title: Spinal brucellosis in South of Tunisia: review of 32 cases.
abstract: BACKGROUND
  Brucellosis remains an important economic and public health problem in some parts of the world. The spine is the most common site of musculoskeletal involvement of brucellosis.
  
  
  OBJECTIVE
  Assess the clinical, laboratory, radiological findings, and outcomes of vertebral involvement in brucellosis.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Thirty-two patients with spinal brucellosis during a period of 21 years (1990-2010) were included.
  
  
  METHODS
  Clinical and radiological improvement.
  
  
  METHODS
  Diagnosis made on clinical presentation, laboratory findings, radiographic evidence, and the Brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp were isolated in the blood or sample cultures.
  
  
  RESULTS
  The mean age of patients was 51±15.85 years (23 males, 9 females; age range, 19-74 years). The median diagnostic delay was 3 months. Back or neck pain (100% of patients), fever (78%), and sweats (68.6%) were the most common symptoms. Cultures of blood specimens from five patients (15.6%) were positive for Brucella melitensis. Four patients (12.5%) had motor weakness or paralysis. Magnetic resonance imaging was performed in 24 (75%) cases. Paravertebral masses, epidural masses, and psoas abscesses were detected in 65.6%, 59.4%, and 28.1% of patients, respectively. The lumbar vertebra was the most frequently involved region with the rate of 68.7%, followed by thoracal (18.7%), cervical (6.3%), lumbosacral (6.3%), and thoracolumbar (3.1%) segments. The duration of antimicrobial therapy of brucellosis (median, 6 months; range, 3-13 months) varied according to clinical response and the presence of epidural and paravertebral masses. There were no deaths or severe sequelae in this study.
  
  
  CONCLUSIONS
  Brucellar spondylitis should be considered in patients with back pain and fever in endemic areas. A high index of suspicion and clinical, laboratory, and radiological examinations help to confirm the diagnosis of vertebral involvement.
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia. Electronic address: makram.koubaa@gmail.com.
authors: Makram
authors: M
authors: Koubaa
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
authors: Imed
authors: I
authors: Maaloul
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
authors: Chakib
authors: C
authors: Marrakchi
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
authors: Dorra
authors: D
authors: Lahiani
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
authors: Boussaima
authors: B
authors: Hammami
authors: Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia.
authors: Zeinab
authors: Z
authors: Mnif
authors: Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia.
authors: Kaireddine
authors: K
authors: Ben Mahfoudh
authors: Department of Microbiology, Habib Bourguiba University Hospital, Sfax 3029, Tunisia.
authors: Adnane
authors: A
authors: Hammami
authors: Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
authors: Mounir
authors: M
authors: Ben Jemaa
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001416:Back Pain / Q000473:pathology; D017347:Brucella melitensis / Q000302:isolation & purification; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000473:pathology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013131:Spine / Q000473:pathology; D016896:Treatment Outcome; D014416:Tunisia; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Antibiotic therapy; Brucellar spondylitis; Brucellosis; Computed tomography; Magnetic resonance imaging