Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases.

BACKGROUNDS: Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement. METHODS: This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey. RESULTS: A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement. CONCLUSION: A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.

Increased 18F-FAPI PET/CT Uptake in a Case of Brucellosis of Lumbar Vertebral Body.

ABSTRACT: Vertebral brucellosis is a relatively rare disease that usually emerges in animal husbandry areas. We report a case that brucellosis of lumbar vertebral body showed an intense uptake of FAPI on 18F-FAPI PET/CT, which mimics to malignant lesions or vertebral tuberculosis. It is an interesting finding to realize that vertebral brucellosis is also one of the reasons for intense uptake of FAPI.

Hepatic brucellosis detected by 18F-FDG PET/CT.

A 52-year old woman with fever of unknown origin underwent fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan for further evaluation. A clinical history of cervical cancer (CIS) operated 20 years ago was documented. Two foci in the right lobe of the slightly enlarged liver presented increased 18F-FDG uptake. Visceral brucellosis was diagnosed via blood culture. The patient received anti-brucella therapy and recovered rapidly, the liver lesions diminished on control CT.

Diffuse Neurobrucellosis of Cerebellum, Brainstem, Spinal Cord, and Cauda Equina: A case report and Literature review.

Neurobrucellosis is an uncommon serious complication of brucellosis. Diagnosis of neurobrucellosis could be difficult due to non-specific clinical and radiological findings. So, in endemic regions, neurobrucellosis should be included in the differential diagnosis list of patients with recent neurological disorders. We report an unusual case of neurobrucellosis with neurologic deficits in the central and peripheral nervous system and MRI lesions in the brainstem, spinal cord, and nerve roots Also, related articles are reviewed in the discussion section.

Isolated neurobrucellosis-characteristic clinical and laboratory features.

To report various neurological syndromes, CSF findings, imaging and diagnostic methods used in neurobrucellosis patients admitted in our Neurology department over a period of 6 years. Case records of patients admitted to our department from August 2014 to May 2020 were searched for neurobrucellosis and data were obtained. A total of 19 patients were diagnosed as neurobrucellosis over a period of 6 years. Ten patients had chronic meningitis, five had VIII nerve involvement, one had optic neuritis, two had acute meningitis, one had subacute meningitis, four had myelopathy, five had polyradiculitis and two had spondylodiscitis. CSF was abnormal in 17 patients. Neutrophilic pleocytosis was seen in 12 patients who included nine patients with chronic symptomatology. Brain imaging was abnormal in three chronic meningitis patients. One had diffuse meningeal enhancement, another had hydrocephalus while the third patient had meningeal enhancement with basal exudates and contrast enhancement of bilateral VIII nerve. One of the patients of acute meningitis had hydrocephalus while the other one had bilateral T2/FLAIR hyperintensities with enhancement of meninges and leptomeningeal vessels. Elevated antibody titers only in serum was seen in six patients while elevated antibody titers only in CSF was seen in seven patients. Four patients had elevated antibody titers in both serum and CSF. CSF culture was positive in three patients. Neurobrucellosis is a rare clinical complication of brucellosis but may pose a problem in diagnosis as it can mimic tuberculosis. Involvement of VIII nerve and neurophilic pleocytosis in CSF despite chronic symptomatology can be diagnostic clues favoring neurobrucellosis.

An Adolescent With Neurobrucellosis Caused by Brucella abortus Cattle Vaccine Strain RB51.

We present the case of an 18-year-old female with a 1-month history of fever, headache, and double vision, whose examination revealed papilledema and cranial nerve VI palsy. Blood cultures grew Brucella abortus cattle vaccine strain RB51, which is inherently resistant to rifampin. We discuss the management of the first known case of neurobrucellosis by this strain.

Brucella involving the heart: a hidden disease.

Brucellosis is a multisystemic disease with serious cardiac involvement mainly endocarditis. It is a lethal but rare complication involving congenital, prosthetic and even native valves. Positive hemoculture confirm the diagnosis. Brucella endocarditis is known for large vegetations and surgery is the treatment of choice. Abscess formation can be seen in untreated patients. An 80-year-old male patient presented with fever, cough and progressive shortness of breath for 14 days. His known history revealed a poorly treated brucellosis 18 months ago due to noncompliance. Four months later, he presented for recurrent fever. Physical examination showed a systolic aortic murmur radiating to the carotid. Blood cultures were negative; however, blocking antibodies were 1/2560. Echocardiography showed calcified aortic stenosis. Transesophageal echocardiogram (TEE) showed an abscess formation at the level of the non-coronary cusp. A quadritherapy was initiated involving Ceftriaxone, gentamicin, doxycycline, and trimethoprim-sulfamethoxazole (shortage in molecule replaced by ciprofloxacin). Patient underwent surgery. An aortic valve bioprostheses was successfully implanted one week after initiating antibiotics. Intraoperative cultures were negative. A post-operative transthoracic echocardiography revealed a moderate periprosthetic aortic leak with a mean gradient of 18mmHg. He was discharged 18 days following surgery on doxycycline, rifampicin, and ciprofloxacin for 3 more months, with adequate follow up. The challenge remains in the timing of diagnosis which affects the prognosis of the disease. Early diagnosis and effective medical and surgical management are essential.

Brucellosis aortitis: An interesting case.

A 24-year-old woman referred to our radiology department with the diagnosis of new positive blood culture brucellosis and severe aortic regurgitation for evaluation of periaortic thickening. Cardiac magnetic resonance imaging elegantly revealed the presence of active aortitis, most probably caused by brucellosis.

Safety and efficacy of polyetheretherketone (PEEK) cages in combination with one-stage posterior debridement and instrumentation in Lumbar Brucella Spondylitis.

OBJECTIVE: The aim of this study was to explore the efficacy and safety of surgical treatment of lumbar brucella spondylitis with PEEK cages combined with one-stage posterior debridement and instrumentation. METHODS: We performed a retrospective study for adult patients with lumbar brucella spondylitis. Medical records, imaging studies and laboratory data were collected, back pain was measured by employing the visual analog scale (VAS) and the neurological status was evaluated by using the American Spinal Injury Association (ASIA) scale. RESULTS: A total of 61 consecutive patients (42 males and 19 females) were enrolled with the mean age at presentation of 56.33 ±â€¯9.16 years old. L3-4 and L4-5 were the most infected levels with the ratios of 21.31 % and 19.67 % respectively. Moreover, 12 (19.67 %) patients suffered multiple-level infection and 5 (5/12, 41.67 %) of them had non-contiguous spondylitis. In addition, epidural masses were found in 26 (42.62 %) cases and psoas abscesses were found in 14 (22.95 %) cases. The number of operative segment depended on operation indications (failure of conservative measures, instability, kyphosis, intractable pain and/or neurological impairment). VAS scores were significantly improved at 6-weeks and the last follow-up. Among the 23 (37.70 %) patients with neurological deficits, 19 (19/23, 82.61 %) obtained a full recovery and 4 (4/23, 17.39 %) had been improved incompletely during the last follow-up. All patients exhibited satisfactory bone fusion during the last follow-up. Local infection of surgical site was identified in 6 (9.84 %) cases and no other surgery-related complications were found. CONCLUSION: Use of PEEK cages for interbody fusion is feasible and safe in patients suffering from lumbar brucella spondylitis.

Extensive Intraspinal Hypermetabolism Caused by Neurobrucellosis Shown on 18F-FDG PET/CT.

A 55-year-old man and a 52-year-old man presenting with neurological symptoms were referred for F-FDG PET/CT for the underlying malignancy. In both cases, extensive intraspinal hypermetabolism was observed in F-FDG PET/CT. The cerebrospinal fluid culture finally confirmed infection of Brucella. This report illustrates that neurobrucellosis may present as intraspinal hypermetabolism on F-FDG PET/CT, and thus it should be added to the differential diagnosis.

[Values of Apparent Diffusion Coefficient and Fractional Anisotropy in the Diagnosis of Brucella Spondylitis].

Objective To compare the differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between brucella spondylitis (BS) groups at different stages before treatment and the normal control group and to evaluate the change trend of ADC value and FA value at different time points before and after treatment. Methods Totally 53 patients suspected of BS by conventional magnetic resonance imaging (MRI) and later confirmed as BS patients by serological tests were enrolled in this study. These patients underwent conventional MRI and diffusion tensor imaging scans,and the ADC value and FA value were measured. Independent sample t test was used to compare the ADC value and FA value between the BS group and the control group,the ADC value and FA value between the BS group at each stage. Repeated measurement ANOV was used to compare the ADC values and FA values at different time points before and after treatment. Results FA imaging showed that the color code of BS was different from that of the normal control group,and the color code of FA imaging showed increased singal. The ADC values of BS in the acute,subacute,and chronic stages [(1.45±0.02)×10 -3 mm 2/s,(1.35±0.03)×10 -3 mm 2/s,(1.26±0.05)×10 -3 mm 2/s,respectively] were significantly higher than those in the control group [(1.06±0.09) ×10 -3 mm 2/s](t=2.538,P=0.009;t=1.998,P=0.032;t=1.575,P=0.004),and the FA value (0.55±0.02,0.65±0.03,0.71±0.04,respectively) were significantly lower than those of the control group (0.78±0.02) (t=2.440,P=0.012; t=1.847,P=0.041;t=2.102,P=0.003). Repeated measurement analysis showed that there were statistically significant differences in ADC values and FA values at different time points before and after treatment in the acute,subacute,and chronic stages (ADC:F=12.100,P<0.001;F=8.439,P=0.005;F=9.704,P=0.004,respectively;FA:F=7.080,P=0.002;F=6.607;P=0.003;F=8.868,P=0.001,respectively). The ADC values at different time points after treatment were significantly lower than those before treatment or at a previous time point after treatment (F=332.14,P<0.001),and the FA values were significantly higher than those before treatment or at a previous time point after treatment (F=134.26,P<0.001). Conclusions FA color code can intuitively display differences in BS and normal vertebral bodies and show change of color code before and after treatment. Also,the ADC values and FA values can quantitatively reveal differences between BS and normal vertebral body in different time points and quantify BS vertebral lesion changes before and after treatment. In particular,in BS patients who are recovering from treatment,it can quantify microscopic edema. Therefore,diffusion tensor imaging may be useful objective indicator in evaluating the effectiveness of a specific treatment for BS.

Three Cases of Brucellar Spondylitis with Noncontiguous Multifocal Involvement.

BACKGROUND: Brucellosis is an endemic disease. Brucellar spondylitis is mainly manifested as a unifocal lesion, but noncontiguous multifocal brucellar spondylitis is more rare. CASE DESCRIPTION: Herein, we report 3 patients with noncontiguous multifocal involvement of brucellar spondylitis who are over 51 years of age. The diagnosis was established by using magnetic resonance imaging (MRI) and positive brucellar agglutination test. All patients were cured with antibrucellosis chemotherapy and surgery. For patients with a high degree of suspicion of noncontiguous multifocal brucellar spondylitis, especially elderly patients, screening with the use of serologic test for brucellosis and whole spine MRI is crucial to reduce the rate of misdiagnosis and missed diagnosis. CONCLUSIONS: Clinicians should raise awareness of noncontiguous multifocal brucellar spondylitis. The Wright agglutination test and whole spine MRI are the key methods to reduce misdiagnosis and missed diagnosis of noncontiguous multifocal brucellar spondylitis. Drug therapy for brucellar spondylitis is the basis, and surgical treatment is complementary therapy. The use of alternative chemotherapy and surgery for noncontiguous multifocal brucellar spondylitis is also safe and effective.

Bruceloma hepático: manifestación infrecuente de una enfermedad endémica / Hepatic Brucelloma: uncommon manifestation of an endemic disease

Se presenta el caso de un varón de 44 años de edad, que consultó por fiebre de origen desconocido de dos semanas de evolución. Los cultivos revelaron la presencia del microorganismo Brucella Canis.

Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis.

PURPOSE: Both pyogenic spondylitis (PS) and brucellar spondylitis (BS) can cause deformities and permanent neurologic deficits without prompt diagnosis and treatment. However, differential diagnosis is challenging. The aim of this study was to compare the computed tomography (CT) imaging features of PS with those of BS. METHODS: Thirty-two patients with PS and 44 with BS were enrolled in the study. CT images were obtained in all cases. Data on bone destruction and formation, vertebral wall destruction, and osteosclerotic changes were collected and compared using the Chi-square test or t test. A P value < 0.01 was considered statistically significant. Positive predictive values (PPV) for detecting PS or BS were reported. RESULTS: Involvement of the lumbar vertebrae and multiple spinal levels was more common in the BS group than in the PS group. Bone destruction was significantly greater in the PS group than in the BS group (30.8 vs 18.0%; t = 3.920, P = 0.000), with more extensive destruction of the vertebral body (35.8 vs 12.5%, χ2 = 12.672, P = 0.002, PPV = 63.16%). In the BS group, there was more osteosclerosis around erosions (70.5 vs 43.3%, χ2 = 11.59, P = 0.001, PPV = 67.74%) and fan-shaped osteosclerosis (27.3 vs 19.4%, χ2 = 18.556, P = 0.006, PPV = 64.86%), more bone formation around the vertebra (77.2 vs 34.3%, χ2 = 33.608, P = 0.000, PPV = 76.83%), more bone formation under the anterior longitudinal ligament (63.6 vs 19.4%, χ2 = 30.133, P = 0.000, PPV = 76.09%), more longer anterior bone formation (3.55 vs 0.78 mm, t = 3.997, P = 0.000), and more anterior and closed-bone formation with local erosion (42.0 vs 9.0%, χ2 = 74.243, P = 0.000, PPV = 74.36%). CONCLUSIONS: CT images have unique advantages of revealing the morphology of erosions, osteosclerosis, and bone formation around the vertebra and help to differentiate PS from BS. These slides can be retrieved under Electronic Supplementary Material.

Brucella and non-Brucella epididymo-orchitis: comparison of ultrasound findings.

AIM: In brucellosis the male genitourinary system can be affected in a small number of patients. In this study we aimed to identify, discuss and compare the radiologic findings of 24 cases with Brucella epididymo-orchitis (BEO) and 285 cases with non-Brucella epididymis orchitis (NBEO). MATERIAL AND METHODS: The study had a retrospective design. The area of involvement, side of involvement (left, right or bilateral), presence of abscess, hydrocele and testicular involvement pattern were analyzed and compared between the BEO and NBEO cases. RESULTS: The median age of the included cases was 33 years, with a minimum of 0 and maximum of 89. Epididymo-orchitis and isolated orchitis were more frequent in BEO cases while isolated epididymis involvement was more common in patients with non-BEO (p=0.0117). Bilateral involvement was present in 20.8% and 4.6% cases in the BEO and non-BEO groups, respectively (p=0.008). The frequency of abscess was significantly higher in BEO cases (p=0.003). CONCLUSION: Although the radiological indications of BEO are similar to those of other types of epididymo-orchitis, abscess formation, bilateral involvement and testicular involvement contribute significantly to diagnosis.

Brucellosis, an uncommon cause of acute acalculous cholecystitis: two new cases and concise review.

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.