Brucellar spondylitis: a detailed analysis based on current findings

Abstract

Three hundred thirty-one cases of brucellosis included in a 10-year prospective protocol were reviewed to identify and follow up patients with spondylitis. Of 20 patients (17 male and three female; mean age, 54 years), spondylitis was diagnosed soon after onset of the brucellosis in 15, there were significant systemic symptoms in 17, and blood cultures were positive for Brucella melitensis in 14. The main symptom was vertebral pain. The commonest radiographic changes were narrowing of the disk and epiphysitis. The discrete character of radiographic alterations and negative uptake on bone scanning caused diagnostic delays in three patients. 99mTc bone scans finally became abnormal in all patients, but were not useful for follow-up because low uptake persisted after the clinical status stabilized. Three patients had paravertebral abscesses; in two of them fever and pain persisted despite antibiotic therapy until diagnosis and surgical drainage. Finally, all patients were cured, ten with sequelae. Brucellar spondylitis often had an acute clinical course with bacteremia. Because neither clinical nor radiographic changes one year after onset were significant, long-term follow-up is not considered necessary except when paravertebral abscess is suspected.