From the Guidelines
Brucellosis is associated with spondyloarthritis, a complication that can lead to long-term damage, particularly in the lumbar spine. This association is supported by a study published in the Journal of Infection in 2009 1, which highlights the various clinical presentations of brucellosis, including osteoarticular disease, septic arthritis, and sacroiliitis. The study notes that spondylitis is a recognized complication of brucellosis, often affecting the lumbar spine and leading to long-term damage.
Key aspects of brucellosis-related spondyloarthritis include:
- Clinical presentation: back pain, fever, and neurological symptoms
- Diagnosis: combination of clinical presentation, blood cultures, serology, and imaging studies such as MRI
- Treatment: prolonged course of antibiotics, usually a combination of doxycycline and rifampin, with possible addition of streptomycin in severe cases
- Supportive measures: pain management, rest, and physical therapy
- Potential complications: spinal instability, abscess formation, and long-term damage to the spine
It is essential to note that the treatment of brucellosis-related spondyloarthritis requires a prolonged antibiotic course due to the intracellular nature of the Brucella bacteria and its tendency to persist in bone tissue, as highlighted in the study 1. Patients should be advised about the zoonotic nature of brucellosis and the importance of avoiding unpasteurized dairy products to prevent reinfection. Close monitoring during and after treatment is crucial, with follow-up imaging to ensure resolution of the infection.
From the Research
Relationship Between Brucellosis and Spondyloarthritis
- Brucellosis is a zoonotic disease that can affect various organs and tissues, including the osteoarticular system, which is one of the most commonly affected systems in humans 2.
- Spondylitis is a common complication of brucellosis, and it is often debilitating and difficult to treat 3.
- The relationship between brucellosis and spondyloarthritis is complex, and the best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined 4.
Treatment of Brucellar Spondylitis
- Several antimicrobial regimens have been used to treat brucellar spondylitis, including doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole, and rifampicin 2.
- A combination of doxycycline, streptomycin, and rifampicin has been recommended as therapy for brucellar spondylitis to reduce relapse rates 4.
- Prolonged treatment, usually more than 12 weeks, is important for the treatment of brucellar spondylitis 3.
- Alternative regimens, such as a combination of doxycycline and ciprofloxacin, have been proposed and reported to be successful in some cases 3.
Diagnosis and Clinical Presentation
- Brucellosis is diagnosed with clinical inflammatory signs, positive serological tests, and positive blood/synovial fluids cultures 2.
- Spondylitis and spondylodiscitis are the most frequent complications of brucellosis, and they often affect the lumbar and low thoracic vertebrae 2.
- Back pain and sciatica radiculopathy are the most common complaints of patients with brucellar spondylitis 2.