The skeletal manifestations of brucellosis

A prospective study of 33 patients with skeletal complications of brucellosis is reported. The diagnosis depends on the brucellar agglutination titre because the clinical, radiological and histological features are not specific, and blood culture and culture of synovial fluid are often negative. The commonest site is the sacroiliac joint, and brucellosis must be differentiated from tuberculosis as an important cause of backache. Treatment is with chemotherapy, the preferred combination being rifampicin and co-trimoxazole. Relapse can occur, but the chances can be reduced by careful clinical monitoring, and by repeated serological tests and gallium scanning; it is treated by further chemotherapy. Operation is indicated to relieve spinal cord compression or to drain a large paravertebral abscess.