title: Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis.
abstract: BACKGROUND
  Osteoarticular complications are the most common focal complications of brucellosis. Although vertebral osteomyelitis is the most frequent location in adults >30 years of age, little information is available about this serious complication of brucellosis, and great confusion surrounds its prognosis and the most appropriate treatment.
  
  
  METHODS
  We undertook a descriptive, retrospective, observational study of 96 patients who received a diagnosis of brucella vertebral osteomyelitis from September 1982 through December 2005 at a tertiary care hospital. All of the patients were treated for 3 months, after which they were followed up monthly for the first 3 months and then at 2-month intervals for the subsequent 6 months.
  
  
  RESULTS
  The incidence of vertebral osteomyelitis was 10.4%. The mean diagnostic delay was 12.7 weeks. Inflammatory spinal pain (occurring in 94.8% of patients) and fever (91.7%) were the most relevant clinical characteristics. Eight patients (8.3%) had motor weakness or paralysis. Paravertebral masses, epidural masses, and psoas abscesses were detected in 45.8%, 27.1%, and 10.4% of patients, respectively. Sixty-three patients (65.6%) received medication only, and 33 (34.4%) required surgical therapy in addition to medication. Twenty percent of patients experienced therapeutic failure. Attributable mortality was 2.1%, and severe functional sequelae were apparent in 6.2% of the patients. No significant differences were seen between patients who were treated with doxycycline-streptomycin and those treated with doxycycline-rifampicin.
  
  
  CONCLUSIONS
  Vertebral osteomyelitis is a serious complication of brucellosis. It generates a high rate of therapeutic failure and functional sequelae. In the absence of more-powerful controlled studies, the duration of treatment of brucellar vertebral osteomyelitis should be 3 months.
authors.affiliation: Infectious Diseases Service, Carlos Haya University Hospital, Málaga, Spain. jdcolmenero@telefonica.net
authors.forename: Juan D
authors.initials: JD
authors.lastname: Colmenero
authors.forename: Juan D
authors.initials: JD
authors.lastname: Ruiz-Mesa
authors.forename: Antonio
authors.initials: A
authors.lastname: Plata
authors.forename: Pilar
authors.initials: P
authors.lastname: Bermúdez
authors.forename: Patricia
authors.initials: P
authors.lastname: Martín-Rico
authors.forename: María I
authors.initials: MI
authors.lastname: Queipo-Ortuño
authors.forename: José M
authors.initials: JM
authors.lastname: Reguera
mesh_terms: D002002:Brucella / Q000302:isolation & purification*; D002006:Brucellosis / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000382:microbiology* / Q000628:therapy; D013131:Spine / Q000382:microbiology* / Q000473:pathology