Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review

Zou,Dexin; Zhou,Junlin; Jiang,Xiaobing

doi:10.3892/etm.2018.5812

Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review

Authors:
- Dexin Zou
- Junlin Zhou
- Xiaobing Jiang
View Affiliations

Affiliations: Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China, Department of Equipment, Yantai Yuhuangdi Hospital, Yantai, Shandong 264000, P.R. China
Published online on: January 30, 2018 https://doi.org/10.3892/etm.2018.5812
Pages: 3455-3458

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Tuberculosis combined with brucellosis is a very rare condition. Overlapping clinical presentation and laboratory parameters of tuberculosis and brucellosis may lead to misdiagnosis or delayed diagnosis of the condition. The current study presents the case of a 45‑year‑old male with symptoms of lower back pain, non‑tender swelling in the right flank, intermittent hyperpyrexia, sweating, body aches and numbness and weakness of right lower limb. A lumbar computed tomograph (CT) scan and magnetic resonance imaging indicated vertebral destruction and the formation of sequestra and thecal sac compression. Tuberculosis was suspected, but subsequent culture of blood and pus revealed the co‑infection of Mycobacterium tuberculosis and Brucella melitensis. The patient was treated with antibiotics, CT‑guided percutaneous drainage of the abscess and posterior approach decompression, debridement, instrumentation and fusion. Co‑existence of spinal tuberculosis and brucellosis is rare and clinicians should strengthen the awareness of such conditions in similar patients. CT‑guided percutaneous drainage is effective in the diagnosis and management of spinal tuberculosis with abscess.

View Figures

View References

1	Metha JS and Bhojraj SY: Tuberculosis of the thoracic spine. J Bone Joint Surg Br. 85:1502003.PubMed/NCBI
2	World Health Organization, . Global tuberculosis report 2012. WHO; Geneva: 2012
3	Samohyl M, Solovic I, Rams R, Hirosova K, Vondrova D, Krajcova D, Nadazdyova A, Filova A and Jurkovicova J: Effect of spa treatment and the epidemiology of tuberculosis in the Slovak republic in the year 2014. Clin Soc Work Health Interven. 7:24–35. 2016. View Article : Google Scholar
4	Cui X, Ma YZ, Chen X, Cai XJ, Li HW and Bai YB: Outcomes of different surgical procedures in the treatment of spinal tuberculosis in adults. Med Princ Pract. 22:346–350. 2013. View Article : Google Scholar : PubMed/NCBI
5	Saraf SK and Tuli SM: Tuberculosis of hip: A current concept review. Indian J Orthop. 49:1–9. 2015. View Article : Google Scholar : PubMed/NCBI
6	Fuentes Ferrer M, Gutiérrez Torres L, Ayala Ramírez O, Rumayor Zarzuelo M and del Prado González N: Tuberculosis of the spine. A systematic review of case series. Int Orthop. 36:221–231. 2012. View Article : Google Scholar : PubMed/NCBI
7	Moon MS: Tuberculosis of spine: Current views in diagnosis and management. Asian Spine J. 8:97–111. 2014. View Article : Google Scholar : PubMed/NCBI
8	Polley P and Dunn R: Noncontiguous spinal tuberculosis: Incidence and management. Eur Spine J. 18:1096–1101. 2009. View Article : Google Scholar : PubMed/NCBI
9	Pawlowski A, Jansson M, Sköld M, Rottenberg ME and Källenius G: Tuberculosis and HIV co-infection. PLoS Pathog. 8:e10024642012. View Article : Google Scholar : PubMed/NCBI
10	Franco MP, Mulder M, Gilman RH and Smits HL: Human brucellosis. Lancet Infect Dis. 7:775–786. 2007. View Article : Google Scholar : PubMed/NCBI
11	Turgut M, Haddad FS and De Divitiis O: Neurobrucellosis: Clinical, diagnostic and therapeutic features. BMJ. 333:152015.
12	Hadush A and Pal M: Brucellosis-An infectious re-emerging bacterial zoonosis of global importance. Int J Livest Res. 3:28–34. 2013. View Article : Google Scholar
13	Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD and Walsh JJ: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 7:179–192. 1969.PubMed/NCBI
14	Seibert FB and Dufour EH: Comparison between the international standard tuberculins, PPD-S and old tuberculin. Am Rev Tuberc. 69:585–594. 1954.PubMed/NCBI
15	Bai Y, Han X, Wu J, Chen Z and Li L: Ecosystem stability and compensatory effects in the inner mongolia grassland. Nature. 431:181–184. 2004. View Article : Google Scholar : PubMed/NCBI
16	Rose JE and Roepke MH: An acidified antigen for detection of nonspecific reactions in the plate-agglutination test for bovine brucellosis. Am J Vet Res. 18:550–555. 1957.PubMed/NCBI
17	Alton GG, Maw J, Rogerson BA and Mcpherson GG: The serological diagnosis of bovine brucellosis: An evaluation of the complement fixation, serum agglutination and rose bengal tests. Aust Vet J. 51:57–63. 1975. View Article : Google Scholar : PubMed/NCBI
18	Dasari S, Naha K and Prabhu M: Brucellosis and tuberculosis: Clinical overlap and pitfalls. Asian Pac J Trop Med. 6:823–825. 2013. View Article : Google Scholar : PubMed/NCBI
19	Kurtaran B, Sarpel T, Tasova Y, Candevir A, Saltoglu N, Inal AS and Aksu HSZ: Brucellar and tuberculous spondylitis in 87 adult patients: A descriptive and comparative case series. Infect Dis Clin Prac. 16:166–173. 2008. View Article : Google Scholar
20	Dal T, Celen MK, Ayaz C, Dal MS, Kalkanli S, Mert D, Yildirim N, Aktas E and Arserim N: Brucellosis is a major problem: A five years experience. Acta Med Mediterr. 29:6652013.
21	Pappas G, Akritidis N, Bosilkovski M and Tsianos E: Brucellosis. N Engl J Med. 352:2325–2336. 2005. View Article : Google Scholar : PubMed/NCBI
22	Zhong Z, Yu S, Wang X, Dong S, Xu J, Wang Y, Chen Z, Ren Z and Peng G: Human brucellosis in the People's Republic of China during 2005–2010. Int J Infect Dis. 17:e289–e292. 2013. View Article : Google Scholar : PubMed/NCBI
23	Yilmaz E, Parlak M, Akalin H, Heper Y, Ozakin C, Mistik R, Oral B, Helvaci S and Töre O: Brucellar spondylitis: Review of 25 cases. J Clin Rheumatol Pract Rep Dis. 10:300–307. 2004. View Article : Google Scholar
24	Ansari S, Ashraf AN, Najib A, Moutaery and Al K: Spinal infections: A review. Neuro Quart. 11:112–123. 2001. View Article : Google Scholar
25	Alothman A, Memish ZA, Awada A, Al-Mahmood S, Al-Sadoon S, Rahman MM and Khan MY: Tuberculous spondylitis: Analysis of 69 cases from Saudi Arabia. Spine (Phila Pa 1976). 26:E565–E570. 2001. View Article : Google Scholar : PubMed/NCBI
26	Schaaf HS, Shean K and Donald PR: Culture confirmed multidrug resistant tuberculosis: Diagnostic delay, clinical features, and outcome. Arch Dis Child. 88:1106–1111. 2003. View Article : Google Scholar : PubMed/NCBI
27	Billard E, Cazevieille C, Dornand J and Gross A: High susceptibility of human dendritic cells to invasion by the intracellular pathogens Brucella suis, B. Abortus, and B. Melitensis. Infect Immun. 73:8418–8424. 2005. View Article : Google Scholar : PubMed/NCBI
28	Hartady T, Saad MZ, Bejo SK and Salisi MS: Clinical human brucellosis in Malaysia: A case report. Asian Pac J Trop Dis. 4:150–153. 2014. View Article : Google Scholar
29	Human brucellosis: Systematic review and meta-analysis of randomised controlled trials. BMJ. 336:7012008. View Article : Google Scholar : PubMed/NCBI
30	Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM and Lee V: Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br. 85:100–106. 2003. View Article : Google Scholar : PubMed/NCBI
31	Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC and Lai PL: Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res. 1–59. 2002.
32	Liu P, Sun M, Li S, Wang Z and Ding G: A retrospective controlled study of three different operative approaches for the treatment of thoracic and lumbar spinal tuberculosis: Three years of follow-up. Clin Neurol Neurosurg. 128:25–34. 2015. View Article : Google Scholar : PubMed/NCBI
33	Li J, Li XL, Zhou XG, Zhou J and Dong J: Surgical treatment for spinal tuberculosis with bilateral paraspinal abscess or bilateral psoas abscess: One-stage surgery. J Spinal Disord Tech. 27:E309–E314. 2014. View Article : Google Scholar : PubMed/NCBI