Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis.
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.
Colmenero
Juan D
JD
Infectious Diseases Service, Carlos Haya University Hospital, Málaga, Spain. jdcolmenero@telefonica.net
Ruiz-Mesa
Juan D
JD
Plata
Antonio
A
Bermúdez
Pilar
P
Martín-Rico
Patricia
P
Queipo-Ortuño
María I
MI
Reguera
José M
JM
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