Can brucellosis cause rib pain?

Brucellosis Can Cause Rib Pain

Yes, brucellosis can cause rib pain as part of its osteoarticular manifestations, which occur in 10-85% of patients with brucellosis. 1 While the sacroiliac joints (up to 80%) and spine (up to 54%) are the most commonly affected sites, brucellosis can involve any bone or joint in the body, including the ribs and costochondral junctions.

Musculoskeletal Manifestations of Brucellosis

Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella, characterized by:

• Fever, sweating, and musculoskeletal pains in most patients 2
• Systemic symptoms affecting multiple organs and tissues 3
• Osteoarticular involvement as the most frequent complication 1

Common Osteoarticular Manifestations:

• Spondylitis and spondylodiscitis (most severe forms)
• Sacroiliitis
• Peripheral arthritis
• Osteomyelitis
• Discitis
• Bursitis
• Tenosynovitis 1

Rib Involvement in Brucellosis

While not specifically mentioned as the most common site, rib involvement in brucellosis can manifest as:

• Osteomyelitis of the ribs
• Costochondritis (inflammation of the cartilage connecting ribs to the sternum)
• Referred pain from thoracic spine involvement 4

The World Health Organization recognizes that brucellosis can cause back pains and can affect multiple organs and tissues 5, which would include the thoracic cage and ribs.

Diagnostic Approach for Suspected Brucellosis with Rib Pain

When a patient presents with rib pain in an endemic area for brucellosis, consider:

1. Clinical evaluation:

   • History of exposure to risk factors (consumption of unpasteurized dairy products, occupational contact with infected animals) 3
   • Presence of systemic symptoms (fever, sweating, fatigue)

2. Laboratory tests:

   • Serological tests (agglutination tests, ELISA)
   • Blood cultures
   • PCR for rapid diagnosis 3

3. Imaging studies:

   • Radiography (limited value, may show advanced disease) 4
   • MRI (method of choice for assessing extent of disease) 4
   • CT scan (for bone involvement)
   • Bone scintigraphy (may help identify multifocal involvement) 4

Treatment Considerations

For brucellosis with osteoarticular involvement, including rib pain:

• Combination antibiotic therapy is essential:

  • Doxycycline (100 mg twice daily) plus rifampicin for 3-6 months
  • Addition of an aminoglycoside (preferably streptomycin) for the first 2-3 weeks 5

• Duration of treatment:

  • At least 3 months for uncomplicated cases
  • 6 months or longer for complicated cases 5

Important Clinical Considerations

• Brucellosis should be considered in the differential diagnosis for patients with rib pain and fever, especially in endemic regions 1
• Early diagnosis and appropriate treatment are crucial to prevent complications 1
• MRI can help differentiate between pyogenic and brucellar bone involvement 1
• The nonpurulent nature of joint aspirates should raise suspicion for brucella arthritis 6

Prevention

To prevent brucellosis:

• Pasteurize dairy products
• Vaccinate livestock
• Use personal protective equipment when handling potentially infected animals
• Educate the public about risks of consuming unpasteurized dairy products 5

Remember that brucellosis remains a significant global health problem with 500,000 new cases reported annually, particularly in the Mediterranean, Middle East, Latin America, Western Asia, and parts of Africa 5.