Brucellar Spondylodiscitis: Case Series of the Last 25 Years
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117 |
Resumo: | Introduction: 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.Material and Methods: 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).Results: 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.Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial.Conclusions: 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. |
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Brucellar Spondylodiscitis: Case Series of the Last 25 YearsEspondilodiscite Brucélica: Casuística dos Últimos 25 AnosIntroduction: 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.Material and Methods: 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).Results: 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.Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial.Conclusions: 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.Introdução: A brucelose é uma zoonose endémica em Portugal, sendo a espondilodiscite brucélica uma das manifestações focaismais frequentes. Pode provocar sequelas graves, apesar da terapêutica dirigida.Material e Métodos: Estudo retrospectivo dos processos dos doentes com espondilodiscite brucélica, internados no Serviço de Doenças Infecciosas do Centro Hospitalar e Universitário de Coimbra, num período de 25 anos (1988-2012).Resultados: Foram identificados 54 doentes, 55,6% do sexo masculino, com idade média de 54,8 anos. Em 81,5% identificou-se contexto epidemiológico, maioritariamente contacto com gado ovino e caprino. A duração da sintomatologia prévia ao diagnóstico foi de 5,5 meses. Os sinais e sintomas mais frequentes foram: dor (98,1%), febre (46,3%) e défices neurológicos (25,9%). A ressonância magnética nuclear da coluna foi o exame imagiológico mais usado (77,8%) evidenciando abcessos em 29,6% dos doentes. A localizaçãolombar predominou (77,7%). O diagnóstico etiológico foi confirmado em 47 doentes (87,0%): microbiologicamente (3 doentes), serologicamente (32 doentes) ou por ambos (12 doentes). As associações de doxiciclina com rifampicina (64,8%), ou estreptomicina (24,1%) foram as mais utilizadas, com duração média de 4,4 meses de tratamento. Um doente teve indicação cirúrgica para drenar abcesso. A evolução foi maioritariamente favorável (92,6%), sem óbitos.Discussão: A investigação de contexto epidemiológico revelou ser uma peça importante na suspeita do diagnóstico. O tratamento da brucelose osteoarticular ainda é controverso.Conclusões: A espondilodiscite brucélica deve ser considerada no diagnóstico diferencial dos doentes com lombalgia, mesmo naausência de febre, particularmente em regiões onde a doença é endémica. O esquema antibiótico, sua duração e a necessidade de cirurgia deverão ser individualizados, com vista a um melhor prognóstico. O número de casos tem diminuído ao longo dos anos, facto relacionado com melhor controlo da endemia animal.Ordem dos Médicos2014-03-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfimage/jpegapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117oai:ojs.www.actamedicaportuguesa.com:article/4117Acta Médica Portuguesa; Vol. 27 No. 2 (2014): March-April; 204-210Acta Médica Portuguesa; Vol. 27 N.º 2 (2014): Março-Abril; 204-2101646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/3952https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/4114https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6907https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6908https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6909https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6910https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6911https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6912https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6913https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/6914https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/7187https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/7221https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/7222https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117/7223Lebre, AnaVelez, JorgeSeixas, DianaRabadão, EduardoOliveira, JoaquimSaraiva da Cunha, J.Silvestre, A. Meliçoinfo:eu-repo/semantics/openAccess2022-12-20T11:03:17Zoai:ojs.www.actamedicaportuguesa.com:article/4117Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:18:42.142457Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos |
title |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
spellingShingle |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years Lebre, Ana |
title_short |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
title_full |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
title_fullStr |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
title_full_unstemmed |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
title_sort |
Brucellar Spondylodiscitis: Case Series of the Last 25 Years |
author |
Lebre, Ana |
author_facet |
Lebre, Ana Velez, Jorge Seixas, Diana Rabadão, Eduardo Oliveira, Joaquim Saraiva da Cunha, J. Silvestre, A. Meliço |
author_role |
author |
author2 |
Velez, Jorge Seixas, Diana Rabadão, Eduardo Oliveira, Joaquim Saraiva da Cunha, J. Silvestre, A. Meliço |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Lebre, Ana Velez, Jorge Seixas, Diana Rabadão, Eduardo Oliveira, Joaquim Saraiva da Cunha, J. Silvestre, A. Meliço |
description |
Introduction: 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.Material and Methods: 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).Results: 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.Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial.Conclusions: 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. |
publishDate |
2014 |
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2014-03-30 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117 oai:ojs.www.actamedicaportuguesa.com:article/4117 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4117 |
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por eng |
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por eng |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 27 No. 2 (2014): March-April; 204-210 Acta Médica Portuguesa; Vol. 27 N.º 2 (2014): Março-Abril; 204-210 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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