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Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases

Year 2025, , 68 - 72, 27.06.2025

Şebnem Çalık , Selma Tosun , Alpay Arı , Hüseyin Can

https://doi.org/10.22391/fppc.1662481

Abstract

Introduction: Since there is no standard treatment regimen and duration in brucellosis spondylodiscitis cases, management of brucellosis spondylodiscitis cases is difficult. This study aimed to evaluate the risk factors, clinical features and follow-up results of brucellosis spondylodiscitis cases followed up in a tertiary healthcare institution.
Methods: In this retrospective study, data from 60 patients with brucellosis spondylodiscitis who were followed up in a training and research hospital between 2009-2019 were evaluated from the electronic data recording system. All statistical analyses were performed using the SPSS 26 program. Comparison of the distributions of variables in the compared groups was made using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables.
Results: A total of 212 patients were followed up with a diagnosis of brucellosis. Spondylodiscitis was detected in 60 (28.30%) cases. In cases developing brucella spondylodiscitis, the duration of symptoms was longer (p=0.007), lower back pain (p=0.000), muscle pain (p=0.023) were more common and sedimentation values were higher (p=0.044). Three (5%) cases had single vertebra involvement, 34 (56.70%) cases had two vertebra involvement and 23 (38.30%) cases had ≥3 vertebra involvement. The most common involvement was in the lumbar region (23 cases, 38.30%), followed by the thoracic region (13 cases, 21.70%) and lumbosacral region (11 cases, 18.33%). Abscess was detected in 21 (35%) cases. Seventeen (28.30%) cases were given a treatment regimen containing two antibiotics and 43 (71.70%) cases were given a treatment regimen containing three antibiotics. Treatment regimens containing three antibiotics were found to be more successful (p=0.001). The mean treatment duration of the cases was 19.7±12 weeks (minimum 12-maximum 66 weeks). Relapse occurred in five (8.30%) cases. While muscle weakness and neurological deficits developed in three (5%) cases, two of them underwent surgery.
Conclusion: Brucella spondylodiscitis is a not uncommon manifestation of the disease. In most cases, more than one vertebral involvement was affected. Treatment regimens containing three antibiotics were found to be more successful than regimens containing two antibiotics. Cases with muscle weakness and neurological deficits as complications were detected. A team consisting of infectious diseases, radiologists, neurosurgeons and physical therapy specialists may be useful for the treatment of spondylodiscitis.

Keywords

Brucellosis spondylodiscitis complication

References

  • 1. Qureshi KA, Parvez A, Fahmy NA, Abdel Hady BH, Kumar S, Ganguly A, et al. Brucellosis: epidemiology, pathogenesis, diagnosis and treatment-a compreensive review. Ann Med 2023; 55(2): 2295398. https://doi.org/10.1080/07853890.2023.2295398
  • 2. 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
  • 3. Spernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, et al. Brucella spondylitis: Current knowledge and recent advances. Clin Med 2024; 13(2): 595. https://doi.org/10.3390/jcm13020595
  • 4. Bosilkovski M, Krteva L, Dimzova M, Vidinic I, Sopova Z, Spasovska K. Human brucellosis in Macedonia-10 years of clinical experience in endemic region. Croat Med J 2010; 51(4): 327–36. https://doi.org/10.3325/cmj.2010.51.327
  • 5. Di Bonaventura G, Angeletti S, Ianni A, Petitti T, Gherardi G. Microbiological Laboratory Diagnosis of Human Brucellosis: An Overview. Pathogens 2021; 10(12): 1623. https://doi.org/10.3390/pathogens10121623
  • 6. Geyik MF, Gur A, Nas K, Cevik R, Sarac J, Dikici B, et al. Musculoskeletal involvement of brucellosis in different age groups: A study of 195 cases. Swiss Med Wkly 2002; 132(7-8): 98–105. https://doi.org/10.57187/smw.2002.09900
  • 7. Buzgan, T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: A retrospective evaluation and review of the literature. Int J Infect Dis 2010; 14(6): e469–78. https://doi.org/10.1016/j.ijid.2009.06.031
  • 8. Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Intern. Med 2011; 50(5): 421–28. https://doi.org/10.2169/internalmedicine.50.4700
  • 9. Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2014; 20(2): O75–82. https://doi.org/10.1111/1469-0691.12351
  • 10. Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. Eur. J Radiol 2008; 67(1): 153–58. https://doi.org/j.ejrad.2007.07.002
  • 11. Kaptan F, Gulduren HM, Sarsilmaz A, Sucu HK, Ural S, Vardar I, et al. Brucellar spondylodiscitis: comparision of patients with and without abscesses. Rheumatol Int 2013; 33(4): 985-92. https://doi.org/10.1007/s00296-012-2491-4
  • 12. Bosilkovski M, Keramat F, Arapovic J. The current therapeutical strategies in human brucellosis. Infection. 2021; 49(5): 823–32. https://doi.org/10.1007/s15010-021-01586-w
  • 13. 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
  • 14. Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis 2008; 12(6): 573-77. https://doi.org/10.1016/j.ijid.2008.03.014
  • 15. Colmenero JD, Ruiz-Mesa JD, Plata A, Bermudez P, Martin-Rico P, Queipo-Ortuno MI, et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis 2008; 46(3): 426–33. https://doi.org/10.1086/525266
  • 16. Yang XM, Jia YL, Zhang Y, Zhang PN, Yao Y, Yin YL, et al. Clinical effect of doxycycline combined with compound sulfamethoxazole and rifampicin in the treatment of Brucellosis spondylitis. Drug Des Devel Ther 2021; 15: 4733–40. https://doi.org/10.2147/DDDT.S341242

Brusella spondilodiskiti olgularının klinik özellikleri ve izlem sonuçlarının değerlendirilmesi

Year 2025, , 68 - 72, 27.06.2025

Şebnem Çalık , Selma Tosun , Alpay Arı , Hüseyin Can

https://doi.org/10.22391/fppc.1662481

Abstract

Giriş: Brusella spondilodiskiti olgularında standart bir tedavi rejimi ve süresi olmadığı için brusella spondilodiskiti olgularının yönetimi zordur. Bu çalışmada üçüncü basamak bir sağlık kuruluşunda izlenmiş olan bruselloz spondilodiskiti olgularının risk faktörleri, klinik özellikleri ve izlem sonuçlarının değerlendirilmesi amaçlanmıştır.
Yöntem: Retrospektif olarak planlanan bu çalışmada bir Eğitim ve araştırma hastanesinde 2009-2019 yılları arasında takip edilen 60 brusella spondilodiskiti tanılı hastaya ait veriler elektronik veri kayıt sisteminden değerlendirilmiştir. Tüm istatistiksel analizler SPSS 26 programı kullanılarak yapılmıştır. Karşılaştırılan Gruplardaki değişkenlerin dağılımlarının karşılaştırılması kategorik değişkenler için ki kare testi veya Fisher’s exact testi, sürekli değişkenler için ise Mann-Whitney U testi ile yapılmıştır.
Bulgular: Bruselloz tanısıyla toplam 212 hasta takip edilmiştir. Altmış (%28,30) olguda spondilodiskit tespit edilmiştir. Brusella spondilodiskit gelişen olgularda semptom süresi daha uzun (p=0,007), bel ağrısı (p=0,000), kas ağrısı (p=0,023) daha sık ve sedimentasyon değerleri daha yüksekti (p=0,044). Üç (%5) olguda tek vertebra tutulumu, 34 (%56,70) olguda iki vertebra tutulumu ve 23 (%38,30) olguda ≥3 vertebra tutulumu vardı. En sık tutulum lomber bölgede (23 olgu, %38,30) görülürken bunu torasik bölge (13 olgu, %21,70) ve lumbosakral bölge (11 olgu, %18,33) takip etmiştir. Yirmi bir (%35) olguda apse saptanmıştır. On yedi (%28,30) olguya iki antibiyotik kombinasyon rejimi ve 43 (%71,70) olguya üç antibiyotik kombinasyon rejimi verilmiştir. Üç antibiyotik kombinasyon rejiminin daha başarılı olduğu bulunmuştur (p=0,001). Olguların ortalama tedavi süresi 19,7±12 haftaydı (minimum 12-maksimum 66 hafta). Beş (%8,30) olguda relaps meydana gelmiştir. Üç (%5) olguda kas güçsüzlüğü ve nörolojik defisitler gelişirken, ikisi ameliyata alınmıştır.
Sonuç: Brucella spondilodiskit hastalığın nadir olmayan bir belirtisidir. Çoğu olguda birden fazla vertebral tutulum etkilenmiştir. Üç antibiyotik kombinasyon rejiminin iki antibiyotik içeren rejimlerden daha başarılı olduğu bulunmuştur. Komplikasyon olarak kas güçsüzlüğü ve nörolojik defisitler olan olgular saptanmıştır. Spondilodiskit tedavisinde enfeksiyon hastalıkları, radyologlar, beyin cerrahları ve fizik tedavi uzmanlarından oluşan bir ekibin yardımı faydalı olabilir.

Keywords

Bruselloz spondilodiskit komplikasyon

Thanks

We would like to thank all of our assistant physicians who helped with the follow-up of the patients.

References

  • 1. Qureshi KA, Parvez A, Fahmy NA, Abdel Hady BH, Kumar S, Ganguly A, et al. Brucellosis: epidemiology, pathogenesis, diagnosis and treatment-a compreensive review. Ann Med 2023; 55(2): 2295398. https://doi.org/10.1080/07853890.2023.2295398
  • 2. 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
  • 3. Spernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, et al. Brucella spondylitis: Current knowledge and recent advances. Clin Med 2024; 13(2): 595. https://doi.org/10.3390/jcm13020595
  • 4. Bosilkovski M, Krteva L, Dimzova M, Vidinic I, Sopova Z, Spasovska K. Human brucellosis in Macedonia-10 years of clinical experience in endemic region. Croat Med J 2010; 51(4): 327–36. https://doi.org/10.3325/cmj.2010.51.327
  • 5. Di Bonaventura G, Angeletti S, Ianni A, Petitti T, Gherardi G. Microbiological Laboratory Diagnosis of Human Brucellosis: An Overview. Pathogens 2021; 10(12): 1623. https://doi.org/10.3390/pathogens10121623
  • 6. Geyik MF, Gur A, Nas K, Cevik R, Sarac J, Dikici B, et al. Musculoskeletal involvement of brucellosis in different age groups: A study of 195 cases. Swiss Med Wkly 2002; 132(7-8): 98–105. https://doi.org/10.57187/smw.2002.09900
  • 7. Buzgan, T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: A retrospective evaluation and review of the literature. Int J Infect Dis 2010; 14(6): e469–78. https://doi.org/10.1016/j.ijid.2009.06.031
  • 8. Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Intern. Med 2011; 50(5): 421–28. https://doi.org/10.2169/internalmedicine.50.4700
  • 9. Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2014; 20(2): O75–82. https://doi.org/10.1111/1469-0691.12351
  • 10. Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. Eur. J Radiol 2008; 67(1): 153–58. https://doi.org/j.ejrad.2007.07.002
  • 11. Kaptan F, Gulduren HM, Sarsilmaz A, Sucu HK, Ural S, Vardar I, et al. Brucellar spondylodiscitis: comparision of patients with and without abscesses. Rheumatol Int 2013; 33(4): 985-92. https://doi.org/10.1007/s00296-012-2491-4
  • 12. Bosilkovski M, Keramat F, Arapovic J. The current therapeutical strategies in human brucellosis. Infection. 2021; 49(5): 823–32. https://doi.org/10.1007/s15010-021-01586-w
  • 13. 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
  • 14. Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis 2008; 12(6): 573-77. https://doi.org/10.1016/j.ijid.2008.03.014
  • 15. Colmenero JD, Ruiz-Mesa JD, Plata A, Bermudez P, Martin-Rico P, Queipo-Ortuno MI, et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis 2008; 46(3): 426–33. https://doi.org/10.1086/525266
  • 16. Yang XM, Jia YL, Zhang Y, Zhang PN, Yao Y, Yin YL, et al. Clinical effect of doxycycline combined with compound sulfamethoxazole and rifampicin in the treatment of Brucellosis spondylitis. Drug Des Devel Ther 2021; 15: 4733–40. https://doi.org/10.2147/DDDT.S341242
There are 16 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Original Research
Authors

Şebnem Çalık 0000-0003-3798-4819

Selma Tosun 0000-0001-9844-9399

Alpay Arı 0000-0002-9990-1882

Hüseyin Can 0000-0002-4686-7879

Publication Date June 27, 2025
Submission Date March 21, 2025
Acceptance Date April 30, 2025
Published in Issue Year 2025

Cite

APA Çalık, Ş., Tosun, S., Arı, A., Can, H. (2025). Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases. Family Practice and Palliative Care, 10(2), 68-72. https://doi.org/10.22391/fppc.1662481
AMA Çalık Ş, Tosun S, Arı A, Can H. Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases. Fam Pract Palliat Care. June 2025;10(2):68-72. doi:10.22391/fppc.1662481
Chicago Çalık, Şebnem, Selma Tosun, Alpay Arı, and Hüseyin Can. “Evaluation of Clinical Features and Follow-up Results of Brucella Spondylodiscitis Cases”. Family Practice and Palliative Care 10, no. 2 (June 2025): 68-72. https://doi.org/10.22391/fppc.1662481.
EndNote Çalık Ş, Tosun S, Arı A, Can H (June 1, 2025) Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases. Family Practice and Palliative Care 10 2 68–72.
IEEE Ş. Çalık, S. Tosun, A. Arı, and H. Can, “Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases”, Fam Pract Palliat Care, vol. 10, no. 2, pp. 68–72, 2025, doi: 10.22391/fppc.1662481.
ISNAD Çalık, Şebnem et al. “Evaluation of Clinical Features and Follow-up Results of Brucella Spondylodiscitis Cases”. Family Practice and Palliative Care 10/2 (June 2025), 68-72. https://doi.org/10.22391/fppc.1662481.
JAMA Çalık Ş, Tosun S, Arı A, Can H. Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases. Fam Pract Palliat Care. 2025;10:68–72.
MLA Çalık, Şebnem et al. “Evaluation of Clinical Features and Follow-up Results of Brucella Spondylodiscitis Cases”. Family Practice and Palliative Care, vol. 10, no. 2, 2025, pp. 68-72, doi:10.22391/fppc.1662481.
Vancouver Çalık Ş, Tosun S, Arı A, Can H. Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases. Fam Pract Palliat Care. 2025;10(2):68-72.

Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505