Infection and Drug Resistance (Jun 2019)
Spinal brucellosis in Hulunbuir, China, 2011–2016
Abstract
Chen Liang,1,2,* Wei Wei,3,* Xiuwen Liang,1,2 Enjin De,1,2 Beiwen Zheng41Department of Brucellosis, Hulunbuir People’s Hospital, Hulunbuir, People’s Republic of China; 2School of Medicine, Inner Mongolia University for Nationalities, Hulunbuir, People’s Republic of China; 3Hulunbuir Center for Disease Control and Prevention, Hulunbuir, People’s Republic of China; 4Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China*These authors contributed equally to this work Purpose: To investigate the demographic, epidemiological, clinical, and laboratory characteristics; treatment options; and outcome of human brucellosis with spine involvement at a major hospital in Hulunbuir, a brucellosis epidemic region of China.Patients and methods: A total of 842 patients with human brucellosis treated in the Department of Brucellosis, Hulunbuir People’s Hospital from January 2011 to December 2016 were included and analyzed in this study. The results of 67 brucellar spondylodiscitis (BS) cases were compared with those that were negative for spine involvements.Results: The mean age of spinal brucellosis patients was 50.5±10.2 years (43 males and 24 females; age range 29–70). The risk factors for transmission are direct contact with animals, such as working in the farm, and consumption of unpasteurized milk or daily products. Back pain (92.5%), fever (85.1%), sweating (62.7%), and fatigue (52.8%) were the most common symptoms. Magnetic resonance imaging (MRI) was performed in all the patients with spondylodiscitis. The sites of involvement were lumbar (81.2%), thoracic (8.7%), cervical (4.3%), thoracolumbar (2.9%), and lumbosacral (2.9%). All isolates from blood culture were identified as Brucella melitensis, with 61% biovar 3 and 39% biovar 1 isolates. The antimicrobial therapy for BS lasted for at least 3 months. In the presence of paravertebral or epidural abscess, longer treatment was conducted to avoid possible sequelae.Conclusion: In endemic areas such as Hulunbuir, BS should be considered in patients with back pain and fever. MRI is a highly sensitive imaging modality that can be used to differentiate BS from other spinal infections. This study will be helpful to establish strategies for prevention, surveillance, and management of spinal brucellosis in China.Keywords: brucellosis, spine, spondylitis, brucella melitensis, treatment outcome
