Brucellosis – Granulomatous Spine Infection

Abstract

Brucellosis mainly affects the musculoskeletal system, with the spine as the most common location. Diagnosis is based on clinical symptoms, but in some cases, they may be lacking. Laboratory diagnosis is mainly made on the combination of high erythro-cyte sedimentation rate (ESR) together with high levels of C-reactive protein (CRP) and leukocytosis. Blood culture is a very cost-effective investigation; plain radio-graphs may be useful, but magnetic resonance images (MRI) with gadolinium enhancement is the choice for diagnosing osteoarticular and spinal complications of human brucellosis. MRI diffusion-weighted imaging fast sequence is the most sensitive for differentiating acute and chronic forms of spondylodiscitis. The basis for treatment is usually the medical management. The indications for surgical treatment (endoscopy or open) are when: no microorganism has been isolated, spinal cord or dural compression is seen in MRI, or there's spinal instability or severe deformity. Open surgery is the standard: the anterior approach allows for anterior disc and bone debridement. If there is an epidural abscess or posterior elements are involved it's indicated as a posterior approach. To prevent relapses and reduce the rate of sequelae, it's necessary to have an appropriate duration of antimicrobial therapy and a timely indication to perform surgery.