Lebre Ana, Velez Jorge, Seixas Diana, Rabadão Eduardo, Oliveira Joaquim, Saraiva da Cunha J, Silvestre A Meliço
Serviço de Doenças Infecciosas. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal..
Serviço de Infecciologia. Centro Hospitalar do Baixo Vouga. Aveiro. Portugal.
Acta Med Port. 2014 Mar-Apr;27(2):204-10. Epub 2014 Apr 30.
Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy.
Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period (1988-2012).
We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring.
Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial.
Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.
布鲁氏菌病是葡萄牙的一种地方性人畜共患病。布鲁氏菌性脊椎间盘炎是最常见的局灶性表现之一，尽管进行了适当治疗，仍可能导致严重后遗症。
对科英布拉大学中心医院传染病科收治的诊断为布鲁氏菌性脊椎间盘炎的患者进行回顾性研究，研究时间跨度为25年（1988 - 2012年）。
我们确定了54例患者，其中男性占55.6%，平均年龄54.8岁。81.5%的患者有流行病学背景，主要是与绵羊和山羊接触。诊断前症状持续时间为5.5个月。最常见的体征和症状是疼痛（98.1%）、发热（46.3%）和神经功能缺损（25.9%）。脊柱磁共振成像（MRI）是最常用的成像方法（77.8%），29.6%的患者显示有脓肿。腰椎部位最为常见（77.7%）。47例患者（87.0%）得以确诊：血培养阳性（3例）、血清学阳性（32例）或两种方法均阳性（12例）。最常用的联合治疗方案是多西环素和利福平（64.8%），或链霉素（24.1%），平均疗程为4.4个月。有1例患者因脓肿引流接受了手术治疗。病情转归大多良好（92.6%），无死亡病例。
流行病学背景调查是确诊的关键因素。骨关节布鲁氏菌病的治疗仍存在争议。
即使没有发热，对于腰痛患者的鉴别诊断也应考虑布鲁氏菌性脊椎间盘炎，特别是在该病的地方性流行地区。抗生素治疗方案、疗程及手术需求应个体化，以获得更好的预后。多年来病例数有所下降，这与动物疫病的更好控制有关。
