Neurological complications of brucella spondylitis

Abstract

Twenty‐two patients with brucella spondylitis and neurobrucellosis were studied during a 2‐year period. The diagnosis was based on history of exposure, compatible signs and symptoms, high antibody titre and/or positive culture of a clinical specimen(s). Spondylitis was confirmed by plain radiographs, bone scan, CT and in some cases by histology. Neurobrucellosis was confirmed by CSF examination and culture, myelography, NCV, EMG and CT head. The spondylitis was early in 4 cases, chronic active in 12, smouldering “partially healed”in 3 and healed in 3 cases. Of these, 15 patients (68%) had neurological complications of various types. Plain radiographs were not a good index of activity of spondylitis. Tc99 bone scan was not specific and it remained positive long after the completion of therapy. CT was superior in revealing details of bone destruction, soft tissue swelling and entrapment of nerve roots and cord. The 3 modalities were complementary. Spondylitis is commonly associated with neurobrucellosis and symptoms of one may over shadow those of the other and in some cases neurobrucellosis may be subclinical. In all cases of spondylitis, a thorough search for neurobrucellosis should be made and vice versa. Prolonged treatment with a combination of 3 antibrucella drugs is recommended and prolonged follow‐up is necessary.

Non-pyogenic infections of the spine

“…Brucella melitensis is relatively prevalent in the Mediterranean basin [9,10], the Middle East [11,12] and Latin America [13]. Whilst in the USA only 200 cases of brucellosis are reported every year, it is the most frequent zoonosis in Spain [14].…”

Brucella: A Cause of Peripheral Neuropathy

“…In acute infections, neurological involvement is not specific, and headache, fatigue and myalgia are observed [1, 6]. Chronic neurobrucellosis occurs in 5–10% of diagnosed cases [6] including meningitis, encephalitis, myelitis and involvement of cranial or peripheral nerves alone or in combination [1, 2,6,7,8,9,10,11,12]. Demyelinization in spinal tracts and peripheral nerves has been reported [6].…”

A Rare Case of Brucella Spondylodiscitis Mimicking Lumbar Disc Herniation

“…Inflammation can then distribute to the entire vertebral body or to the intervertebral disc, causing spondylodiscitis. Literature regarding nerve root compression in brucellar spondylodiscitis involves complications such as epidural abscess, granuloma or discitis secondary to vertebral body involvement by brucellosis [1][2][3]. Brucellosis discitis as an infectious etiology of spinal root compression is uncommon.…”

“…Spinal brucellosis originates through a haematogenous route and infection usually initiates from the anterior superior endplate of a vertebra corpus due to the rich supply of blood in this area [1,2]. Inflammation can then distribute to the entire vertebral body or to the intervertebral disc, causing spondylodiscitis.…”