Background Brucellosis is a major health problem in Mediterranean countries including Tunisia. The clinical presentation of this zoonosis varies considerable but osteoarticular involvement and spinal brucellosis particulary is the commonest complication.
Methods This study was carried out between 2000 and 2015. One hundred and six patients with infectious spondylodicitis hospitalized in the department of rheumatology were analyzed. All patients were thoroughly interrogated subjected to a rigorous clinical examination and a battery of investigations including: complete blood count, urine analysis, blood culture, erythrocyte sedimentation rate, C - reactive protein (CRP) and serology for brucellosis. The imaging of spine ordered including: X-ray, bone scan and magnetic resonance imaging (MRI) with contrast enhancement.
Results Thirty of the 106 patients (28%) proved to have spinal brucellosis. The mean age of these patients was 53 years (range 15–68 years) and female/men ratio at 1.5. The mean delay of diagnosis was 8 months. The following symptoms were observed: fever in 14 patients and back pain in all of patients. Other symptoms were less frequently observed, such as splenomegaly (2 patients), peripheral adenopathy (5 patients) and diarrhea (2 patients). Laboratory exams showed elevated erythrocyte sedimentation rate in 13 patients, high levels of CRP in all patients and leukocytosis in 11 cases. Wright serology was positive in 21 of the patients. Brucella melitensis was isolated in blood cultures in 2 cases. Standard X-rays were performed in all patients. They showed signs of spondylodiscitis in the lumbar spine in 20 cases, cervical in 2 cases and dorsal in 8 cases. Ct-scan and MRI confirms the diagnosis and showed associated epiduritis in 2 cases or abscess in 6 cases. Bone biopsy with histopathological examination was performed in 7 cases. A combination of cycline and rifampicin was given to all patients. The duration of therapy was between 6 and 8 weeks.
Conclusions Brucellosis is present with various clinical signs in endemic areas and may simulate many diseases. The need for prompt diagnosis and treatment of spinal brucellosis is of utmost importance to prevent serious bone destruction and severe neurologic Sequelae.
Disclosure of Interest None declared
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