was positive in all cases. The spondylodiscitis was located in only one stage in all cases: the lumbar spine (8 cases), thoracic (3 cases) and cervical (1 case). Standard-X ray showed narrowing of intervertebral space (10 cases), endplate destruction (8 cases), bone condensation (1 case) and were normal in one case. MRI were performed in all cases and showed low signal intensity on T1- weighted images and high signal intensity on T2-weighted images of the vertebral bodies, endplates and intervertebral disc in all cases. Three patients had paravertebral abcess formation, 8 had epidural extension and one had posterior longitudinal ligament elevation and 2 had psoas abscess. Bone biopsy and histopathological examination were performed in nine cases. All of patients were treated with the combinations of 2 antibiotics (tetracycline and rifampicin) for 3 to 6 months. Patient with spinal cord compression died. One patient developed pulmonary embolism and another a thrombophlebitis.
Conclusions Diagnosis and treatment of brucellar spondylodiscitis should be done early to prevent serious complications, as the neurological ones.
Disclosure of Interest None Declared