Document Detail


Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis.
MedLine Citation:
PMID:  18181740     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Osteoarticular complications are the most common focal complications of brucellosis. Although vertebral osteomyelitis is the most frequent location in adults >30 years of age, little information is available about this serious complication of brucellosis, and great confusion surrounds its prognosis and the most appropriate treatment. METHODS: We undertook a descriptive, retrospective, observational study of 96 patients who received a diagnosis of brucella vertebral osteomyelitis from September 1982 through December 2005 at a tertiary care hospital. All of the patients were treated for 3 months, after which they were followed up monthly for the first 3 months and then at 2-month intervals for the subsequent 6 months. RESULTS: The incidence of vertebral osteomyelitis was 10.4%. The mean diagnostic delay was 12.7 weeks. Inflammatory spinal pain (occurring in 94.8% of patients) and fever (91.7%) were the most relevant clinical characteristics. Eight patients (8.3%) had motor weakness or paralysis. Paravertebral masses, epidural masses, and psoas abscesses were detected in 45.8%, 27.1%, and 10.4% of patients, respectively. Sixty-three patients (65.6%) received medication only, and 33 (34.4%) required surgical therapy in addition to medication. Twenty percent of patients experienced therapeutic failure. Attributable mortality was 2.1%, and severe functional sequelae were apparent in 6.2% of the patients. No significant differences were seen between patients who were treated with doxycycline-streptomycin and those treated with doxycycline-rifampicin. CONCLUSIONS: Vertebral osteomyelitis is a serious complication of brucellosis. It generates a high rate of therapeutic failure and functional sequelae. In the absence of more-powerful controlled studies, the duration of treatment of brucellar vertebral osteomyelitis should be 3 months.
Authors:
Juan D Colmenero; Juan D Ruiz-Mesa; Antonio Plata; Pilar Bermúdez; Patricia Martín-Rico; María I Queipo-Ortuño; José M Reguera
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  46     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-09     Completed Date:  2008-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  426-33     Citation Subset:  IM    
Affiliation:
Infectious Diseases Service, Carlos Haya University Hospital, Málaga, Spain. jdcolmenero@telefonica.net
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MeSH Terms
Descriptor/Qualifier:
Brucella / isolation & purification*
Brucellosis / microbiology,  pathology*,  therapy
Female
Humans
Male
Middle Aged
Osteomyelitis / microbiology*,  pathology,  therapy
Retrospective Studies
Spinal Diseases / microbiology*,  therapy
Spine / microbiology*,  pathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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