Feng Qiangsheng, Song Yuejuan, Xing Yuan, Ha Xiaoqin
Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, China.
Front Cell Infect Microbiol. 2025 Jun 10;15:1611398. doi: 10.3389/fcimb.2025.1611398. eCollection 2025.
This study evaluates the diagnostic value of etiological and serological testing in distinguishing brucellosis arthropathy from other inflammatory joint diseases.
A retrospective analysis was conducted on 68 cases of brucellosis arthropathy diagnosed between 2012 and 2024, alongside 60 non-infected controls. Bacterial cultures were performed using blood, joint fluid-blood bottle culture, and joint tissue samples, with microbial identification via VITEK Compact-II or MALDI-TOF MS. Clinical features, serological results (Standard Agglutination Test [SAT] and Rose Bengal Test [RBT]), and imaging findings were analyzed. The diagnostic performance of biomarkers was assessed using receiver operating characteristic (ROC) curves.
Among the 68 cases, 22 (32.4%) were confirmed by bacterial culture, with Brucella melitensis identified as the causative agent. Joint fluid-blood bottle culture was the most effective method (62.2%), with a mean detection time of 74.8 ± 17.9 hours (range: 41-110 hours) in aerobic bottles. Blood culture and joint tissue culture yielded positive results in 40.9% and 4.5% of cases, respectively. Brucellosis arthropathy accounted for 7.5% of total brucellosis cases, predominantly affecting males (67.6%) with a median age of 43.1 ± 13.2 years. Brucellosis arthropathy infection median time were 90[30,343] days. The knee joint was the most commonly affected site (64.7%), followed by the hip (20.6%) and sacroiliac joints (10.3%). Imaging revealed septic arthritis (20.7%), joint effusion (31.0%), bone destruction (12.0%), degenerative changes (10.3%), and prosthetic joint infection (6.9%). The sensitivity for Brucella culture, SAT, and RBT were 69.7%, 87.7%, and 91.2%, respectively, with a combined sensitivity of 92.6%. ROC analysis identified CRP as a highly sensitive and specific biomarker (cutoff: 4.07 mg/mL; sensitivity: 84.2%, specificity: 72.2%; Z = 5.568, p < 0.001). All patients were treated with doxycycline and rifampicin for 3 months, with 34% requiring surgical intervention. The prognosis was satisfactory in all cases.
Brucellosis arthropathy, often chronic and predominantly affecting the knee and hip joints, presents with septic arthritis, joint effusion, and bone destruction on imaging. Diagnosis can be effectively achieved through aerobic joint fluid-blood bottle culture, SAT, and RBT. Early diagnosis and combined medical-surgical management yield favorable outcomes.
本研究评估病因学和血清学检测在区分布鲁氏菌病性关节炎与其他炎性关节疾病中的诊断价值。
对2012年至2024年间诊断的68例布鲁氏菌病性关节炎患者及60例未感染对照进行回顾性分析。采用血液、关节液血培养瓶培养及关节组织样本进行细菌培养，并通过VITEK Compact-II或MALDI-TOF MS进行微生物鉴定。分析临床特征、血清学结果（标准凝集试验[SAT]和虎红试验[RBT]）及影像学表现。使用受试者工作特征（ROC）曲线评估生物标志物的诊断性能。
68例患者中，22例（32.4%）通过细菌培养确诊，病原菌为羊布鲁氏菌。关节液血培养瓶培养是最有效的方法（62.2%），需氧瓶中的平均检测时间为74.8±17.9小时（范围：41 - 110小时）。血培养和关节组织培养的阳性率分别为40.9%和4.5%。布鲁氏菌病性关节炎占布鲁氏菌病总病例的7.5%，主要影响男性（67.6%），中位年龄为43.1±13.2岁。布鲁氏菌病性关节炎感染的中位时间为9〇[3〇,343]天。膝关节是最常受累部位（64.7%），其次是髋关节（20.6%）和骶髂关节（1〇.3%）。影像学表现为化脓性关节炎（20.7%）、关节积液（31.0%）、骨质破坏（12.0%）、退行性改变（1〇.3%）和人工关节感染（6.9%）。布鲁氏菌培养、SAT和RBT的敏感性分别为69.7%、87.7%和91.2%，联合敏感性为92.6%。ROC分析确定CRP为高度敏感和特异的生物标志物（临界值：4.07mg/mL；敏感性：84.2%，特异性：72.2%；Z = 5·568，P < 〇.〇〇1）。所有患者接受多西环素和利福平治疗3个月，34%的患者需要手术干预。所有病例预后良好。
布鲁氏菌病性关节炎通常为慢性，主要影响膝关节和髋关节，影像学表现为化脓性关节炎、关节积液和骨质破坏。通过需氧关节液血培养瓶培养、SAT和RBT可有效实现诊断。早期诊断及药物 - 手术联合治疗可取得良好疗效。
