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Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis

Year 2023, Volume: 15 Issue: 1, 42 - 51, 15.03.2023
https://doi.org/10.18521/ktd.1112409

Abstract

Objective: Musculoskeletal involvement in brucellosis is very important. This study aimed to evaluate the magnetic resonance imaging (MRI) findings and hematological parameters as a predictive value for the diagnosis of musculoskeletal brucellosis.
Methods: This prospective case-control study was conducted between June 2011 and November 2019 in a university hospital. Ninety-nine patients with the confirmed diagnosis of brucellosis without musculoskeletal involvement and forty-three brucellosis patients with musculoskeletal involvement were examined. The hematological, biochemical parameters, and radiological imaging findings of both groups were recorded. These parameters were statistically compared between the two groups.
Results: The mean age of the patients (non-involvement group) and musculoskeletal involvement groups was 44.04 ± 23.11 and 37.92 ± 24.80 years, respectively (P = 0.062). C-reactive protein (CRP) and alkaline phosphatase (ALP) levels were significantly higher in the musculoskeletal involvement group (P < 0.05). The lower lymphocyte level was statistically significant in this group. Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 70% and 65% for ALP, 77% and 58% for CRP, 83% and 45% for lymphopenia, respectively. There was no statistically significant difference between the two groups in terms of the other hematological and biochemical parameters. Spondylodiscitis (34.8%) was the most common MRI finding in patients with musculoskeletal involvement.
Conclusions: Our study results show that CRP, ALP, and lymphopenia can be used as valuable markers in the preliminary diagnosis of musculoskeletal brucellosis.

References

  • 1. Akpinar O. Historical perspective of brucellosis: a microbiological and epidemiological overview. Le Infezioni in Medicina. 2016;24(1):77-86.
  • 2. Akpınar O, KILIÇ H. BRUCELLOSİS: RETROROSPECTİVE EVALUATİON OF 382 PATİENTS. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi.3(3):108-13.
  • 3. Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS neglected tropical diseases. 2019;13(1):e0007112.
  • 4. Akpinar O, Guzel M. Spinal stenosis caused by epidural and paraspinal abscess due to brucella infection. J Pak Med Assoc. 2020;70(7):1275-8.
  • 5. Duman A, Akpınar O. Brucellar spondylodiscitis in chronic low back pain patients. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2016;7(3):63-5.
  • 6. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World journal of orthopedics. 2019;10(2):54.
  • 7. Demirdal T, Sen P. Risk factors for focal involvement in brucellosis. Diagnostic Microbiology and Infectious Disease. 2020:115003.
  • 8. Özden H, Togan T. Osteoarticular Involvement among Brucellosis Cases in Konya City. Cukurova Medical Journal. 2015;40(3):483-94.
  • 9. Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Internal Medicine. 2011;50(5):421-8.
  • 10. Taşova Y, Saltoğlu N, Şahin G, Aksu H. Osteoarthricular involvement of brucellosis in Turkey. Clinical rheumatology. 1999;18(3):214-9.
  • 11. Gotuzzo E, Alarcón GS, Bocanegra TS, Carrillo C, Guerra JC, Rolando I, et al., editors. Articular involvement in human brucellosis: a retrospective analysis of 304 cases. Seminars in arthritis and rheumatism; 1982: Elsevier.
  • 12. Colmenero J, Reguera J, Martos F, Sanchez-De-Mora D, Delgado M, Causse M, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine. 1996;75(4):195-211.
  • 13. Mousa ARM, Muhtaseb SA, Almudallal DS, Khodeir SM, Marafie AA. Osteoarticular complications of brucellosis: a study of 169 cases. Reviews of infectious diseases. 1987;9(3):531-43.
  • 14. Weil Y, Mattan Y, Liebergall M, Rahav G. Brucella prosthetic joint infection: a report of 3 cases and a review of the literature. Clinical Infectious Diseases. 2003;36(7):e81-e6.
  • 15. Hashemi SH, Keramat F, Ranjbar M, Mamani M, Farzam A, Jamal-Omidi S. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. International journal of infectious diseases. 2007;11(6):496-500.
  • 16. BUCHANAN TM, SULZER CR, FRIX MK, FELDMAN RA. Brucellosis in the United States, 1960-1972: an abattoir-associated disease. Medicine. 1974;53(6):415-25.
  • 17. Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I, et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. American Journal of Roentgenology. 2006;187(4):873-80.
  • 18. Geyik MF, GüR A, Nas K, Cevik R, Saraç J, Dikici B, et al. Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases. Swiss medical weekly. 2002;132(7-8):98-105.
  • 19. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45(6):727-33.
  • 20. Bodur H, Erbay A, Çolpan A, Akıncı E. Brucellar spondylitis. Rheumatology international. 2004;24(4):221-6.
  • 21. Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. European journal of radiology. 2008;67(1):153-8.
  • 22. Arkun R, Mete BD, editors. Musculoskeletal brucellosis. Seminars in musculoskeletal radiology; 2011: © Thieme Medical Publishers.
  • 23. Harman M, Unal Ö, Onbaşi K, Kıymaz N, Arslan H. Brucellar spondylodiscitis: MRI diagnosis. Clinical imaging. 2001;25(6):421-7.
  • 24. Yang X, Zhang Q, Guo X. Value of magnetic resonance imaging in brucellar spondylodiscitis. La radiologia medica. 2014;119(12):928-33.
  • 25. Solera J, Lozano E, Martínez-Alfaro E, Espinosa A, Castillejos ML, Abad L. Brucellar spondylitis: review of 35 cases and literature survey. Clinical infectious diseases. 1999;29(6):1440-9.
  • 26. Gonzalez-Gay M, Garcia-Porrua C, Ibanez D, Garcia-Pais M. Osteoarticular complications of brucellosis in an Atlantic area of Spain. The Journal of rheumatology. 1999;26(1):141-5.
  • 27. Namiduru M, Karaoglan I, Gursoy S, Bayazıt N, Sirikci A. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatology international. 2004;24(3):125-9.
  • 28. Bosilkovski M, Kirova-Urosevic V, Cekovska Z, Labacevski N, Cvetanovska M, Rangelov G, et al. Osteoarticular involvement in childhood brucellosis: experience with 133 cases in an endemic region. The Pediatric infectious disease journal. 2013;32(8):815-9.
  • 29. Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR, et al. Epidemiological and clinical features of Brucella arthritis in 24 children. Annals of Saudi medicine. 2011;31(3):270-3.
  • 30. Al-Eissa YA, Kambal AM, Alrabeeah A, Abdullah A, Al-Jurayyan NA, Al-Jishi NM. Osteoarticular brucellosis in children. Annals of the rheumatic diseases. 1990;49(11):896-900.
  • 31. Aktar F, Tekin R, Bektaş MS, Güneş A, Köşker M, Ertuğrul S, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Italian journal of pediatrics. 2016;42(1):3.
  • 32. Çiftdoğan DY, Aslan S. Osteoarticular involvement of brucellosis in pediatric patients: clinical and laboratory characteristics. Turkish Journal of Pediatrics. 2020;62(2).
  • 33. Özaksoy D, Yücesoy K, Yücesoy M, Kovanlıkaya I, Yüce A, Naderi S. Brucellar spondylitis: MRI findings. European Spine Journal. 2001;10(6):529-33.
  • 34. Mrabet D, Mizouni H, Khiari H, Rekik S, Chéour E, Meddeb N, et al. Brucellar spondylodiscitis affecting non-contiguous spine levels. Case Reports. 2011;2011.
  • 35. Tekkök IH, Berker M, Özcan OE, Özgen T, Akalin E. Brucellosis of the spine. Neurosurgery. 1993;33(5):838-44.
  • 36. de Divitiis O, Elefante A. Cervical spinal brucellosis: a diagnostic and surgical challenge. World neurosurgery. 2012;78(3-4):257.
  • 37. Sharif HS, Aideyan OA, Clark DC, Madkour MM, Aabed MY, Mattsson TA, et al. Brucellar and tuberculous spondylitis: comparative imaging features. Radiology. 1989;171(2):419-25.
  • 38. Jung N-Y, Jee W-H, Ha K-Y, Park C-K, Byun J-Y. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. American Journal of Roentgenology. 2004;182(6):1405-10.
  • 39. Tali ET, Gültekin S. Spinal infections. European radiology. 2005;15(3):599-607.

Brusellozda Kas İskelet Tutulumunda Manyetik Rezonans Görüntüleme ve İnflamatuar Belirteçlerin Tanıya Katkısı

Year 2023, Volume: 15 Issue: 1, 42 - 51, 15.03.2023
https://doi.org/10.18521/ktd.1112409

Abstract

Amaç: Brusellozda kas iskelet sistemi tutulumu çok önemlidir. Bu çalışmada, manyetik rezonans görüntüleme (MRG) bulgularının ve hematolojik parametrelerin kas-iskelet sistemi brusellozu tanısında prediktif değer olarak değerlendirilmesi amaçlandı.
Metod: Bu prospektif vaka-kontrol çalışması Haziran 2011 ile Kasım 2019 tarihleri arasında bir üniversite hastanesinde yapıldı. Kas-iskelet tutulumu olmayan bruselloz tanısı doğrulanmış 99 hasta ve kas-iskelet tutulumu olan kırk üç bruselloz hastası incelendi. Her iki grubun hematolojik, biyokimyasal parametreleri ve radyolojik görüntüleme bulguları kaydedildi. Bu parametreler istatistiksel olarak iki grup arasında karşılaştırıldı.
Bulgular: Hastaların (tutulum olmayan grup) ve kas-iskelet tutulum gruplarının ortalama yaşı sırasıyla 44.04 ± 23.11 ve 37.92 ± 24.80 yıldı (P = 0.062). C-reaktif protein (CRP) ve alkalin fosfataz (ALP) düzeyleri kas-iskelet tutulumu grubunda anlamlı olarak daha yüksekti (P < 0.05). Lenfosit miktarının düşüklüğü bu grupta istatistiksel olarak anlamlıydı. Alıcı işletim özelliği (ROC) analizine göre, duyarlılık ve özgüllük ALP için sırasıyla %70 ve %65, CRP için %77 ve %58, lenfopeni için %83 ve %45 idi. Diğer hematolojik ve biyokimyasal parametreler açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu. Spondilodiskit (%34.8) kas iskelet sistemi tutulumu olan hastalarda en sık MRG bulgusuydu.
Sonuç: Çalışma sonuçlarımız, kas-iskelet sistemi brusellozunun ön tanısında CRP, ALP ve lenfopeninin değerli belirteçler olarak kullanılabileceğini göstermektedir.

References

  • 1. Akpinar O. Historical perspective of brucellosis: a microbiological and epidemiological overview. Le Infezioni in Medicina. 2016;24(1):77-86.
  • 2. Akpınar O, KILIÇ H. BRUCELLOSİS: RETROROSPECTİVE EVALUATİON OF 382 PATİENTS. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi.3(3):108-13.
  • 3. Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS neglected tropical diseases. 2019;13(1):e0007112.
  • 4. Akpinar O, Guzel M. Spinal stenosis caused by epidural and paraspinal abscess due to brucella infection. J Pak Med Assoc. 2020;70(7):1275-8.
  • 5. Duman A, Akpınar O. Brucellar spondylodiscitis in chronic low back pain patients. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2016;7(3):63-5.
  • 6. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World journal of orthopedics. 2019;10(2):54.
  • 7. Demirdal T, Sen P. Risk factors for focal involvement in brucellosis. Diagnostic Microbiology and Infectious Disease. 2020:115003.
  • 8. Özden H, Togan T. Osteoarticular Involvement among Brucellosis Cases in Konya City. Cukurova Medical Journal. 2015;40(3):483-94.
  • 9. Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Internal Medicine. 2011;50(5):421-8.
  • 10. Taşova Y, Saltoğlu N, Şahin G, Aksu H. Osteoarthricular involvement of brucellosis in Turkey. Clinical rheumatology. 1999;18(3):214-9.
  • 11. Gotuzzo E, Alarcón GS, Bocanegra TS, Carrillo C, Guerra JC, Rolando I, et al., editors. Articular involvement in human brucellosis: a retrospective analysis of 304 cases. Seminars in arthritis and rheumatism; 1982: Elsevier.
  • 12. Colmenero J, Reguera J, Martos F, Sanchez-De-Mora D, Delgado M, Causse M, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine. 1996;75(4):195-211.
  • 13. Mousa ARM, Muhtaseb SA, Almudallal DS, Khodeir SM, Marafie AA. Osteoarticular complications of brucellosis: a study of 169 cases. Reviews of infectious diseases. 1987;9(3):531-43.
  • 14. Weil Y, Mattan Y, Liebergall M, Rahav G. Brucella prosthetic joint infection: a report of 3 cases and a review of the literature. Clinical Infectious Diseases. 2003;36(7):e81-e6.
  • 15. Hashemi SH, Keramat F, Ranjbar M, Mamani M, Farzam A, Jamal-Omidi S. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. International journal of infectious diseases. 2007;11(6):496-500.
  • 16. BUCHANAN TM, SULZER CR, FRIX MK, FELDMAN RA. Brucellosis in the United States, 1960-1972: an abattoir-associated disease. Medicine. 1974;53(6):415-25.
  • 17. Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I, et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. American Journal of Roentgenology. 2006;187(4):873-80.
  • 18. Geyik MF, GüR A, Nas K, Cevik R, Saraç J, Dikici B, et al. Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases. Swiss medical weekly. 2002;132(7-8):98-105.
  • 19. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45(6):727-33.
  • 20. Bodur H, Erbay A, Çolpan A, Akıncı E. Brucellar spondylitis. Rheumatology international. 2004;24(4):221-6.
  • 21. Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. European journal of radiology. 2008;67(1):153-8.
  • 22. Arkun R, Mete BD, editors. Musculoskeletal brucellosis. Seminars in musculoskeletal radiology; 2011: © Thieme Medical Publishers.
  • 23. Harman M, Unal Ö, Onbaşi K, Kıymaz N, Arslan H. Brucellar spondylodiscitis: MRI diagnosis. Clinical imaging. 2001;25(6):421-7.
  • 24. Yang X, Zhang Q, Guo X. Value of magnetic resonance imaging in brucellar spondylodiscitis. La radiologia medica. 2014;119(12):928-33.
  • 25. Solera J, Lozano E, Martínez-Alfaro E, Espinosa A, Castillejos ML, Abad L. Brucellar spondylitis: review of 35 cases and literature survey. Clinical infectious diseases. 1999;29(6):1440-9.
  • 26. Gonzalez-Gay M, Garcia-Porrua C, Ibanez D, Garcia-Pais M. Osteoarticular complications of brucellosis in an Atlantic area of Spain. The Journal of rheumatology. 1999;26(1):141-5.
  • 27. Namiduru M, Karaoglan I, Gursoy S, Bayazıt N, Sirikci A. Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients. Rheumatology international. 2004;24(3):125-9.
  • 28. Bosilkovski M, Kirova-Urosevic V, Cekovska Z, Labacevski N, Cvetanovska M, Rangelov G, et al. Osteoarticular involvement in childhood brucellosis: experience with 133 cases in an endemic region. The Pediatric infectious disease journal. 2013;32(8):815-9.
  • 29. Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR, et al. Epidemiological and clinical features of Brucella arthritis in 24 children. Annals of Saudi medicine. 2011;31(3):270-3.
  • 30. Al-Eissa YA, Kambal AM, Alrabeeah A, Abdullah A, Al-Jurayyan NA, Al-Jishi NM. Osteoarticular brucellosis in children. Annals of the rheumatic diseases. 1990;49(11):896-900.
  • 31. Aktar F, Tekin R, Bektaş MS, Güneş A, Köşker M, Ertuğrul S, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Italian journal of pediatrics. 2016;42(1):3.
  • 32. Çiftdoğan DY, Aslan S. Osteoarticular involvement of brucellosis in pediatric patients: clinical and laboratory characteristics. Turkish Journal of Pediatrics. 2020;62(2).
  • 33. Özaksoy D, Yücesoy K, Yücesoy M, Kovanlıkaya I, Yüce A, Naderi S. Brucellar spondylitis: MRI findings. European Spine Journal. 2001;10(6):529-33.
  • 34. Mrabet D, Mizouni H, Khiari H, Rekik S, Chéour E, Meddeb N, et al. Brucellar spondylodiscitis affecting non-contiguous spine levels. Case Reports. 2011;2011.
  • 35. Tekkök IH, Berker M, Özcan OE, Özgen T, Akalin E. Brucellosis of the spine. Neurosurgery. 1993;33(5):838-44.
  • 36. de Divitiis O, Elefante A. Cervical spinal brucellosis: a diagnostic and surgical challenge. World neurosurgery. 2012;78(3-4):257.
  • 37. Sharif HS, Aideyan OA, Clark DC, Madkour MM, Aabed MY, Mattsson TA, et al. Brucellar and tuberculous spondylitis: comparative imaging features. Radiology. 1989;171(2):419-25.
  • 38. Jung N-Y, Jee W-H, Ha K-Y, Park C-K, Byun J-Y. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. American Journal of Roentgenology. 2004;182(6):1405-10.
  • 39. Tali ET, Gültekin S. Spinal infections. European radiology. 2005;15(3):599-607.
There are 39 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Yasemin Ogul 0000-0002-9357-3603

Veysel Atilla Ayyıldız 0000-0003-0252-9023

Mustafa Güzel 0000-0001-5408-0905

Orhan Akpınar 0000-0001-8397-8247

Hikmet Orhan 0000-0002-8389-1069

Publication Date March 15, 2023
Acceptance Date November 16, 2022
Published in Issue Year 2023 Volume: 15 Issue: 1

Cite

APA Ogul, Y., Ayyıldız, V. . A., Güzel, M., Akpınar, O., et al. (2023). Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. Konuralp Medical Journal, 15(1), 42-51. https://doi.org/10.18521/ktd.1112409
AMA Ogul Y, Ayyıldız VA, Güzel M, Akpınar O, Orhan H. Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. Konuralp Medical Journal. March 2023;15(1):42-51. doi:10.18521/ktd.1112409
Chicago Ogul, Yasemin, Veysel Atilla Ayyıldız, Mustafa Güzel, Orhan Akpınar, and Hikmet Orhan. “Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis”. Konuralp Medical Journal 15, no. 1 (March 2023): 42-51. https://doi.org/10.18521/ktd.1112409.
EndNote Ogul Y, Ayyıldız VA, Güzel M, Akpınar O, Orhan H (March 1, 2023) Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. Konuralp Medical Journal 15 1 42–51.
IEEE Y. Ogul, V. . A. Ayyıldız, M. Güzel, O. Akpınar, and H. Orhan, “Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis”, Konuralp Medical Journal, vol. 15, no. 1, pp. 42–51, 2023, doi: 10.18521/ktd.1112409.
ISNAD Ogul, Yasemin et al. “Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis”. Konuralp Medical Journal 15/1 (March 2023), 42-51. https://doi.org/10.18521/ktd.1112409.
JAMA Ogul Y, Ayyıldız VA, Güzel M, Akpınar O, Orhan H. Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. Konuralp Medical Journal. 2023;15:42–51.
MLA Ogul, Yasemin et al. “Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis”. Konuralp Medical Journal, vol. 15, no. 1, 2023, pp. 42-51, doi:10.18521/ktd.1112409.
Vancouver Ogul Y, Ayyıldız VA, Güzel M, Akpınar O, Orhan H. Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. Konuralp Medical Journal. 2023;15(1):42-51.