Type:
Educational Exhibit
Keywords:
Infection, Epidemiology, Education, Diagnostic procedure, Decision analysis, MR, Fluoroscopy, CT, Musculoskeletal spine, Musculoskeletal joint, Musculoskeletal bone
Authors:
K. Mohamed Amine1, M. Chelli Bouaziz2, M. F. Ladeb3; 1Sfax/TN, 2Tunis/TN, 3La Manouba/TN
DOI:
10.1594/ecr2013/C-1659
Background
Brucellosis is a disorder of worldwide distribution,
relatively frequent in Mediterranean countries,
in Middle East and parts of central and south America [1].
Brucellosis is a zoonosis caused in humans by one of four species of the Brucella genus: B.
melitensis,
B.
abortus,
B.
canis and B.
suis.
B.
melitensis is the most virulent and invasive [2].
Brucella organisms are found in the excreta of infected animals (urine,
stool,
milk and products of conception).
Human can be affected by direct contact with infected animals or after ingestion of infected dairy products.
The brucellian infection mainly affects organs rich in mononuclear phagocytes,
such as the liver,
the spleen,
the lymph nodes and the bone marrow [3].
Brucellar spondylitis represents 6 to 58% of musculoskeletal localizations.
It typically occurs in men over 40 years of age.
The lumbar spine is the most affected (60%),
particularly at the L4–L5 level,
followed by thoracic (19%) and cervical spine (12%).
More than one level is affected in 6% to 14% of the cases.
Involvement of the spine may be either focal or diffuse.
The focal form is confined to the anterior portion of an endplate morphologically known for its rich blood supply.
The diffuse form may involve the entire vertebral body and extend to the adjacent disc,
vertebrae and epidural space.
Infection diffuses via the ligaments and vascular communications.
Posterior elements involvement and facet joint arthritis may occur [4].
Non-destructive pattern,
duration of symptoms (chronic course),
age of patients (older individuals) and paucity of fever and malaise may help to clinically suspect the diagnosis.