Elsevier

Clinical Imaging

Volume 38, Issue 5, September–October 2014, Pages 719-723
Clinical Imaging

Original Article
Magnetic resonance imaging findings of musculoskeletal brucellosis

https://doi.org/10.1016/j.clinimag.2014.04.007Get rights and content

Abstract

Objective

The aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis.

Materials and methods

Sixty-eight among 304 patients with musculoskeletal brucellosis, aged 12–82 years (average, 50.2 years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitis-spondylodiscitis, and peripheral arthritis.

Results

Brucella serum agglutination test was > 1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%).

Conclusion

Brucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas.

Introduction

Human brucellosis, a chronic granulomatous zoonosis caused by facultative intracellular bacteria of the genus Brucella, involves many organs and tissues, [1]. The disease usually affects young and middle age adults. It is an endemic disease in the Mediterranean region including Turkey, Indian and Arabian Peninsula, parts of the Central and South America and Mexico [2]. The disease is transmitted to humans either by direct contact with the infected animals or by consumption of unpasteurized milk obtained from the infected animals or dairy products produced from such milk [3]. The disease mainly affects organs rich in reticuloendothelial cells, particularly the musculoskeletal system, which is the most frequent target site [4], [5]. The most common symptoms of brucellosis include fever, arthralgia, fatigue, sweating, inapetence, weight loss, chill, and myalgia. Incubation time of the disease is usually 1–5 weeks that may extend up to three months [6]. Diagnosis of musculoskeletal brucellosis may be difficult due to nonspecific clinical symptoms. Analysis of imaging of musculoskeletal brucellosis may be helpful in the diagnosis of the disease and in prevention of delayed manifestation of brucellosis with abscess which requires invasive treatment methods. The aim of this study was to present magnetic resonance imaging (MRI) findings of the musculoskeletal brucellosis.

Section snippets

Patients and methods

A retrospective analysis of 304 patients with brucellosis, presented to our hospital in last six years, was carried out. Sixty-eight patients with brucellosis involving musculoskeletal system were identified. Diagnosis of brucellosis was made by culturing the sera/body fluids employing standard BACTEC method [7] or testing the sera for Brucella agglutinins using the standard agglutination test. All positive agglutination tests were assumed to be secondary to brucellosis. Titers of 1:160 or more

Results

Twenty-seven (39.7%) male and 41 (60.2%) female patients with musculoskeletal brucellosis (mean age 50.2 years, range 12–82 years) were included in the study. Brucella serum agglutination test was > 1/160 in all patients; and blood cultures were positive in 12 patients. The sensitivity of serum agglutination test and blood culture in the diagnosis of brucellosis in our patients were 100% and 17.6%, respectively. As well, bacteria from abscess formation were identified in three patients.

The most

Discussion

Brucellosis is one of the commonest anthropozoonotic infections with a pandemic distribution [11] and stays as an uncontrolled problem in regions of high endemicity. Although it has been manifested more commonly in developing countries, but the world is clearly becoming a “smaller” place due to increased travel rates; therefore understanding of these infectious processes from abroad is important. Brucellosis is an infectious process which may mimic other atypical infectious processes.

In conclusion

Brucellosis is an endemic disease in the Mediterranean and Indian regions, and some parts of the Central and South America and Mexico. The spine is the most frequently affected site; whereas, sacroiliac joints and the other peripheral joints are less commonly involved sites. Spondylodiscitis is important complication of brucellosis which can cause persistent neurologic deficits. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of

References (33)

  • S Luk et al.

    Diagnostic challenges of human brucellosis in Hong Kong: a case series in two regional hospitals

    Hong Kong Med J

    (2010)
  • MF Geyik et al.

    Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases

    Swiss Med Wkly

    (2002)
  • RA Salata et al.

    Brucella species (brucellosis)

  • MS Al-Shahed et al.

    Imaging features of musculoskeletal brucellosis

    Radiographics

    (1994)
  • JD Colmenero et al.

    Complications associated with Brucella melitensis infection: a study of 530 cases

    Medicine (Baltimore)

    (1996)
  • A Dagirmanjian et al.

    MR imaging of vertebral osteomyelitis revisited

    AJR Am J Roentgenol

    (1996)

    • Cited by (0)

    View full text
    Copyright © 2014 Elsevier Inc. All rights reserved.