Acta Neurochirurgica

, Volume 148, Issue 10, pp 1033–1044 | Cite as

Spinal brucellosis: Turkish experience based on 452 cases published during the last century

  • M. Turgut
  • A. T. Turgut
  • U. Koşar
Clinical Article

Summary

Background. Spinal brucellosis continues to be the leading cause of morbidity from infectious disease in the infested regions of the world, particularly in the rural areas including Turkey. The purpose of this review was to present the Turkish experience by analyzing the literature on the management of spinal brucellosis during the last century.

Materials and method. To establish new guidelines for the diagnosis and treatment of this disabling health problem, publications reported from Turkey in national (n = 27) and international (n = 37) journals during the last century and databases containing medical literature were analysed.

Results. It was observed that the number of articles produced by Turkish authors regarding spinal brucellosis has tremendously increased throughout the study period. Although the total number of reported cases with spinal brucellosis from a total of 34 secondary or tertiary referral centers in Turkey was 452, only cases having detailed information were evaluated for further analysis according to inclusion/exclusion criteria. Despite the inherent limitations, this type of study clearly indicates that the incidence of brucellosis has not decreased in Turkey over recent years. The clinical and radiological findings of brucellosis involving the spine were mostly atypical and it was difficult to diagnose this infectious disease owing to its nonspecific and variable clinical picture. Therefore, it may easily lead to a misdiagnosis of lumbar disc herniation or other spinal infections and a high index of suspicion is required to diagnose this condition in endemic parts of the world. In addition to serological tests, CT and/or MRI techniques were found to be sensitive for diagnosis and follow-up because they provide early diagnosis of lesions involving the spine and more accurate localization of intraspinal and paraspinal infestation by means of multiplanar images. Histologically, noncaseating granulomatous tissue and chronic inflammation were characteristic features of cases of brucellosis with spinal involvement.

Conclusions. Based on this critical review of literature from Turkey, it is concluded that early diagnosis and correct management are important to prevent the harmful effects of brucellosis and its complications, and that the treatment of choice is antibiotic therapy alone in most cases of brucellosis involving the spine.

Keywords: Spinal brucellosis; radiology; spondylitis; spinal surgery; antibiotic therapy; Turkey. 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Acar, Ü, Güner, M, Yücesoy, K, Yüce, A, Yücesoy, M, Mertol, T 1995Brucellosis imitating discal herniaTr J Med Sci235762Google Scholar
  2. Aguilar, JA, Elvidge, AR 1961Intervertebral disc disease caused by the brucella organismJ Neurosurg182733PubMedCrossRefGoogle Scholar
  3. Akdeniz, H, Irmak, H, Anlar, Ö, Demiröz, AP 1998Central nervous system brucellosis: presentation, diagnosis and treatmentJ Infect36297301PubMedCrossRefGoogle Scholar
  4. Ariza, J, Gudiol, F, Valverde, R, Pallares, R, Fernandez-Viladrich, P, Rufi, G, Espadaler, L, Fernandez-Nogues, F 1985Brucellar spondylitis: a detailed analysis based on current findingsRev Infect Dis7656664PubMedGoogle Scholar
  5. Arslantaş A, Kerimoğlu A, Durmaz R, Coşan E, Atasoy M, Tel E (2002) Epidemiology and treatment of spinal infections (in Turkish). Annual Meeting of Turkish Neurosurgical Society, June 03–08, 2002, İstanbul, Turkey; Congress Book, PS 43Google Scholar
  6. Aygen, B, Sümerkan, B, Kardaş, Y, Doğanay, M, İnan, M 1995Brucellosis: an evaluation of 183 cases (in Turkish)Klimik Derg81316Google Scholar
  7. Bağrıaçık, N, Öker, C, Biyal, F 1969A case of disturbance of glucoregulation in the course of an infection with Brucella (in Turkish)Türk Tıp Cemiyeti Mecmuası35136144PubMedGoogle Scholar
  8. Bahemuka, M, Shemena, AR, Panayiotopoulos, CP, Al-Aska, AK, Obeid, T, Daif, AK 1988Neurological syndromes of brucellosisJ Neurol Neurosurg Psychiatry5110171021PubMedCrossRefGoogle Scholar
  9. Başaranoğlu, M, Mert, A, Tabak, F, Kanberoğlu, K, Aktuğlu, Y 1999A case of cervical Brucella spondylitis with paravertebral abscess and neurological deficitsScand J Infect Dis31214215PubMedCrossRefGoogle Scholar
  10. Bashir, R, Al-Kawi, MZ, Harder, EJ, Jinkins, J 1985Nervous system brucellosis: diagnosis and treatmentNeurology3515761581PubMedGoogle Scholar
  11. Bayındır, Y, Sönmez, E, Aladağ, A, Büyükberber, N 2003Comparison of five antimicrobial regimens for the treatment of brucellar spondylitis: a prospective, randomized studyJ Chemother15466471PubMedGoogle Scholar
  12. Baykaner, K, Çeviker, N, Şener, L, Göksel, HM, Alp, H 1989Brucellosis in neurosurgery. Two cases of brucellosis presenting with major neurological signs and symptoms (in Turkish)Türk Nöroşir Der17881Google Scholar
  13. Bezircioğlu, H, Sucu, HK, Güvenç, G, Tektaş, Ş 1994Spinal tuberculosis, spinal brucellosis and nonspecific spinal infections (in Turkish)İzmir Devlet Hastanesi Tıp Dergisi32156162Google Scholar
  14. Bingöl, A, Yücemen, N, Meço, O 1999Medically treated intraspinal “Brucella” granulomaSurg Neurol52570576PubMedCrossRefGoogle Scholar
  15. Bodur H, Çevik MA, Erbay A, Sayılır K (2001) Three cases of brucellosis with discitis (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, p 340Google Scholar
  16. Bodur, H, Erbay, A, Çolpan, A, Akıncı, E 2004Brucellar spondylitisRheumatol Int24221226PubMedCrossRefGoogle Scholar
  17. Bucher, A, Gaustad, P, Pape, E 1987Chronic neurobrucellosis due to Brucella melitensisJ Neurol Neurosurg Psychiatry5017071708Google Scholar
  18. Çapar, Y, Cesur, S, Yüksel, O, Kurt, H, Sözen, TH 2002Case report: psoas abscess due to brucellosis (in Turkish)Mikrobiyol Bul36219221PubMedGoogle Scholar
  19. Cesur, S, Çiftçi, A, Sözen, TH, Tekeli, E 2002Case report: brucellosis complicated by epididymo-orchitis and paravertebral abscessMikrobiyol Bul369598PubMedGoogle Scholar
  20. Cesur, S, Çiftçi, A, Sözen, TH, Tekeli, E 2003A case of epididymo-orchitis and paravertebral abscess due to brucellosisJ Infect46251253PubMedCrossRefGoogle Scholar
  21. Çeviker, N, Baykaner, K, Göksel, M, Şener, L, Alp, H 1989Spinal cord compression due to Brucella granulomaInfection17304305PubMedCrossRefGoogle Scholar
  22. Çokça, F, Meço, O, Arasıl, E, Ünlü, A 1994An intramedullary dermoid cyst due to Brucella abortus biotype 3 at T11-L2 spinal levelsInfection22359360PubMedCrossRefGoogle Scholar
  23. Çokça F, Solak S, Meço O (1997) A case of brucellosis with cervical spondylitis and epidural abscess (in Turkish). VIIth Congress of Turkish Clinical Microbiology and Infection Diseases, October 6–10, 1997, Antalya, Turkey, Congress Book p 622Google Scholar
  24. Colmenero, JD, Reguera, JM, Martos, F, Sanchez-De-Mora, D, Delgado, M, Causse, M, Martin-Farfan, A, Juarez, C 1996Complications associated with Brucella melitensis infection: a study of 530 casesMedicine75195211PubMedCrossRefGoogle Scholar
  25. Çoşkun, E, Süzer, T, Yalçın, N, Tahta, K 1998Spinal extradural compression caused by granuloma of brucellosisScand J Infect Dis30311313PubMedCrossRefGoogle Scholar
  26. Dalmak, S, Erek, E, Altıparmak, MR, Ülkü, U 1996A porter with pain in his neckLancet348444PubMedCrossRefGoogle Scholar
  27. Demirci, I 2003Brucella diskitis mimicking herniation without spondylitis; MRI findingsZentralbl Neurochir64178181PubMedCrossRefGoogle Scholar
  28. Demirci, M, Tan, E, Durguner, M, Zileli, T, Eryılmaz, M 1989Spinal brucellosis. A case with “cauliflower” appearance on CTNeuroradiology31282283PubMedCrossRefGoogle Scholar
  29. Demirtürk N, Karaaslan T, Aktepe OC (2001) A case of brucellosis with spondylitis and epidural abscess (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, pp 340–341Google Scholar
  30. HB Diren (1992) Spinal infections (in Turkish). Magnetic resonance imaging. Ünal Ofset, AnkaraGoogle Scholar
  31. Doyduk E, Özgüneş I, Usluer G, Çolak H, Nayman S (2001) Complications of brucellosis: a study of 61 cases (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, p 357Google Scholar
  32. Duyur, B, Erdem, HR, Özgöçmen, S 2001Paravertebral abscess formation and knee arthritis due to brucellosis in a patient with rheumatoid arthritisSpinal Cord39554556PubMedCrossRefGoogle Scholar
  33. Ertem, GC, Tanyel, E, Tülek, N, Ulkar, GB, Doğancı, L 2004Osteoarticular involvement of brucellosis and HLA-B27 antigen frequency in Turkish patientsDiagn Microbiol Infect Dis48243245PubMedCrossRefGoogle Scholar
  34. Ganado, W, Craig, AJ 1958Brucellosis myelopathyJ Bone Joint Surg [Am]4013801388Google Scholar
  35. Geyik, MF, Gür, A, Nas, K, Çevik, R, Saraç, J, Dikici, B, Ayaz, C 2002Musculoskeletal involvement of brucellosis in different age groups: a study of 195 casesSwiss Wkly13298105Google Scholar
  36. Gotuzzo, E, Seas, C, Guerra, JG, Carrillo, C, Bocanegra, TS, Calvo, A, Castaneda, O, Alarcon, GS 1987Brucellar arthritis: a study of 39 Peruvian familiesAnn Rheum Dis46506509PubMedCrossRefGoogle Scholar
  37. Gök, A, Sırmatel, F, Bayram, M 1992Vertebral osteomyelitis and spinal epidural inflamation due to brucellosisErciyes Tıp Dergisi14123126Google Scholar
  38. Gökay, HK 1962Brucellosis and intervertebral disc disease (in Turkish)Tıb Dünyası35163165Google Scholar
  39. Gül, S, Danacı, M, Kücükardalı, Y, Kandemir, EG, Başak, M, Özkan, Y 1995Brucellosis: five cases with atypical clinical courseKlimik Derg81719Google Scholar
  40. Gülek B, Börüban S, Kavuncu I, Sucak G, Inal S, Toğal A (2002) Cervical brucellosis (in Turkish). XXIIIrd National Congress of Radiology, November 5–8, 2002, Antalya, Turkey, Congress Book, E 124Google Scholar
  41. Gür, A, Geyik, MF, Dikici, B, Nas, K, Çevik, R, Saraç, J, Hoşoğlu, S 2003Complications of brucellosis in different age groups: a study of 283 cases in Southeastern Anatolia of TurkeyYonsei Med J443344PubMedGoogle Scholar
  42. Harman, M, Ünal, O, Onbaşı, KT, Kıymaz, N, Arslan, H 2001Brucellar spondylodiscitis: MRI diagnosisClin Imaging25421427PubMedCrossRefGoogle Scholar
  43. Helvacı, M, Kasırga, E, Çetin, N, Yaprak, I 2002Intramedullary spinal cord abscess suspected of Brucella infectionPediatr Int44446448PubMedCrossRefGoogle Scholar
  44. Inal AS, Taşova Y, Saltoğlu N, Şeki T, Dündar IH (2001) Brucellar sacroiliitis (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, p 366Google Scholar
  45. Kılıç, T, Özer, AF, Özgen, S, Pamir, MN 1995Brucellar spondylitis mimicking lumbar disc herniation. Case reportParaplegia33167169PubMedGoogle Scholar
  46. Lifeso, RM, Harder, E, McCorkell, SJ 1985Spinal brucellosisJ Bone Joint Surg67345351Google Scholar
  47. Mousa, AM, Bahar, RH, Araj, GF, Koshy, TS, Muhtaseb, SA, Al-Mudallal, DS, Marafie, AA 1990Neurological complications of brucella spondylitisActa Neurol Scan811623CrossRefGoogle Scholar
  48. Naderi, S, Yücesoy, K, Mertol, T, Arda, MN 2000Epidural Brucella abscess. Report of a spinal brucellosis manifesting itself with epidural abscessNeuro-Orthopedics281115Google Scholar
  49. Namiduru, M, Karaoğlan, I, Gürsoy, S, Beyazıt, N, Sırıkçı, A 2004Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patientsRheumatol Int24125129PubMedCrossRefGoogle Scholar
  50. Namiduru, M, Karaoğlan, I, Yılmaz, M 2003Guillain-Barre syndrome associated with acute neurobrucellosisInt J Clin Pract57919920PubMedGoogle Scholar
  51. Nas, K, Gür, A, Kemaloğlu, MS, Geyik, MF, Cevik, R, Buke, Y, Ceviz, A, Saraç, AJ, Aksu, Y 2001Management of spinal brucellosis and outcome of rehabilitationSpinal Cord39223227PubMedCrossRefGoogle Scholar
  52. Özaksoy, D, Yücesoy, K, Yücesoy, M, Kovanlıkaya, İ, Yüce, A, Naderi, S 2001Brucellar spondylitis: MRI findingsEur Spine J10529533PubMedCrossRefGoogle Scholar
  53. Özateş, M, Özkan, U, Bukte, Y, Ceviz, A, Sarı, I, Şimşek, M 1999Lumbar epidural brucellar abscess causing nerve root compressionSpinal Cord37448449PubMedCrossRefGoogle Scholar
  54. Özerbil, OM, Ural, O, Topatan, HI, Erongun, U 1998Lumbar spinal root compression caused by Brucella granulomaSpine23491493PubMedCrossRefGoogle Scholar
  55. Özgöçmen, S, Ardıçoğlu, Ö 1998Spinal nerve root compression due to Brucella disc infection. A case reportEur J Phys Med Rehabil8133135Google Scholar
  56. Özgöçmen, S, Ardıçoğlu, Ö 1999Osteoarticular brucellosisAPLAR J Rheumatol3322325Google Scholar
  57. Özgöçmen, S, Ardıçoğlu, A, Kocakoç, E, Kiriş, A, Ardıçoğlu, Ö 2001Paravertebral abscess formation due to brucellosis in a patient with ankylosing spondylitisJoint Bone Spine68521524PubMedCrossRefGoogle Scholar
  58. Özgöçmen, S, Yılmaz, N, Ardıçoğlu, O, Erdem, HR 1999Brucella disc infection mimicking lumbar disc herniation: a case reportKaohsiung J Med Sci15710714PubMedGoogle Scholar
  59. Rajapakse, CAN, Karim Al-Aska, A, Al-Orainey, I, Halim, K, Arabi, K 1987Spinal brucellosisBr J Rheumatol262831PubMedGoogle Scholar
  60. Roberts, A, Kemp, C 2001Brucellosis (Mediterranean fever, Gibralter fever, Malta fever, Cyprus fever, undulant fever, typhomalarial fever)J Am Acad Nurse Pract13106107PubMedCrossRefGoogle Scholar
  61. Saraç, J, Erdoğan, F, Şendur, ÖF 1989Involvement of joint in Brucella (in Turkish)Dicle Üniversitesi Tıp Fakültesi Dergisi16190196Google Scholar
  62. Şahinbeyoğlu B, Tekiner A, Çaylı S, Koçak A, Aladağ A, Karayol A, Tektaş Ş, Kırımlıoğlu H (2001) Paraplegia due to thoracic brucellar granuloma: case report (in Turkish). XVth National Congress of Turkish Neurosurgical Society, May 22–26, 2001, Antalya, Turkey, Congress Book, p 293Google Scholar
  63. Şendur, ÖF, Erdoğan, F, Bakırcı, N 1989Localization features of Brucella arthropathy (in Turkish)Dicle Üniversitesi Tıp Fakültesi Dergisi16174179Google Scholar
  64. Sharif, HS, Aideyan, OA, Clark, DC, Madkour, MM, Aebed, MY, Mattsson, TA, Al-Deeb, SM, Moutaery, KR 1989Brucellar and tuberculous spondylitis: comparative imaging featuresRadiology171419425PubMedGoogle Scholar
  65. Talı, T 2001Imaging of spinal infectious diseasesRivista di Neuroradiologia14177187Google Scholar
  66. Talı, T 2004Spinal infectionsEur J Radiol50120133PubMedCrossRefGoogle Scholar
  67. Tanakol, R, Tanakol, M, Aral, O, Alpan, H, Demirhan, M 1990Comparative trial of tetracycline plus rifampin in the therapy of brucellosis with musculoskeletal system involvement (in Turkish)Klimik Derg33032Google Scholar
  68. Taşbakan, MI, Yamazhan, T, Gökengin, D, Arda, B, Serpolat, M, Ulusoy, S, Ertem, E, Serter, D 2003Brucellosis: a retrospective evaluationTrop Doct33151153PubMedGoogle Scholar
  69. Taşova, Y, Saltoğlu, N, Şahin, G, Aksu, HSZ 1999Osteoarticular involvement of brucellosis in TurkeyClin Rheumatol18214219PubMedCrossRefGoogle Scholar
  70. Tekkök, İH, Berker, M, Özcan, OE, Özgen, T, Akalın, E 1993Brucellosis of the spineNeurosurgery33838844PubMedCrossRefGoogle Scholar
  71. Tünger Ö, Arısoy AS, Özbakkaloğlu B, Temiz C, Borand H (2001) A case of brucellosis with psoas abscess (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, p 359Google Scholar
  72. Tur, BS, Suldur, N, Ataman, S, Özyurt, EA, Bingöl, A, Atay, MB 2004Brucellar spondylitis: a rare cause of spinal cord compressionSpinal Cord42321324PubMedCrossRefGoogle Scholar
  73. Turgut, M, Çullu, E, Şendur, ÖF, Gürer, G 2004Brucellar spine infection – four case reportsNeurol Med Chir (Tokyo)44562567CrossRefGoogle Scholar
  74. Turgut, M, Şendur, ÖF, Gürel, M 2003Brucellar spondylodiscitis in the lumbar region. Case reportNeurol Med Chir (Tokyo)43210212CrossRefGoogle Scholar
  75. Türker N, Erbay A, El S, Kaptan F, Müftüoğlu I, Ural S, Vardar I, Coşkun NA (2001) Study of spondylitis and spondylodiscitis in patients with brucellosis using magnetic resonance imaging (in Turkish). Xth Congress of Turkish Clinical Microbiology and Infection Diseases, October 15–19, 2001, Adana, Turkey, Congress Book, p 340Google Scholar
  76. Turkish Ministry of Health (2001) Report of Division of Communicable Diseases (in Turkish). Turkish MoH, AnkaraGoogle Scholar
  77. Türkmen, CS 2001

    Spinal infections and outcome (in Turkish)

    Palaoğlu, S eds. Spinal InfectionsMeta Basımİzmir245271
    Google Scholar
  78. Ulaş, UH, Hamamcıoğlu, K, Eroğlu, E, Odabaşı, Z, Alanoğlu, E, Demirkaya, S, Görenek, L, Vural, O 2003Paraplegia associated with brucellosis involving the anterior lumbosacral nerve rootsJ Peripher Nerv Syst8812PubMedGoogle Scholar
  79. Ünal, O, Özçakar, L, İnancı, F 2004Magnetic resonance imaging: a sine qua non in the diagnosis of brucella spondylitisClin Rheumatol23473474PubMedCrossRefGoogle Scholar
  80. Yıldırım, RC, Afşar, OZ, Eker, L 1997Brucellosis in the World and Turkey (in Turkish)Sürekli Tıp Eğitimi Dergisi6189192Google Scholar
  81. Yıldız, B 1994Epidural abscess and granulation tissue formation in Brucella spondylitis: a case reportTürk Nöroşir Derg44951Google Scholar
  82. Young, EJ 2000

    Brucella species

    Mandell, GLBennett, JEDolin, R eds. Principles and practice of infectious diseasesChurchill LivingstoneNew York23862393
    Google Scholar
  83. Zekai,  1932Case with Malta fever (in Turkish)Askeri Sıhhiye Mecmuası617378Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • M. Turgut
    • 1
  • A. T. Turgut
    • 2
  • U. Koşar
    • 2
  1. 1.Department of NeurosurgeryAdnan Menderes University School of MedicineAydınTurkey
  2. 2.Department of RadiologyAnkara Training and Research HospitalAnkaraTurkey

Personalised recommendations