Demographic trend and clinical features of brucellosis in patients with history of lower back pain - A study in tertiary care hospital
Introduction: Even though Lower Backpain (LBP) is the common symptom presenting to orthopedic OPD, not all the patients get relief from back pain. Due to complexity of the problem and heterogeneity of its nature many patients suffer from chronic lower back pain for long period. Infective agents do play a significant role in LBP and one of the differential diagnosis is Brucellosis. The present study is intended to find epidemiological correlation between brucellosis and LBP patients with pertinent serological tests and aid in decreasing morbidity associated with back pain.
Materials and methods: Study involved evaluation of seventy adult patients (n=70) with history of low back pain attending orthopedic OPD. A detailed history of fever, work atmosphere, occupation in animal husbandry and ingestion of raw milk were collected and followed by radiological investigation (X-ray lower back). After physical examination serum samples were collected from these patients. First year MBBS students (n=30) without history of LBP were taken as controls.
Results: Out of these 70 patients, seropositivity was seen in 10 patients by rapid slide agglutination test as screening procedure followed by tube agglutination test (SAT) as confirmatory test. Patients affected were men of 31 to 40 years age group. Incidence of brucellosis in our patients was 14.1%. Most of them were farmers by occupation. Of these 6 gave history of ingestion of raw milk. 6 patients had history of occupational exposure to animals and fever was seen in 5 cases. Radiological findings were positive in 4 patients.
Conclusion: Diagnosing Brucellosis in patients with chronic backache is a challenge due to heterogeneity of condition. High clinical suspicion in patients with rural back ground, relevant serological tests with radiological evidence help in clinching the diagnosis of brucellosis in patients with chronic lower backpain.
2. Papageorgiou AC, Croft PR, Ferry S, Jayson MI, Silman AJ. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine (Phila Pa 1976). 1995 Sep 1;20(17):1889-94.
3. Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34(5):440-54. doi: 10.1179/2045772311Y.0000000023.
4. Urquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, Hussain SM, Cicuttini FM. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015 Jan 22;13:13. doi: 10.1186/s12916-015-0267-x.
5. Kil-Byung Lim. Back Pain Secondary to Brucella Spondylitis in the Lumbar Region. Ann Rehabil Med. 2012 Apr; 36(2): 282–286. [PubMed]
6. Taif S, Alrawi A. Spinal brucellosis: a forgotten cause of chronic back pain. BMJ Case Rep. 2014 Jul 2;2014. pii: bcr2014205816. doi: 10.1136/bcr-2014-205816. [PubMed]
7. Tsimichodimos et al. Severe Low Back Pain Due to Brucella Spondylitis: A Case of Diagnostic and Therapeutic Challenge. Infect Dis ClinPract.Nov 2002; 11: 8437-440.
8. Gokhle YA, Bichile LS, Gogate A, Tillu AV, Zamre. Brucella spondylitis: an important treatable cause of low backache. J Assoc Physicians India. 1999 Apr;47(4):384-8. [PubMed]
9. Ruiz-Mesa JD, Sánchez-Gonzalez J, Reguera JM, Martín L, Lopez-Palmero S, Colmenero JD. Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas. ClinMicrobiol Infect. 2005 Mar;11(3):221-5. [PubMed]
10. Young EJ. Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature. Rev Infect Dis. 1991 May-Jun;13(3):359-72.
11. Kothari G. C. Brucellosis – a review.J J Group Hosp Grant Med Coll. 1956; 1(2): 140–157.
12. Sonnenwirth A. C. and Jarrett L. Gradwohl's Clinical Laboratory Methods and Diagnosis, Volume 2, 8th Edition. St. Louis: C.V. Mosby Co., 1980; 2305 – 2307.
13. Javier Solera et al Brucellar Spondylitis: Review of 35 Cases and Literature Survey.CID.1999; 29:1440–9. [PubMed]
14. Jia B, Zhang F, Lu Y, Zhang W, Li J, Zhang Y, et al. The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications. 2017.PLoS Negl Trop Dis 11(5): e0005577. https://doi.org/10.1371/journal.pntd.0005577.
15. Mahakur AC, Panda GK. Incidence of brucellosis in and around Burla. Indian J Med Sci. 1972 Dec;26(12):826-30. [PubMed]
16. Young E. Mandell, Douglus. Bennett’s Principles and Practice of Infectious Diseases.4th ed. Vol.2.Newyork: Churchill – Livingstone;1995. 2053 –2060.
17. Zaks N, Sukenik S, Alkan M, Flusser D, Neumann L, Buskila D. Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel. Semin Arthritis Rheum. 1995 Oct;25(2):97-102. [PubMed]
18. Gokhle YA, Bichile LS, Gogate A, Tillu AV, Zamre. Brucella spondylitis: an important treatable cause of low backache. J Assoc Physicians India. 1999 Apr;47(4):384-8.
19. Nagalotimath S.J. Bones and Joints in Brucellosis. In: Kulkarni G.S. editor. Text book of Orthopedics and Trauma. 1st edn. Vol.1 Jaypee; 1999; 212-216.
20. Al-Nakshabandi NA. The spectrum of imaging findings of brucellosis: a pictorial essay. Can AssocRadiol J. 2012 Feb;63(1):5-11. doi: 10.1016/j.carj.2010.09.011. Epub 2010 Nov 12.
21. Sharif HS, Aideyan OA, Clark DC, Madkour MM, Aabed MY, Mattsson TA, al-Deeb SM, Moutaery KR. Brucellar and tuberculous spondylitis: comparative imaging features. Radiology. 1989 May;171(2):419-25. [PubMed]
22. Ozgül A, Yazicioğlu K, Gündüz S, Kalyon TA, Arpacioğlu O. Acute brucella sacroiliitis: clinical features. ClinRheumatol. 1998;17(6):521-3.
23. Sadat-Ali M, al-Mousa MS, al-Salem AH. Brucellosis as a cause of backache. Trop Geogr Med. 1991 Jan-Apr;43(1-2):148-51. [PubMed]
24. Sankaran-Kutty M, Marwah S, Kutty MK. The skeletal manifestations of brucellosis. IntOrthop. 1991;15(1):17-9.
25. Rajapakse CN, Al-Aska AK, Al-Orainey I, Halim K, Arabi K. Spinal brucellosis. Br J Rheumatol. 1987 Feb;26(1):28-31. [PubMed]
26. Khateeb MI, Araj GF, Majeed SA, Lulu AR. Brucella arthritis: a study of 96 cases in Kuwait. Ann Rheum Dis. 1990 Dec;49(12):994-8.
27. Malik GM. A clinical study of brucellosis in adults in the Asir region of southern Saudi Arabia. Am J Trop Med Hyg. 1997 Apr;56(4):375-7.
28. HCDCP.org[Internet]. Human brucellosis: diagnosis and treatment.[updated on June8, 2012] Available from;http://www2.keelpno.gr/blog/?p=2023&lang=en.
29. CDC. gov.in [Internet] .Brucellosis Reference Guide: Exposures, Testing, And Prevention[ Updated on February 2017]. Available from;https://www.cdc.gov/brucellosis/pdf/brucellosis-reference-guide.pdf
30. Mousa A.R et al.The nature of human brucellosis in Kuwait: study of 379 cases. Rev Infect Dis. 1988 Jan-Feb;10(1):211-7.
31. Mathur TN. Brucella strains isolated from cows, buffaloes, goats, sheep and human beings at karnal: their significance with regard to the epidemiology of brucellosis. Indian J Med Res. 1964 Dec;52:1231-40.