Figure - available from: European Journal of Medical Research
This content is subject to copyright. Terms and conditions apply.
The MRI of a 23-year-old woman complaining of continuous lumbago with tuberculous spondylitis. The sagittal MRI T1WI (a), the sagittal MRI with fat saturation (b) and the coronal MRI T2WI (c) presented a combination of MRI findings: the lesions, in lumbar vertebral bodies 4 and 5, showed hypointense signal in T1WI and hyperintense signal in T2WI. They revealed typical vertebral bodies destruction and collapse, along with the vertebral posterior convex deformity and a narrowed intervertebral space. There also existed extensive psoas abscess and paraspinal abscess around
Source publication
Background
Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping.
Methods
We performed on 26 BS and 27 TS pati...
Similar publications
Background: Brucellosis can vary in severity and duration, requiring multiple tests for diagnosis. Its prevalence in Iraq complicates the interpretation of test results. Objective: This study aimed to develop a diagnostic tool leveraging variations in γ interferon to aid the immune system in recognizing illness. Methods: A comparative study was con...
Key clinical massage
A 23‐year‐old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications.
Abstract
Brucellosis (also known as “undulant fever,” “Medi...
Introduction
Early warning and objective evidence of systematic errors in laboratory diagnosis ensures evidence based corrective and preventive actions that instill patient safety and confidence. External quality assessment contributes significantly to the above as an essential component of laboratory quality assurance. However, implementation of E...
Brucella spp. can replicate in human endothelial cells, inducing an inflammatory response with increased expression of chemokines. Although Brucella infects humans, its ability to induce the production of chemokines by lung cells is unknown. Therefore, the current investigation was designed to examine the association between brucellosis and CXCL9,...
Brucellosis is a major public health concern worldwide, especially for persons living in resource-limited settings. Historically, an evidence-based estimate of the global annual incidence of human cases has been elusive. We used international public health data to fill this information gap through application of risk metrics to worldwide and region...
Citations
... This discrepancy led us to hypothesize that occupational choices, which often vary between genders, could in uence the likelihood of developing BS. Speci cally, professions such as animal husbandry might expose individuals to environments that elevate their risk of contracting BS 33 . ...
To improve the accuracy in distinguishing between Tuberculosis Spondylitis (TBS) and Brucella spondylitis (BS) through the creation of radiomics deep Learning models. These models incorporate Deep Learning techniques and leverage CT image enhanced by Generative Adversarial Network-based Super-Resolution (GAN-SR).94 patients from Ordos Central and Second People's Hospitals diagnosed with BS or TBS. These patients were divided into a training set (n = 65) and a validation set (n = 29). We utilized conventional CT images to generate SR-CT with twice SR based on GANs-SR. The ROIs underwent manual segmentation, and extraction of Radiomics features, and ResNet18 and ResNet34 were used as Deep Learning models for training and DL feature extraction. Feature fusion and selected were performed, and four models were built based on MLP: clinical; radiomics (Rad); Deep Learning (DL) and combined models. The model efficacy was evaluated using ROC and DCA, etc. In terms of efficacy, the integrated model outperformed others, showing the highest AUC, with the DL model following closely behind. Notably, ResNet34 demonstrated superior performance over ResNet18, SR enhanced model performance across metrics for SR-CT compared to CT. The combination of Rad + ResNet34_SR achieved the best results, with AUC of 0.952, Sensitivity of 0.909, and Specificity of 0.941. DCA curve confirmed the model's clinical decision-making potential.In conclusion, our study creates a 3D Super-Resolution model based on SR-CT images using Deep Learning Radiomics to differentiate between TBS and BS, which is significantly enhanced compared to CT images.
... There was a significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in brucella spondylitis when compared to tuberculous spondylitis. Through the analysis of vertebra and intervertebral space, it was significantly lower in the severe vertebral destruction, vertebral posterior convex deformity, dead bone, and narrow -disappear change of intervertebral space in the patients with brucella spondylitis than those in tuberculous spondylitis (Yang et al. 2014;Liu et al. 2018;Guo et al. 2021).This widespread destruction in tuberculous spondylitis may result from the rapid involvement of the endplate (inflammatory reaction). With the progress of tuberculous spondylitis, gradually the vertebrae were severely destroyed . ...
The skeleton in question derives from the Late Iron Age monument of Nor Armavir and was unearthed from burial No. 19. The deceased was buried in an unusual position. In this article, we characterize the pathological bony changes indicative of tuberculous spondylitis. The skeleton was subject to a detailed macroscopic investigation. Besides age at death estimation and sex determination, a careful palaeopathological evaluation was performed on the bone remains. In addition, volumetric (3D) computed tomography was carried out on four lumbar vertebrae (L2-5) to complement the macromorphology-based diagnosis.
... These results are in agreement with the findings of previous studies by Hammami et al 24 , and Erdem et al 25 . Additionally, more studies 16,20,26,27 have reported higher rates of abscess formation and lower rates of lumbar involvement in tuberculous spondylodiscitis than in brucellar spondylodiscitis. ...
OBJECTIVE: Non-specific features of spondylodiscitis lead to a delay and
challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious
complications may arise. This study aims to
compare brucellar, pyogenic, and tuberculous
types of spondylodiscitis, considering their demographic, clinical, and laboratory differences.
This may provide more rapid management and
good outcomes.
PATIENTS AND METHODS: A total of 131 patients with infectious spondylodiscitis were included in the study. The patients were divided
into brucellar (n=63), pyogenic (n=53), and tuberculous (n=15) types of spondylodiscitis and
compared for demographic, clinical, laboratory,
and imaging features.
RESULTS: Tuberculous spondylodiscitis had
higher scores for weight loss, painless palpation, thoracic spine involvement, and psoas abscess formation than other spondylodiscitis.
Also, tuberculous spondylodiscitis had higher rates of neurologic deficit and lower rates of
lumbar involvement than brucellar spondylodiscitis. Pyogenic spondylodiscitis is more likely
to occur in patients who have a history of spine
surgery compared to other forms of spondylodiscitis. Also, pyogenic spondylodiscitis had
higher rates of fever, erythema, paraspinal abscess, white blood cell (WBC), and erythrocyte
sedimentation rate (ESR) than brucellar spondylodiscitis. On the other hand, brucellar spondylodiscitis had higher rates of rural living and
sweating than pyogenic spondylodiscitis.
CONCLUSIONS: Weight loss, painless palpation, involved thoracic spine, psoas abscess,
and neurologic deficit are symptoms favoring
tuberculous spondylodiscitis. History of spine
surgery, high fever, skin erythema, and paraspinal abscess are findings in favor of pyogenic spondylodiscitis. Rural living, sweating, and
involved lumbar spine are symptoms that indicate brucellar spondylodiscitis. These symptoms can be used to distinguish the types of
spondylodiscitis.
... Due to the proximity of the piriformis muscle to the sciatic nerve, piriformis myositis can present as sacroiliitis or sciatica, making the diagnosis of brucella associated myositis even more challenging. MRI has a high sensitivity for the diagnosis of spondylitis [14] but its sensitivity for brucella myositis requires further investigations to help differentiate brucella spondylitis from other infectious spondylitis [15], and diagnostic standards for piriformis brucellosis are still lacking. Treatment of human brucellosis has been well described, with an optimal regimen consisting of a dual or triple antimicrobial regimen over an extended period. ...
Brucellosis remains an endemic zoonosis in the Middle East, particularly in Lebanon, owing to the high consumption of raw meat and unpasteurized cheese. In this report, we present the case of a twenty-one-year-old girl who was diagnosed with brucellosis during the investigation of persistent fever and night sweats that was confirmed by an elevated Brucella agglutination titer at 1/ 160 for Brucella melitensis species, and an indirect Coombs at 1/1280. Unfortunately, owing to non-adherence to the antibiotic regimen prescribed, her condition progressed, resulting in pir-iformis myositis with sacroiliitis, an unusual complication of brucellosis. Resolution occurred following a treatment regimen comprising intravenous gentamycin 5mg/kg daily for two weeks along with rifampin 300mg TID, and doxycycline 100mg BID for 12 weeks. Furthermore, we conducted a literature review, which revealed the diagnostic and imaging criteria for this uncommon complication to be still unclear, as well as the lack of universally approved guidelines for its treatment. Brucella-myositis should be suspected when patients present with fever and back pain.
... CT and MRI findings in tuberculosis include contiguous on non-contiguous vertebral involvement with preservation of the disc spaces until later in the course of the disease, prevertebral and paravertebral collections, often in the psoas muscles, with an extension beneath the anterior longitudinal ligament, and epidural abscess formation. A straightforward diagnosis may be difficult in atypical cases, and the differential diagnosis should also be supported by clinical and serological findings [83,84]. ...
The most prevalent zoonotic disease is brucellosis, which poses a significant threat for worldwide public health. Particularly in endemic areas, spinal involvement is a major source of morbidity and mortality and can complicate the course of the disease. The diagnosis of Brucella spondylitis is challenging and should be suspected in the appropriate epidemiological and clinical context, in correlation with microbiological and radiological findings. Treatment depends largely on the affected parts of the body. Available treatment options include antibiotic administration for an adequate period of time and, when appropriate, surgical intervention. In this article, we examined the most recent data on the pathophysiology, clinical manifestation, diagnosis, and management of spinal brucellosis in adults.
... The limited number of proteolytic enzymes in M. tuberculosis, compared with agents of pyogenic infection, results in the relatively preserved intervertebral disc in spinal TB [82]. TB spondylitis usually exhibits more severe manifestations than Brucella spondylitis [83]. Myelitis is characterized by spinal cord hyperintensity on T2-weighted images and hypo-or isointensity on T1-weighted images. ...
Neurotuberculosis has the highest morbidity and mortality risk of all forms of extrapulmonary tuberculosis (TB). Early treatment is paramount, but establishing diagnosis are challenging in all three forms of neurotuberculosis: tuberculous meningitis (TBM), spinal TB and tuberculomas. Despite advancements in diagnostic tools and ongoing research aimed at improving TB treatment regimens, the mortality rate for neurotuberculosis remains high. While antituberculosis drugs were discovered in the 1940s, TB treatment regimens were designed for and studied in pulmonary TB and remained largely unchanged for decades. However, new antibiotic regimens and host-directed therapies are now being studied to combat drug resistance and contribute to ending the TB epidemic. Clinical trials are necessary to assess the effectiveness and safety of these treatments, addressing paradoxical responses in neurotuberculosis cases and ultimately improving patient outcomes. Pharmacokinetic–pharmacodynamic analyses can inform evidence-based dose selection and exposure optimization. This review provides an update on the diagnosis and treatment of neurotuberculosis, encompassing both sensitive and resistant antituberculosis drug approaches, drawing on evidence from the literature published over the past decade.
... Radiographic manifestations of spinal tuberculosis typically manifest in the later stages of the disease, necessitating the destruction of over 50% of trabecular bone before becoming evident on radiographs [12,13]. These radiological characteristics include a constellation of findings, comprising intervertebral disc space narrowing, irregularities and erosion of adjacent endplates, sequestrae formation, as well as the presence of paravertebral body masses [7]. ...
... Since infection can lead to fatality, early diagnosis, and antibiotic treatment are essential to prevent disease progression. 20 The differential diagnosis of TS and PS depends on the comprehensive judgment of clinical features, radiology, and laboratory investigations. 21 Comprehensive microbiological analysis plays a crucial role in the treatment of spinal infection 22 ; however, only 30% to 57% of patients have positive results of percutaneous biopsy culture, which has a long and difficult culture period and high false-negative rate. ...
Study Design
Multicenter retrospective observational study.
Objective
This study aimed to distinguish tuberculous spondylitis (TS) from pyogenic spondylitis (PS), using magnetic resonance imaging (MRI). Further, a novel diagnostic model for differential diagnosis was developed.
Summary of Background Data
TS and PS are the two most common spinal infections. Distinguishing between these types clinically is challenging. Delayed diagnosis can lead to deficits or kyphosis. Currently, there is a lack of radiology-based diagnostic models for TS and PS.
Methods
We obtained radiological images from MRI imaging of patients with TS and PS and applied least absolute shrinkage and selection operator (LASSO) regression to select the optimal features for a predictive model. Predictive models were built using multiple logistic regression analysis. Clinical utility was determined using decision curve analysis (DCA) and internal validation was performed using bootstrap resampling.
Results
A total of 201 patients with TS (n=105) or PS (n=96) were enrolled. We identified significant differences in MRI features between both groups. We found that non-contiguous multi- and single-vertebral body involvement were common in TS and PS, respectively. Vertebral bone lesions were more severe in the TS group than in the PS group (Z=−4.553， P <0.001). The patients in the TS group were also more prone to vertebral intraosseous, epidural, and paraspinal abscesses ( P <0.001). A total of 8 predictors were included in the diagnostic model. Analysis of the calibration curve and area under the receiver operating characteristic curve suggested that the model was well-calibrated with a high prediction accuracy.
Conclusion
This is the largest study comparing MRI features in TS and PS and the first to develop an MRI-based nomogram which may help clinicians distinguish between TS and PS.
... In fact, among the various livestock-related occupational groups, a recent meta-analysis showed that the global pooled prevalence of brucellosis was 14% (95% CI: [10][11][12][13][14][15][16][17][18], especially in North America and Africa. Indeed, at that meta-analysis, slaughterhouse workers was associated with the highest prevalence (20%; 95% CI: [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], affecting particularly workers ages of 20 and 25, which suggests that age also had a role. Therefore, it is concluded that the livestock-related occupational groups were found to be at an increased risk of adverse zoonotic disease outcomes [68]. ...
... Osteoarticular presentations include spondylitis, sacroiliitis, spondylodiscitis, bursitis, osteomyelitis, tenosynovitis, and peripheral arthritis, representing brucellosis's frequent musculoskeletal manifestation [7,10,22]. Brucella spondylitis must be differentiated from tubercular or salmonella or pyogenic spondylitis, disc pathologies, and spinal metastasis [23][24][25][26]. Combined clinical and microbiological findings with radiological examination of the spine aid in diagnosing spinal brucellosis. ...
Introduction
The myriad presentation of osteoarticular brucellosis make the patient seek the help of general practitioners, orthopaedic and rheumatology specialists. Moreover, the lack of disease-specific symptomatology is the leading cause of the delay in diagnosing osteoarticular brucellosis. Given the increasing number of spinal brucellosis cases across the country, no literature is presented on the systematic management of spinal brucellosis. However, with our experience, we formulated a classification for managing spinal brucellosis.
Methods
A single-centred prospective observational study was conducted with 25 confirmed cases of spinal brucellosis. Patients were analysed and graded clinically, serologically, and radiologically and were managed with antibiotics for 10–12 weeks, and if necessary, stabilisation and fusion were done based on the treatment classification devised. All patients were followed up to ensure disease clearance at serial follow-up with relevant investigations.
Results
The mean age of the study participants was 52.16 ± 12.53 years. According to spondylodiscitis severity code (SSC) grading, four patients belong to grades 1, 12 to grade 2 and 9 to grade 3 at presentation. Erythrocyte sedimentation rate (p = 0.02), c-reactive protein (p < 0.001), Brucella agglutination titers (p < 0.001), and radiological outcomes improved statistically by six months. The treatment duration was individualised according to the patient's response to the treatment, with a mean time of 11.42 ± 2.66 weeks. The mean follow-up period was 14.42 ± 8 months.
Conclusion
High index of suspicion of patients from endemic regions, proper clinical assessment, serological evaluation, radiological assessment, appropriate decision-making (medical/surgical) in treatment, and regular follow-up were the key to successful comprehensive management of spinal brucellosis.
... Brucellosis related spondylodiscitis are usually misdiagnosed as tuberculosis because of common clinical features like backache, fever, and raised inflammatory markers (2) . Focal vertebral destruction with paravertebral abscess of cervical spine is more common in brucella than tuberculosis (3,4) . Detailed history and thorough physical examination remain vital in the work-up of brucellaassociated spondylodiscitis. ...
Brucellosis is a bacterial zoonotic disease which can affect various organs and usually manifests with non-specific symptoms such as fatigue, low-grade fever, arthralgia, and back pain. The Musculoskeletal system is commonly affected, and the infection can present as arthritis, sacroiliitis, spondylodiscitis, osteomyelitis, tenosynovitis, and bursitis. Due to common constitutional symptoms and radiological features, Brucellosis is often misdiagnosed as tuberculosis.
