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SAT0496 Brucellosis Spondylodiscitis: Retrospective Evaluation of The Clinical, Laboratory and Epidemiological Features of 21 Cases
  1. K. Baccouche,
  2. N. Elamri,
  3. S. Belghali,
  4. Z. Alaya,
  5. H. Zeglaoui,
  6. E. Bouajina
  1. rheumatology, farhat hached hospital, sousse, Tunisia

Abstract

Background Brucellosis is a common zoonosis which still remains a major health problem in our country. Osteoarticular involvement is the most frequent complication.

Objectives The aim of this study was to retrospectively evaluate the clinical, radiological aspects, laboratory characteristics, complications and treatment oucomes of brucellar spondylodiscitis (BS) cases who were followed between 1997 and 2015.

Methods this is a retrospective study of 21 cases of brucella spondylitis collected in our rheumatology department

Results Among 118 cases of infectious spondylodiscitis diagnosed and treated, 21 (17, 8%) were due to brucellosis. It was 16 men and five women with a mean age of 48.9 years. Among our patients, 38% had a profession exposed and 76, 2% were consumers of unpasteurized milk and dairy product. The delay from onset to diagnosis was 4 months and a half. The clinical presentation was fever in 81% cases, sweating in 81% and spinal pain in 100% cases. Neurological signs were observed in 42, 8% cases. A muscular deficit was objectified in 14, 3% cases. Vésicosphinctériens disorders were observed in 9, 5% cases. A single case of spinal cord compression was noted. The localisation of the infection was thoracic, thoraco-lumbar, lumbar and lombo-sacral respectively in 14, 3%, 9, 5%, 62% and 14, 3%. One vertebrae level was affected in 71, 4%. In view of laboratory findings, increased erytrocyte sedimentation rate was detected in 76, 2%, C-reactive protein positivity in 62%, lymphomonocytosis in 19% and anemia in 28, 5% of them. All of the patients had > or =1/160 titers of brucella agglutination test and negative blood culture. MRI findings are as follows: Predilection for the lumbar spine (62%), moderate paraspinal abnormal soft tissue with abscess formation only in 14,3% cases, and diffuse but exclusively anterior involvement, intact vertebral architecture despite evidence of diffuse vertebral osteomyelitis, and disc space involvement. Additionally, epidural extension was detected in 28, 5% cases, and root compression in 9, 5% cases. Clinical and radiological improvements were observed with a combined antimicrobial therapy of doxycycline and rifampicin during 12 weeks.

Conclusions In endemic areas and in our country, BS is still a public health problem and should be considered in the differential diagnosis of patients with spondylodiscitis. It is difficult to diagnose because its symptoms and signs are non-specific. Therefore, MRI, blood cultures, tissue biopsy and cultures are recommended in suspected cases.

Disclosure of Interest None declared

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