Brucellosis 2003 proceedings - PHIDIAS

Short Oral Communications
Human brucellosis
the production, and consumption, of fresh cheese, starting just after lamb slaughter.
When the age of patients was considered, we did not observe a concentration in a
particular age class, but a fairly uniform distribution among them. Moreover, when we
analyzed incidence rates of human brucellosis between 1997 and 2000, the
observed cases were similar to the expected, if we consider an occupational
exposure risk of about 25%. Validation of the mathematical model was done on the
basis of observations conducted on selected Italian regions, and considering a
particular North/South gradient of human and animal brucellosis incidence.
HO9- BRUCELLAR SPONDILODISCITIS. A CASE REPORT IN A RELATIVELY
LOW INCIDENCE AREA.
F. Vignale, P. G. Giuri, A. Di Girolamo, D. De Tullio, E. Pizzigallo, F. Ricci. Clinica Malattie Infettive,
Università degli Studi “G. d’Annunzio”, Chieti, Italy.
Osteoarticular complications of brucellosis are quite common, and are
reported in some 20-60% of cases worldwide. There is a wide spectrum of clinical
manifestations, including arthritis, spondylodiscitis, osteomyelitis, synovitis and
bursitis. In our settings, early diagnosis of such complications is somewhat difficult
because of latency from acute infection, and due to the low incidence of brucellosis in
Central Italy. Here we describe the case of a 52 years old female patient admitted to
our Unit in December 2001 with complaint of diffuse back pain after a period of
recurrent febrile episodes, max 38°C, occurred in the previous months, and resistant
to non specific broad spectrum antibiotic treatment. Before admission, a NMR
showed spondylitic alterations in the thoracic tract. Routine tests showed alteration of
the inflammatory indices (ESR = 15mm/h, CRP = 1,41mg/dl), and a moderate
neutrophilia. Wright serology was positive at high titer (1/1600), and both Rose
Bengal test and complement fixation were positive for brucella antibodies. Blood
culture and PCR were negative for brucella isolation. A further NMR of the dorsal
column showed alteration of the D9 and D10 vertebral bodies, with intervertebral disc
involvement. After exclusion of other causes of spondilodiscitis (i.e. tubercular or
degenerative), a treatment with ciprofloxacin was initiated. After two months,
because of symptoms and inflammation signs persistence, rifampin was associated,
and doxycycline was then associated after discontinuation of ciprofloxacin. A
progressive improvement of the inflammatory indices was noted, and a stable
improvement of both clinical signs and symptoms was achieved. Wright serological
test reverted to negative during treatment, and drugs were discontinued on August
2002. A follow-up NMR showed signs of healing D9-D10 spondylodiscitis, and the
patient is in good clinical conditions to date. In our experience, better efficacy of
doxycycline-rifampin association was noted, when compared to quinolones-rifampin,
somewhat in contrast with other published reports. A prolonged treatment duration is
frequently required for complicated brucellosis.
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Brucellosis 2003 International Research Conference