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Showing swelling around the right elbow representing olecranon bursitis.
Source publication
Brucellosis is still endemic in certain parts of the world including the Mediterranean, the Middle East, Latin America, and African regions. Osteoarticular manifestations are common presenting features. Brucellosis presenting as prepatellar bursitis has already been reported. We present a case of seronegative olecranon bursitis with positive blood...
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Citations
... Serological detection of brucella infection via standard tube agglutination (STA) test has been reported to exhibit a sensitivity of 84.6%. However, lacking a detectable immune response has been frequently recognized in patients with localized disease [29]. ...
Brucellosis, one of the common zoonotic diseases all over the world, is still underdiagnosed. Under diagnosis is mostly due to certain concepts that should be revised especially in endemic areas. First of all, in endemic areas especially raw milk consuming communities, it is not logic to consider brucellosis only in certain occupations, while the whole community is exposed through utilization of non-pasteurized dairy products. Unawareness about the protean manifestations of brucellosis and its ability to affect almost every system in the body from heal to crown is another problem that needs orientation. Brucellosis now is one of the great imitators like SLE and TB. Chronic brucellosis can present by different manifestations even in the absence of fever and with low serum antibody titers. So, physicians in endemic areas should be aware by the usual and unusual presentations of brucellosis and should consider brucellosis in the differential diagnosis of almost every unexplained medical problem until proved otherwise.
... The patient had olecranon bursitis, and after 3 months of antibiotic therapy, she did not show any symptoms. 13 Arvind Mishka et al. reported in 2018 a rare case in which a 16-year-old boy presented with migratory joint pain and limited movement from the knee to the right shoulder and then the right wrist. After receiving corticosteroids, the pain increased, the patient developed a fever, and serologic diagnostic tests for brucellosis were positive. ...
Key Clinical Message
Arthritis is one of the main presentations of chronic brucellosis, but bursitis and tendon rupture are also caused by brucellosis. Therefore, brucellosis should be considered in the differential diagnosis of arthritis, bursitis, and tendon rupture by physicians. In addition, early diagnosis and treatment are very important in the prevention of disability.
Abstract
Brucellosis is a zoonotic disease common in the Middle East. Manifestations of acute disease are fever, sweating, myalgia, and arthralgia. However, bone joint involvement occurs in 10%–85% of patients, and sacroiliac involvement occurs in up to 80% and vertebral joint involvement in up to 54%. A 57‐year‐old woman was admitted to the hospital of Islamic Azad University on February 26, 2021, with a history of one‐month pain and limited movement of the right shoulder joint with fever for surgery of the shoulder ligament. The standard agglutination titer (Wright) for brucellosis at first was 1/640 and then increased. MRI of the shoulder showed a supraspinatus tendon and anterosuperior labral of the glenoid labrum tear. Although the patient was a candidate for shoulder joint ligament surgery, with a diagnosis of brucellosis, the treatment of brucellosis was prescribed, symptoms disappeared with anti‐brucellosis antibiotic therapy without surgery, and the patient recovered. Supraspinatus tendon and antero superior labral of glenoid labrum tear of the shoulder joint in brucellosis is generally very rare. Failure or delay in the treatment of brucellosis can cause ligament rupture or joint disability. Sometimes, there are no symptoms except osteoarticular manifestations in brucellosis; therefore, brucellosis should be one of the differential diagnoses in osteoarticular diseases.
... In some studies, olecranon bursitis was seen in 3 out of 251 cases of brucellosis [10]. Almajid [11] reported a case of olecranon bursitis with negative serologic tests, but positive blood culture and aspirated fluid culture. A case of abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis was reported by Turan et al. [12]. ...
A 51-year-old man shepherd presented with mild pain and swelling of the right posterior aspect of his right elbow. In ultrasonography, the affected bursal space had swelling and effusion. Moreover, the aspiration of the affected bursa revealed an inflammatory profile. Brucella melitensis was detected in aspirated fluid and blood cultures. The serum agglutination test (SAT) and 2-mercaptoethanol test for brucellosis were also positive. Therefore, the diagnosis of brucellar olecranon was confirmed. Treatment was initiated using gentamicin for the first 7 days and doxycycline plus rifampicin for 2 months. After treatment, all clinical signs and symptoms were resolved. No relapse was seen after 1 year of the completion of treatment. Clinicians should pay attention to the symptoms of olecranon brucellar bursitis that is similar to that of pyogenic bursitis.
... For example, misdiagnosis due to serological false negative test and improper interference in surgery was reported about brucellar arthritis of hip [84] . Almajid reported a rare case of brucellar olecranon bursitis whose serology was negative, but the blood and aspirate cultures were positive [85] . Brucellar arthritis following implantation of artificial knee and hip joints has been reported, which the medications may not be enough and removing the prosthesis might be needed [86][87][88] . ...
Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.
... In our study, although osteoarticular involvement was the highest none of the cases had isolated involvement of the bursa. 23 Literature from Saudi Arabia has shown that 47.7 per cent of the clinically diagnosed brucellosis patients had osteoarticular involvement with sacroiliitis, peripheral arthritis and destructive spondylitis as common presentations. 24 Osteoarticular brucellosis is also common in non-endemic areas. ...
Background
Brucellosis is a common zoonotic disease of the Middle Eastern countries. Acute cases of brucellosis are often treated as cases of Pyrexia of unknown origin.
Aims
The main aim of this study is to compare the epidemiological, clinical and laboratory findings of the 42 culture positive cases of Brucella.
Methods
Forty two culture positive cases of Brucella were obtained from both in -patients and outpatients with a history of pyrexia over a period of two years (Nov 2014-Nov 2016). The patients' files were examined retrospectively for the history, clinical features, and lab findings.
Results
The prevalence of brucellosis was calculated to be 11.1 per cent as 42 cases were positive for brucellosis out of 377 of PUO cases Of the 42 cultures positive patients the percentage of males (57.1 per cent) were almost equal to the females(42.8 per cent). The mean±S.D age was 28.5±13.65. 28.5 per cent had a history of livestock associations (Chi-square 3.8889, a p-value of 0.048607) which was statistically significant. 26.2 per cent had a history of raw milk and dairy produce intake (Chi-Square 2.6276, p-value of 0.105023) this was not statistically significant. 9.5 per cent had a family history of brucellosis; this association was not statistically significant as well (chi-square statistic 1.8651, p-value of 0.172034). 61.9 per cent presented as acute cases, 30.9 per cent of sub-acute cases and 7.1 per cent as chronic cases respectively. The pre- dominant clinical symptom was Fever (100 per cent) with the commonest clinical signs being the osteoarticular signs (30.9 per cent). Raised ESR and CRP positives were seen in 34 cases (80.9 per cent) and 23 cases (55 per cent) respectively followed by Anaemia in 22 cases (52.3 per cent).
Forty two cases were blood culture positive. All the cases were sensitive to the recommended regimen of Doxycycline and streptomycin.
Conclusion
Brucellosis is still a major health problem in the Middle Eastern countries especially in the Kingdom of Saudi Arabia. Although latest diagnostic equipment are available lacunae in the skill and knowledge prove to be a disadvantage. This scenario may lead to blind treatment which in turn can lead to the development of antibiotic resistance which is another problem altogether.
Brucellosis is a zoonosis seen all over the world and is still endemic in certain parts of the world. Brucellosis is a systemic infection which involves multiple organs and tissues. Although musculoskeletal system involvement is frequent in brucellosis, bursal involvement is seen rarely. In this article, we present a case of subacromial and subdeltoid brucellar bursitis with positive serology and aspiration culture. Patient achieved complete recovery with rifampicin and doxycycline treatment, without any evidence of relapse. A high clinical suspicion is required for the diagnosis of brucellar bursitis.
Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.
