Brucella and Musculoskeletal Involvement
Özet
Brucellosis is a zoonotic bacterial infection caused by Brucella species, primarily affecting individuals through contact with infected animals, consumption of unpasteurized dairy products, or inhalation of contaminated aerosols. Among its systemic manifestations, musculoskeletal involvement is prevalent in 40-85% of cases, primarily presenting as osteoarticular complications.
Osteoarticular brucellosis includes spondylitis, peripheral arthritis, sacroiliitis, and osteomyelitis. Brucella spondylitis is the most severe form, commonly affecting the lumbar spine and leading to vertebral destruction if untreated. Peripheral arthritis often manifests as mono- or oligoarticular joint involvement, mainly in the knee, hip, or ankle. Brucellar sacroiliitis, a common cause of inflammatory sacroiliitis in endemic regions, mimics ankylosing spondylitis. Osteomyelitis is a severe but rare complication involving long bones.
Diagnosis is based on serology, blood cultures, PCR, and imaging, with MRI being the gold standard. Treatment requires prolonged antibiotic therapy, typically a combination of doxycycline and rifampin for at least 6-8 weeks. Early intervention is crucial to prevent chronic complications, including vertebral collapse, joint damage, and neurological deficits. A multidisciplinary approach is recommended for optimal patient management.
Bruselloz, Brucella türlerinin neden olduğu zoonotik bir bakteriyel enfeksiyondur ve enfekte hayvanlarla temas, pastörize edilmemiş süt ürünleri tüketimi veya kontamine aerosollerin solunması yoluyla bulaşır. Hastalık çoklu organ sistemlerini etkileyebilir ve vakaların %40-85’inde kas-iskelet sistemi tutulumu görülmektedir.
Osteoartiküler bruselloz; spondilit, periferik artrit, sakroileit ve osteomiyelit şeklinde ortaya çıkabilir. Brucella spondiliti en ciddi form olup genellikle lomber omurgayı tutar ve tedavi edilmezse ciddi vertebral yıkıma neden olabilir. Periferik artrit sıklıkla diz, kalça veya ayak bileğini etkileyen mono- veya oligoartiküler tutulum şeklinde gelişir. Brusellar sakroileit, endemik bölgelerde yaygın bir inflamatuvar sakroileit nedenidir ve ankilozan spondilit ile karışabilir. Osteomiyelit nadir ancak ciddi bir komplikasyondur ve uzun kemikleri etkileyebilir.
Tanı serolojik testler, kan kültürleri, PCR ve görüntüleme yöntemlerine dayanır. MRI, osteoartiküler brusellozun saptanmasında en duyarlı yöntemdir. Tedavi, genellikle en az 6-8 hafta süren doksisiklin ve rifampin kombinasyonu ile yapılır. Erken müdahale, vertebral çökme, eklem hasarı ve nörolojik komplikasyonları önlemek için kritik öneme sahiptir. Hastaların yönetiminde multidisipliner yaklaşım önerilmektedir.
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