Salmonella enteritis Spondylitis with Brucella melitensis Infection: A Rare Case of Mixed Infections of Spine

Abstract

Background
As a widespread back condition in orthopedics, spondylitis is rarely caused by Salmonella. Here, we report a rare case of spondylitis caused by Salmonella enteritis associated with Brucella melitensis.

Case Presentation
Salmonella septicemia was initially diagnosed in a 27-year-old woman with high fever and low back pain, but her symptoms did not improve after 3 days of antibiotic treatment. The patient was then referred to our hospital’s Department of Infectious Diseases. This patient had mild anemia. There were no positive results for tuberculosis antibody and Rose Bengal plate agglutination (RBPT). When the patient’s symptoms did not improve after diagnostic anti-tuberculosis treatment, he was transferred to our Orthopaedics department for lumbar posterior lesion removal, decompression, internal fixation, cage implantation, and bone grafting fusion under general anesthesia. Following the operation, a postoperative specimen culture and a real-time polymerase chain reaction (real-time-PCR) indicated Salmonella enteritis with Brucella melitensis (B. melitensis) infection. The symptoms improved and inflammatory markers returned to normal after 2 weeks of treatment with levofloxacin, rifampicin, and doxycycline.

Conclusion
Anaemic patients with immunocompromised conditions should be given special attention in the diagnosis of Salmonella spondylitis. Surgery should be considered if antibiotic therapy fails to identify the pathogen that is infecting the patient with infectious spondylitis.

Full text

CASE REPORT
Salmonella enteritis Spondylitis with Brucella
melitensis Infection: A Rare Case of Mixed
Infections of Spine
WenSheng Zhang*, Jie Wang *, Yao Zhang, Rui Ma, Qiang Zhang
Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Qiang Zhang, Email zhangdtzq@sina.com
Background: As a widespread back condition in orthopedics, spondylitis is rarely caused by Salmonella. Here, we report a rare case
of spondylitis caused by Salmonella enteritis associated with Brucella melitensis.
Case Presentation: Salmonella septicemia was initially diagnosed in a 27-year-old woman with high fever and low back pain, but
her symptoms did not improve after 3 days of antibiotic treatment. The patient was then referred to our hospital’s Department of
Infectious Diseases. This patient had mild anemia. There were no positive results for tuberculosis antibody and Rose Bengal plate
agglutination (RBPT). When the patient’s symptoms did not improve after diagnostic anti-tuberculosis treatment, he was transferred to
our Orthopaedics department for lumbar posterior lesion removal, decompression, internal xation, cage implantation, and bone
grafting fusion under general anesthesia. Following the operation, a postoperative specimen culture and a real-time polymerase chain
reaction (real-time-PCR) indicated Salmonella enteritis with Brucella melitensis (B. melitensis) infection. The symptoms improved and
inammatory markers returned to normal after 2 weeks of treatment with levooxacin, rifampicin, and doxycycline.
Conclusion: Anaemic patients with immunocompromised conditions should be given special attention in the diagnosis of Salmonella
spondylitis. Surgery should be considered if antibiotic therapy fails to identify the pathogen that is infecting the patient with infectious
spondylitis.
Keywords: Salmonella, brucellosis, spondylitis, mixed infection
Background
Salmonella is a gram-negative intracellular bacterium. Enteritis is usually caused by Salmonella enteritis, which lives in the
intestines of humans and animals. For patients with underlying diseases or factors suppressing their resistance to infection, it may
occasionally affect extraintestinal organs, like the brain, thyroid, and musculoskeletal system.
1
Salmonella-related spondylitis
accounts for 0.45% of osteomyelitis cases.
2
Immunocompromised patients, especially those with sickle cell disease, are prone to
Salmonella enteritis osteomyelitis.
3
Multiple organs can be affected by Brucellosis; osteoarticular involvement is the most
common brucellosis complication, manifesting as spondylitis, arthritis, sacroiliitis, discitis, osteomyelitis, tenosynovitis, and
bursitis, involvement of the lumbar and thoracic vertebrae can lead to symptoms such as lumbar and thoracic spondylitis and
discitis.
4–6
In this report, we describe the rarity of Salmonella enteritis spondylitis complicated by B. melitensis infection. No
previous literature has described this co-infection.
Case Presentation
A 27-year-old female with a maximum body temperature of 40.4°C developed low back pain and percussive pain in the renal area
about 3 weeks ago. Cotrimoxazole was sensitive to bovine Salmonella enteritis in blood cultures obtained at Beijing Wangjing
Hospital (Beijing, China). A combination of antibiotics etimicin sulfate (300mg po qd), cefoxitin (2g po q12h) and cotrimoxazole
(4g po qd) was administered. In spite of 3 days of treatment, her symptoms did not improve, so she sought further treatment at our
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Open Access Full Text Article
Received: 10 August 2022
Accepted: 2 November 2022
Published: 7 November 2022

hospital. Previously, the patient had been healthy and did not have any signicant medical or surgical history. In addition to eating
burgers from unknown vendors before fever, she had no history of epidemic areas, livestock, contact with cattle, sheep, or habit of
consuming unpasteurized milk, tuberculosis, smoking, intravenous drug use, or any other HIV infection factors.
At admission, the body temperature was 38.4°C. During the physical examination, there were palpable pains in the spinous
processes of the lumbar 4 and 5 vertebrae, lumbar forced positions, lumbar back pain, and limited lumbar exion. Neither inguinal
nor axillary lymph nodes were found, nor was there any evidence of hepatosplenomegaly. Laboratory tests were as follows:
hemoglobin (Hb) 96 g/L, red blood cell count (RBC) 2.84×10
12
/L, serum ferritin 12μg/L, mean corpuscular volume (MCV) was
74.6 fL, mean corpuscular hemoglobin content (MCH) was 23.8 pg, and mean corpuscular hemoglobin concentration (MCHC)
was 302g/L, white blood cell (WBC) 8.05×10
9
/L accompanied by neutrophil elevation, platelet 344×10
9
/L, erythrocyte
sedimentation rate (ESR) 117mm/h, C-reactive protein (CRP) 75.7mg/L, albumin 34.3g/L, fasting blood glucose 5.6 mmol/L,
HIV antibody negative, complement C3 1290mg/L, complement C4 330 mg/L, IgM 1.04 mg/L, IgG 9.66 mg/L, IgA 1.09 mg/L.
In the absence of tuberculosis antibodies, the RBPT and acid-fast staining of the sputum smear were also negative, and the chest
X-ray was normal. The blood culture was also free of bacteria and fungi after 5 days.
The L4/5 vertebral space was narrowed on the preoperative X-ray (Figure 1A and B). Preoperative CT showed the
intervertebral disc of L4/5 and adjacent vertebral body were heavily damaged with dense pores (Figure 1C and D).
Preoperative sagittal MRI showed vertebral body and intervertebral disc lesions with low signal on T1-weighted imaging
(T1WI), high signal on T2-weighted imaging (T2WI), and high signal on fat-suppressed T2-weighted imaging (FS-T2WI),
which was signicantly enhanced after enhancement (Figure 1E–H). Coronal and transverse MRI showed vertebral body damage
of L4 and L5 complicated by intervertebral disc damage of L4/5 (Figure 1I–L).
The patient’s symptoms did not improve after diagnostic anti-tuberculosis treatment at the Department of Infectious Diseases
of our hospital. As a result, he was transferred to Department of Orthopedics for surgical treatment. Preliminary diagnosis is
suppurative spondylitis, although brucellosis spondylitis and spinal tuberculosis cannot be ruled out. Following general anesthe-
sia, lumbar posterior lesion removal, decompression, internal xation, cage implantation, and bone graft fusion were performed
(Figure 2A–D). Real-time PCR of the nucleus pulposus samples showed that there was B. melitensis (Figure 3).
Figure 1 Radiological studies before operation. Plain radiograph showed narrowing of lumbar space 4–5 (A and B). CT showed dense pore-like destruction of the 4–5
lumbar vertebrae and intervertebral discs (C and D). Sagittal MRI showed vertebral and intervertebral disc lesions with low signal in T1, high signal in T2, and high signal in
fat compression image, which was signicantly enhanced after enhancement (E–H). Coronal MRI demonstrates a large, marked paravertebral abscess with unclear margins
and enhancement (I and J). Axial MRI showed destruction of vertebral bodies and intervertebral discs, and signicant strengthening of psoas after enhancement (K and L).
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Salmonella enteritis was detected in intraoperative pus secretions 7 days after surgery, and the pathological Giemsa
staining of intraoperative tissues (nucleus pulposus, endplate cartilage) showed Brucella contamination (Figure 4). Due
to the long-term use of antibiotics, a stool smear revealed possible yeast growth. The patient was nally diagnosed with
mixed spinal infection of Salmonella enteritis and B. melitensis. Afterwards, she was prescribed levooxacin, rifampicin,
and doxycycline. Antifungal uconazole was administered orally. Oral ferrous sulfate tablets for the treatment of iron
deciency anemia. Two weeks after treatment, the patient was no longer experiencing fever or sweating, and was able to
perform daily activities using a lumbar brace, CRP returned to normal and ESR (39mm/h) was signicantly lower than
before, Hb 112g/L and RBC 3.84×10
12
/L, MCV 91.4 fL, MCH 30.2 pg, MCHC 326. A 6-month treatment course of
levooxacin, rifampicin, and doxycycline was continued after the patient was discharged. A follow-up 2 years later
revealed normal CRP and ESR, Hb 119 g/L, and RBC 3.95×10
12
/L; X-ray showed a good position of internal xation
(Figure 5A and B); CT showed well fusion of L4 and L5 vertebral body, suggesting the formation of new bone in L4/5
disc space (Figure 5C–F); MRI demonstrated a good repair of the lesion (Figure 5G–J).
Figure 2 Intraoperatively, patients were treated with streptomycin to treat infection (A). Surgical specimens (B). Postoperative plain radiographs showed that the L4/5
vertebral space height was restored and the internal xation was rm (C and D).
Figure 3 Brucella melitensis was detected by real-time PCR, real-time PCR showed that the DNA content of Brucella melitensis (dotted red line) increased in 30 cycles. The
ordinate represents the uorescence intensity, the abscissa represents the number of PRC cycles, the blue realization represents the baseline level, and the red realization
represents the positive reference.
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Discussion and Conclusions
Spinal infection is classied as specic infection (B. melitensis, Mycobacterium tuberculosis, syphilis, fungi) and non-
specic infection (Staphylococcus aureus, Escherichia coli, Staphylococcus saprophyticus, Streptococcus pneumo-
niae, etc).
7
There has been an increase in Salmonella-induced spondylitis in recent years.
6,8–16
Spondylitis caused by
Salmonella enteritis and B. melitensis has not been reported to date. An unusual mixed infection characterizes this
case.
Infections in the gastrointestinal tract are usually caused by Salmonella enteritis, a gram-negative bacterium.
Microorganisms in contaminated water and food can cause Salmonella enteritis infection. There are usually conservative
treatments available for symptoms of acute infections, such as diarrhea, vomiting, and abdominal pain. Salmonella
enteritis, however, can persist in host cells and cause chronic infections. Those suffering from anemia (especially sickle
Figure 4 In postoperative pathology, Brucella (red circle) was positive for Giemsa staining (A). Mycobacterium tuberculosis was negative for acid-fast staining of the
intervertebral disc of L4/5 (B).
Figure 5 Radiological studies 2 years after discharge. Plain radiographs showed no abnormal changes in the xed position of L4–L5 vertebral segments (A and B). No
abnormalities on CT and MRI (C–J).
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cell anemia), systemic lupus erythematosus, diabetes, and those receiving immunosuppressive medications are more
likely to contract Salmonella enteritis spondylitis.
17,18
In patients with low immunity, Salmonella enteritis can cause extraintestinal infections; non-typhoid salmonellosis does not
always present with gastrointestinal symptoms, especially in patients with low immunity, because diarrhea is a defense
mechanism that depends on a normal immune response.
19
Spinal tuberculosis and Salmonella spondylitis are easily confused
—It has been shown that fever, a higher white blood cell count, CRP, alkaline phosphatase, and a higher proportion of neutrophils
are all indications of suppurative spondylitis; the symptoms and signs of spinal tuberculosis are less obvious than those of
Salmonella spondylitis.
20,21
It is possible to distinguish tuberculous spondylitis from suppurative spondylitis with MRI—There
are often paraspinal abnormalities, paraspinal abscesses with thin and smooth walls involving thoracic vertebrae in tuberculous
spondylitis.
22
A blood culture is essential for diagnosing spinal infections, but only 20% to 60% of the patients have a positive
culture, the gold standard for diagnosis is percutaneous biopsy, culture of the lesion site, and histopathological examination.
23
Salmonella osteomyelitis is commonly treated with chloramphenicol, third-generation cephalosporins, and uoroqui-
nolones, although there are no standard antimicrobial treatment guidelines, antibiotic treatment should be continued for at
least 6 weeks to avoid recurrence and failure.
24,25
Surgical indications of Salmonella spondylitis include neurological
impairment, large intraspinal and paraspinal abscesses, extensive bone destruction and spinal instability.
26,27
Around 500,000 cases of brucellosis spondylitis occur each year worldwide, making it the most common zoonotic
disease; infection occurs mainly through contact with animals or through consumption of unpasteurized milk and fresh
cheese.
28
Brucellosis spondylitis is a nonspecic disease that causes fevers, night sweats, fatigue, and is mainly found in
northern provinces of China.
29
It is difcult to differentiate from spinal tuberculosis based on these non-specic
symptoms. Thus, brucellosis spondylitis is often misdiagnosed as spinal tuberculosis in areas with low brucellosis
incidence. There are many subtle differences between the two diseases: intermittent high fever of brucellosis spondylitis
is more common than low fever of spinal tuberculosis; patients with spinal tuberculosis were more likely to experience
vertebral body destruction, kyphosis, paraspinal abscess, and spinal cord compression.
30,31
The RBPT is mainly used for
Brucella infection screening.
32
Presently, blood culture is the gold standard for diagnosing brucellosis, but positive
detection rate in chronic bacteremia is low.
33
As compared with other detection techniques, PCR is highly sensitive and
specic for identifying Brucella species from peripheral blood and other tissues.
34
In the acute phase of Brucellosis, rifampicin and doxycycline are the most commonly used drugs. The clinical treatment
of brucellosis in China is mainly a triple-drug regimen, and enduring drug treatment for more than 3 months can reduce the
risk of recurrence.
35–37
When drug treatment does not seem to be working, surgical intervention may be necessary for
patients with brucellosis spondylitis. The surgical treatment has been demonstrated in clinical studies to be effective in
removing lesions, relieving pain, improving local blood ow to lesions, maintaining and rebuilding spinal stability, reducing
complications, promoting early rehabilitation and cure of lesions, and improving clinical outcomes.
38,39
Anemia, a risk factor for Salmonella, was moderate in our case. As we speculated, the patient probably had
Salmonella enteritis and B. melitensis infection through the digestive tract after eating a burger from an unidentied
vendor prior to the fever. After antibiotic treatment, the patient’s symptoms were not relieved, and the preoperative
laboratory examination was unable to identify the infection bacteria. The infectious bacteria were nally identied
through surgery and laboratory tests. Our case is characterized by the following points: 1) Salmonella enteritis
spondylitis complicated by B. melitensis infection is extremely rare; 2) This patient had no obvious gastrointestinal
symptoms; 3) All preoperative tests were negative, and pathogens were not detected; 4) Due to atypical manifestations,
the patient was originally misdiagnosed as having spinal tuberculosis.
As a result, patients with spondylitis who are clinically immunocompromised should be cautious of Salmonella
infections. In spite of the fact that Brucellosis spondylitis often complicates with Mycobacterium tuberculosis, when the
diagnosis is unclear and conservative treatment is ineffective, surgical intervention should be considered as soon as
possible.
Patient Consent and Ethics Statement
The patient provided informed consent for publication of this study and accompanying images. The Ethics Committee of
the Beijing Ditan Hospital of Capital Medical University approved the study.
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Author Contributions
All authors made a signicant contribution to the work reported, whether that is in the conception, study design,
execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically
reviewing the article; gave nal approval of the version to be published; have agreed on the journal to which the article
has been submitted; and agree to be accountable for all aspects of the work.
Funding
This work received no funding.
Disclosure
The authors have no conicts of interest to declare in this work.
References
1. Shrestha P, Mohan S, Roy S. Bug on the back: vertebral osteomyelitis secondary to uoroquinolone resistant Salmonella typhi in an immuno-
competent patient. BMJ Case Rep. 2015;2015:bcr2015212503. doi:10.1136/bcr-2015-212503
2. Huang ZD, Wang CX, Shi TB, et al. Salmonella osteomyelitis in adults: a systematic review. Orthop Surg. 2021;13(4):1135–1140. doi:10.1111/
os.12912
3. Chen M, Wang R, Shan J, et al. Salmonella enteritis spondylitis of thoracic spine: a case report and review of the literature. BMC Surg. 2020;20
(1):180. doi:10.1186/s12893-020-00841-5
4. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World J Orthop. 2019;10
(2):54–62. doi:10.5312/wjo.v10.i2.54
5. Ebrahimpour S, Bayani M, Moulana Z, et al. Skeletal complications of brucellosis: a study of 464 cases in Babol, Iran. Caspian J Intern Med.
2017;8(1):44–48.
6. Kutlu SS, Kutlu M, Tuzun T, et al. Spondylodiscitis: a common complication of brucellosis. J Infect Dev Countries. 2018;12(07):550–556.
doi:10.3855/jidc.10557
7. Skaf GS, Domloj NT, Fehlings MG, et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3(1):5–16. doi:10.1016/j.
jiph.2010.01.001
8. Feng ZY, Guo F, Chen Z. Literature review and clinical presentation of cervical spondylitis due to Salmonella enteritidis in immunocompetent.
Asian Spine J. 2014;8(2):206–210. doi:10.4184/asj.2014.8.2.206
9. Zaki M, Muhammad Arifn MH. Single-stage debridement and spinal instrumentation for Salmonella spondylodiscitis of thoracic vertebra. Cureus.
2021;13(9):e18306. doi:10.7759/cureus.18306
10. Farrar H, Abbey A, Patel V, et al. Osteomyelitis, discitis, epidural and psoas abscess secondary to Salmonella enterica in a man with diabetes
mellitus and newly diagnosed α-thalassaemia trait. BMJ Case Rep. 2015;2015:bcr2014207008. doi:10.1136/bcr-2014-207008
11. Banerjee B, Madiyal M, Madhava PK, et al. Typhoid spondylodiscitis mimicking tuberculosis in a teenage girl. J Infect Public Health. 2018;11
(1):136–137. doi:10.1016/j.jiph.2017.04.004
12. Muhamad Effendi F, Ibrahim MI, Mohd Miswan MF. Salmonella spondylodiscitis of the thoracic vertebrae mimicking spine tuberculosis. BMJ
Case Rep. 2016;2016:bcr2016215909. doi:10.1136/bcr-2016-215909
13. Fukuda T, Bouchi R, Minami I, et al. Retrograde pyelonephritis and lumbar spondylitis as a result of Salmonella typhi in a type 2 diabetes patient
with neurogenic bladder. J Diabetes Investig. 2016;7(3):436–439. doi:10.1111/jdi.12375
14. Cheng W, Lian K, Luo D, et al. Salmonella potsdam causing lumbar vertebral osteomyelitis: a case report. Medicine. 2018;97(18):e0682.
doi:10.1097/MD.0000000000010682
15. Librianto D, Suwarto S, Imran D, et al. An extremely rare case of upper thoracic salmonella infection. Orthop Res Rev. 2021;13:107–112.
doi:10.2147/ORR.S319616
16. Myojin S, Kamiyoshi N, Kugo M. Pyogenic spondylitis and paravertebral abscess caused by Salmonella Saintpaul in an immunocompetent
13-year-old child: a case report. BMC Pediatr. 2018;18(1):24. doi:10.1186/s12887-018-1010-5
17. Gupta SK, Pandit A, White DG. Salmonella osteomyelitis of the thoracic spine: an unusual presentation. Postgrad Med J. 2004;80(940):110–111.
doi:10.1136/pmj.2002.002592
18. Gondusky JS, Gondusky CJ, Helmers SW. Salmonella osteomyelitis in newonset diabetes mellitus. Orthopedics. 2009;32:690–693.
19. Ortiz D, Siegal EM, Kramer C, et al. Nontyphoidal cardiac salmonellosis: two case reports and a review of the literature. Texas Heart Inst J.
2014;41(4):401–406. doi:10.14503/THIJ-13-3722
20. Kim CJ, Song KH, Jeon JH, et al. A comparative study of pyogenic and tuberculous spondylodiscitis. Spine. 2010;35:E1096–E1100. doi:10.1097/
BRS.0b013e3181e04dd3
21. Huang DB, DuPont HL. Problem pathogens: extra-intestinal complications of Salmonella enterica serotype Typhi infection. Lancet Infect Dis.
2005;5(6):341–348. doi:10.1016/S1473-3099(05)70138-9
22. Harada Y, Tokuda O, Matsunaga N. Magnetic resonance imaging characteristics of tuberculous spondylitis vs. pyogenic spondylitis. Clin Imag.
2008;32:303–309. doi:10.1016/j.clinimag.2007.03.015
23. Acosta FL, Chin CT, Quiñones-Hinojosa A, et al. Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg
Focus. 2004;17(6):E2. doi:10.3171/foc.2004.17.6.2
24. Mcanearney S, Mccall D. Salmonella osteomyelitis. Ulster Med J. 2015;84:171–172.
https://doi.org/10.2147/IDR.S385759
DovePress
Infection and Drug Resistance 2022:15
6530
Zhang et al Dovepress
Powered by TCPDF (www.tcpdf.org)

25. Papaioannou I, Baikousis A, Korovessis P. Multi-foci Salmonella enteritis osteomyelitis of thoracic spine with pleural effusion and fatal outcome.
A unique case presentation and review of the literature. J Orthop Case Rep. 2017;7:69–74. doi:10.13107/jocr.2250-0685.694
26. Ikejiri K, Suzuki K, Ito A. Invasive Salmonella Enteritidis infection complicated by bacterial meningitis and vertebral osteomyelitis shortly after
inuenza a infection in an immunocompetent young adult. J Infect Chemother. 2020;262:269–273. doi:10.1016/j.jiac.2019.08.001
27. Santos EM, Sapico FL. Vertebral osteomyelitis due to salmonellae: report of two cases and review. Clin Infect Dis. 1998;27(2):287–295.
doi:10.1086/514668
28. Zou D, Zhou J, Jiang X. Diagnosis and management of spinal tuberculosis combined with brucellosis: a case report and literature review. Exp Ther
Med. 2018;15(4):3455–3458. doi:10.3892/etm.2018.5812
29. Zhong Z, Yu S, Wang X, et al. Human brucellosis in the People’s Republic of China during 2005–2010. Int J Infect Dis. 2013;17(5):e289–e292.
doi:10.1016/j.ijid.2012.12.030
30. Dasari S, Naha K, Prabhu M. Brucellosis and tuberculosis: clinical overlap and pitfalls. Asian Pac J Trop Med. 2013;6(10):823–825. doi:10.1016/
S1995-7645(13)60145-5
31. Kurtaran B, Sarpel T, Tasova Y, et al. Brucellar and Tuberculous spondylitis in 87 adult patients: a descriptive and comparative case series. Infect
Dis Clin Prac. 2008;16(3):166–173. doi:10.1097/IPC.0b013e318168ffb3
32. Faddoul L, Azar R, Haddad A, et al. The importance of blood culture and serology for Brucellosis diagnosis and treatment. J Infect Dev Ctries.
2018;12(21):19. doi:10.3855/jidc.10120
33. Bozgeyik Z, Aglamis S, Bozdag PG, et al. Magnetic resonance imaging ndings of musculoskeletal brucellosis. Clin Imaging. 2014;38(5):719–723.
doi:10.1016/j.clinimag.2014.04.007
34. Wang Y, Wang Z, Zhang Y, et al. Polymerase chain reaction-based assays for the diagnosis of human brucellosis. Ann Clin Microbiol Antimicrob.
2014;13:31. doi:10.1186/s12941-014-0031-7
35. Zheng R, Xie S, Lu X, et al. A systematic review and meta-analysis of epidemiology and clinical manifestations of human brucellosis in China.
Biomed Res Int. 2018;2018:5712920. doi:10.1155/2018/5712920
36. Chaofan S, Xinming Y. Lumbar Brucella spondylitis vertebrae xation, short safety evaluation and efcacy analysis of segmental xation. Chin
Damage J Prosthodont. 2017;12(05):350–356.
37. Ariza J, Bosilkovski M, Cascio A, et al. Perspectives for the treatment of brucellosis in the twenty-rst century: the Ioannina recommendations.
PLoS Med. 2007;4:e317. doi:10.1371/journal.pmed.0040317
38. Passias PG, Ma Y, Chiu YL, Mazumdar M, Girardi FP, Memtsoudis SG. Comparative safety of simultaneous and staged anterior and posterior
spinal surgery. Spine. 2012;37(3):247–255. doi:10.1097/BRS.0b013e31821350d0
39. Colmenero JD, Fernandez-Nebro A, Reguera JM, et al. Psoas abscess secondary to brucellosis. J Infect. 1991;22(1):107–109. doi:10.1016/0163-
4453(91)91402-J
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