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Bacterial infections: osteoarticular brucellosis

C N Rajapakse1

  • 1Wellington Regional Rheumatology Unit, Hutt Hospital, Lower Hutt, New Zealand.

Bailliere'S Clinical Rheumatology
|February 1, 1995
PubMed
Summary

Osteoarticular brucellosis, often caused by Brucella melitensis, commonly affects large joints and the sacroiliac region. Early diagnosis and a 6-week treatment of doxycycline with streptomycin or rifampicin improve recovery outcomes.

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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.

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