Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2019; 10(2): 54-62
Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.54
Osteoarticular manifestations of human brucellosis: A review
Seyed Mokhtar Esmaeilnejad-Ganji, Seyed Mohammad Reza Esmaeilnejad-Ganji
Seyed Mokhtar Esmaeilnejad-Ganji, Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mokhtar Esmaeilnejad-Ganji, Department of Orthopedics, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mokhtar Esmaeilnejad-Ganji, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mohammad Reza Esmaeilnejad-Ganji, Boston University School of Medicine, Boston, MA 02118, United States
Author contributions: Esmaeilnejad-Ganji SM contributed to study design; Esmaeilnejad-Ganji SM and Esmaeilnejad-Ganji SMR contributed to data collection and writing the draft; Esmaeilnejad-Ganji SM contributed to manuscript revision; all authors approved the final version of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seyed Mokhtar Esmaeilnejad-Ganji, MD, Associate Professor, Department of Orthopedics, Babol University of Medical Sciences, Ganjafrooz Street, Babol 47176-47745, Mazandaran, Iran. smsnganji@yahoo.com
Telephone: +98-11-32199936 Fax: +98-11-32190181
Received: November 14, 2018
Peer-review started: November 15, 2018
First decision: November 29, 2018
Revised: November 30, 2018
Accepted: December 17, 2018
Article in press: December 17, 2018
Published online: February 18, 2019
Processing time: 96 Days and 15.3 Hours
Abstract

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Keywords: Brucellosis; Brucella; Osteoarticular manifestations; Musculoskeletal pain; Bone; Joint

Core tip: The most frequent complication of brucellosis is osteoarticular involvement, with a rate of 10%-85%. Sacroiliac and spinal joints are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis. Brucellosis should be considered as a differential diagnosis for sciatica, back pain and septic arthritis in endemic regions.