Brucellar spondylitis in Kermanshah as an endemic area in West of Iran

Abstract

Background: Spondylitis is an important osteoarticular manifestation of brucellosis that leads to serious complications. Objectives: We aimed to investigate various aspects of spondylitis in brucellosis patients in Kermanshah, a highly endemic area in the West of Iran. Methods: This retrospective, single-center, cross-sectional study investigated 289 brucellosis patients among whom, 32 patients were confirmed to have brucellar spondylitis. The diagnosis of brucellosis was made by Wright or Coombs Wright tests (titers ≥ 1/80) or 2ME test (titer≥ 1/40). Brucellar spondylitis was confirmed by vertebral MRI or whole-body bone scan. All analyses were done using SPSS 21 software. The chi-square or Fisher exact test was used for assessing associations. P values of < 0.05 were considered statistically significant. Results: Among 289 patients studied, 32 (11.07%) had spondylitis with a mean age of 53.44 ± 16.06 years. Unpasteurized dairy product consumption, rural residence, and livestock-related occupation were reported by 30 (93.7%), 22 (68.7%), and 28 (87.5%) patients, respectively. Back pain (100%) was the most common symptom while the temperature of ≥ 37.7 (50%) and vertebral column tenderness (50%) were the most observed signs. Brucellar spondylitis was statistically related to age > 40 years, admission duration > 10 days, and ESR > 40 mm/h but not to sex, fever, anemia, and Wright titer. The lumbar disc involvement was the most common involvement (90.6%) in brucellar spondylitis patients. Vertebral body involvement, abnormal marrow signal, and bone marrow edema were observed in all 31 patients diagnosed with MRI. Conclusions: Brucellar spondylitis should be considered in patients with lower back pain and fever in endemic areas. Positive Wright serology, vertebral body involvement in MRI, and elevated ESR greatly favor the diagnosis of this complication.