Bacterial infections: osteoarticular brucellosis

Area of Science:

• Infectious Diseases
• Rheumatology
• Orthopedics

Background:

• Osteoarticular brucellosis is increasingly reported globally, with Brucella melitensis being the predominant pathogen.
• Common manifestations include peripheral articular pain, sacroiliitis, and spondylitis, with varying clinical presentations and diagnostic challenges.
• Pediatric cases often present with peripheral joint involvement and systemic features.

Purpose of the Study:

• To review the epidemiology, clinical manifestations, diagnostic approaches, and treatment strategies for osteoarticular brucellosis.
• To highlight the importance of recognizing diverse presentations to avoid misdiagnosis.
• To discuss the role of imaging and laboratory diagnostics in managing this condition.

Main Methods:

• Review of documented cases and literature on osteoarticular brucellosis.
• Analysis of clinical presentations, including peripheral joint pain, sacroiliitis, and spondylitis.
• Evaluation of diagnostic aids such as imaging (X-ray, CT, bone scan) and serological tests (Brucella agglutination titre).

Main Results:

• Peripheral large joint pain and sacroiliitis are common, while spondylitis affects older patients with insidious onset.
• CT scans and Technetium bone scans are sensitive for detecting vertebral damage and early osteoarticular involvement.
• A four-fold rise in Brucella agglutination titre is a key diagnostic indicator; 6-week doxycycline treatment, often combined with streptomycin or rifampicin, is effective.

Conclusions:

• Prompt recognition of osteoarticular brucellosis's varied presentations is crucial for accurate diagnosis and management.
• Effective treatment regimens, including prolonged antibiotic therapy, significantly reduce relapse rates.
• Surgical intervention may be necessary for spinal complications, but the overall prognosis with appropriate treatment is favorable.