Abstract
Osteoarticular brucellosis (OAB) usually occurs as sacroiliitis, spondylitis, or peripheral arthritis. Although OAB is the most frequent complication of human brucellosis, tissue specimens of OAB are rarely histologically examined, because in contrary to pyogenic and tuberculosis infections, biopsy is rarely necessary to confirm the diagnosis of OAB. Tissue diagnosis in patients with OAB is generally used, when other causes are suspected particularly in the presence of paraspinal abscess or neurological deficits. The histological diagnosis of OAB lacks pathognomonic features. Microscopically, OAB shows a spectrum of lesions ranging from nonspecific forms mimicking pyogenic infection to granulomatous forms mimicking tuberculosis and other granulomatous diseases. This broad histological spectrum and the rareness of histological specimens in routine practice make the histological diagnosis of OAB challenging.
The definitive diagnosis of OAB requires combination of clinical context, radiological features, and laboratory tests, mainly serological tests for Brucella agglutinin. The role of histological examination is mainly to rule out other infectious process, particularly tuberculosis and tumor process.
Although not used in routine practice for the diagnosis of OAB, ancillary techniques (immunohistochemistry and molecular methods), with validated protocols, may be helpful to establish the definitive diagnosis of OAB in formalin-fixed specimens.
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Abbreviations
- OAB:
-
Osteoarticular brucellosis
References
Christopher S, Umapathy BL, Ravikumar KL. Brucellosis: review on the recent trends in pathogenicity and laboratory diagnosis. J Lab Physicians. 2010;2(2):55–60.
Castaño MJ, Navarro E, Solera J. Brucellosis. In: Quah SR, editor. International encyclopedia of public health. 2nd ed. Oxford: Academic Press; 2017. p. 281–95.
Dean AS, Crump L, Greter H, Schelling E, Zinsstag J. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6(10):e1865.
Zheng R, Xie S, Lu X, Sun L, Zhou Y, Zhang Y, et al. A systematic review and meta-analysis of epidemiology and clinical manifestations of human brucellosis in China. Biomed Res Int. 2018;2018:5712920.
Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World J Orthop. 2019;10(2):54–62.
Smailnejad Gangi SM, Hasanjani Roushan MR, Janmohammadi N, Mehraeen R, Soleimani Amiri MJ, Khalilian E. Outcomes of treatment in 50 cases with spinal brucellosis in Babol, northern Iran. J Infect Dev Ctries. 2012;6(9):654–9.
Lim KB, Kwak YG, Kim DY, Kim YS, Kim JA. Back pain secondary to Brucella spondylitis in the lumbar region. Ann Rehabil Med. 2012;36(2):282–6.
Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in Urban Shenzhen, China: a case report. J Med Case Rep. 2014;8:367.
Ebrahimpour S, Bayani M, Moulana Z, Hasanjani Roushan MR. Skeletal complications of brucellosis: a study of 464 cases in Babol, Iran. Caspian J Intern Med. 2017;8(1):44–8.
Araj GF. Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents. 2010;36:S12–S7.
Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS Negl Trop Dis. 2019;13(1):e0007112.
Galińska EM, Zagórski J. Brucellosis in humans—etiology, diagnostics, clinical forms. Ann Agric Environ Med. 2013;20(2):233–8.
Chelli Bouaziz M, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol. 2008;37(9):785–90.
Nielsen K. Diagnosis of brucellosis by serology. Vet Microbiol. 2002;90(1–4):447–59.
Pabuccuoglu O, Ecemis T, El S, Coskun A, Akcali S, Sanlidag T. Evaluation of serological tests for diagnosis of brucellosis. Jpn J Infect Dis. 2011;64(4):272–6.
Al Dahouk S, Nöckler K. Implications of laboratory diagnosis on brucellosis therapy. Expert Rev Anti-Infect Ther. 2011;9(7):833–45.
Di Bonaventura G, Angeletti S, Ianni A, Petitti T, Gherardi G. Microbiological laboratory diagnosis of human brucellosis: an overview. Pathogens. 2021;10(12):1623.
Colmenero JD, Jiménez-MejÃas ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997;56(12):709–15.
Dasari S, Naha K, Prabhu M. Brucellosis and tuberculosis: clinical overlap and pitfalls. Asian Pac J Trop Med. 2013;6(10):823–5.
Madkour MM. Osteoarticular brucellosis. In: Madkour MM, editor. Madkour’s brucellosis. Berlin: Springer; 2001. p. 74–84.
Koubâa M, Mâaloul I, Marrakchi C, Lahiani D, Znazen A, Hammami B, et al. Brucellar spinal epidural abscesses. Single center experience of nineteen patients and review of the literature. Egypt Rheumatol. 2013;35(1):15–20.
Lee HJ, Hur JW, Lee JW, Lee SR. Brucellar spondylitis. J Korean Neurosurg Soc. 2008;44(4):277–9.
Li H, Pan S, Zhou J. Correction to: radiology of infectious and inflammatory diseases. In: Li H, Pan S, Zhou J, editors. Radiology of infectious and inflammatory diseases: musculoskeletal system, vol. 5. Singapore: Springer; 2022. p. C1-C.
Colmenero JD, Ruiz-Mesa JD, Plata A, Bermúdez P, MartÃn-Rico P, Queipo-Ortuño MI, et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin InfecT Dis. 2008;46(3):426–33.
Wang J, Zhang Q. Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report. BMC Infect Dis. 2022;22(1):430.
Merino E, Pascual E. Brucellar arthritis. In: Watts RA, Conaghan PG, Denton C, Foster H, Isaacs J, Müller-Ladner U, editors. Oxford textbook of rheumatology. Oxford: Oxford University Press; 2013.
Pandit D. Brucella arthritis—an update. Indian J Rheumatol. 2011;6(1, Supplement):75–9.
Jalan D, Elhence A, Elhence P, Jain P. A case of acute septic arthritis hip caused by Brucella melitensis in an adolescent child. BMJ Case Rep. 2015;2015:bcr2015211678.
Rammeh S, Romdhane E, Riahi H, Ksentini M, Chelli Bouaziz M, Ayadi R, et al. Brucellar spondylodiscitis: a case series with focus on histopathological features. J Clin Neurosci. 2020;78:360–4.
Chelli Bouaziz M, Ladeb MF, Riahi H, Achour W, Berriche A, Ammari L, et al. Imaging of spinal brucellosis. In: Ladeb MF, Peh WCG, editors. Imaging of spinal infection. Cham: Springer; 2021. p. 183–97.
Dubost JJ, Constantin A, Soubrier M, Ristori JM, Cantagrel A, Bussière JL. Does reactive arthritis caused by Brucella exist? Apropos of 4 cases. Presse Med. 1997;26(5):207–10.
Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report. J Med Case Rep. 2014;8(1):367.
Rosenberg AE, Kattapuram SV, Nielsen GP. Bone infections. In: Kradin RL, editor. Diagnostic pathology of infectious disease. New York: W.B. Saunders; 2010. p. 341–75.
Russell DG, Cardona PJ, Kim MJ, Allain S, Altare F. Foamy macrophages and the progression of the human tuberculosis granuloma. Nat Immunol. 2009;10(9):943–8.
Akhtar M, Ali A. Pathology of brucellosis: a review of 88 biopsies. Ann Saudi Med. 1989;9(3):247–53.
Li T, Liu T, Jiang Z, Cui X, Sun J. Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: a retrospective study. Exp Ther Med. 2016;12(4):2069–77.
Sybenga AB, Jupiter DC, Speights VO, Rao A. Diagnosing osteomyelitis: a histology guide for pathologists. J Foot Ankle Surg. 2020;59(1):75–85.
Esendagli-Yilmaz G, Uluoglu O. Pathologic basis of pyogenic, nonpyogenic, and other spondylitis and discitis. Neuroimaging Clin N Am. 2015;25(2):159–61.
Xavier MN, Paixão TA, Poester FP, Lage AP, Santos RL. Pathological, immunohistochemical and bacteriological study of tissues and milk of cows and fetuses experimentally infected with Brucella abortus. J Comp Pathol. 2009;140(2–3):149–57.
Minda AG, Gezahegne MK. A review on diagnostic methods of brucellosis. J Vet Sci Technol. 2016;7(3).
Kaden R, Ferrari S, Alm E, Wahab T. A novel real-time PCR assay for specific detection of Brucella melitensis. BMC Infect Dis. 2017;17(1):230.
Li M, Zhou X, Li J, Sun L, Chen X, Wang P. Real-time PCR assays for diagnosing brucellar spondylitis using formalin-fixed paraffin-embedded tissues. Medicine. 2018;97(9):e0062.
Solooki S, Hoveidaei AH, Kardeh B, Azarpira N, Salehi E. Xanthogranulomatous osteomyelitis of the tibia. Ochsner J. 2019;19(3):276–81.
Borjian A, Rezaei F, Eshaghi MA, Shemshaki H. Xanthogranulomatous osteomyelitis. J Orthop Traumatol. 2012;13(4):217–20.
Ozkaya N, Rosenblum MK, Durham BH, Pichardo JD, Abdel-Wahab O, Hameed MR, et al. The histopathology of Erdheim-Chester disease: a comprehensive review of a molecularly characterized cohort. Modern Pathol. 2018;31(4):581–97.
Veyssier-Belot C, Cacoub P, Caparros-Lefebvre D, Wechsler J, Brun B, Remy M, et al. Erdheim-Chester disease. Clinical and radiologic characteristics of 59 cases. Medicine. 1996;75(3):157–69.
Pathak S, Gautam R, Pc P, Bagtharia P, Sharma A. A rare case report on Xanthogranulomatous osteomyelitis of hip mimicking tuberculosis and review of literature. Cureus. 2019;11(10):e5921.
Shah KK, Pritt BS, Alexander MP. Histopathologic review of granulomatous inflammation. J Clin Tuberc Other Mycobact Dis. 2017;7:1–12.
Agashe VM, Johari AN, Shah M, Anjum R, Romano C, Drago L, et al. Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in the endemic and non-endemic areas of the World-A WAIOT view. Microorganisms. 2020;8(9):1312.
Giner Escobar P, el Amrani A, Corrales Torres AJ, Guijarro Jorge R, Sánchez-Palencia Ramos A, Jiménez-Alonso J. Simultaneous isolation of Brucella melitensis and mycobacterium tuberculosis in pleural empyema. Enferm Infecc Microbiol Clin. 1990;8(9):595.
Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247–80.
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Rammeh Rommani, S., Romdhane, E. (2024). Brucellar Bone and Joint Infection. In: Rammeh Rommani, S., Ladeb, M.F. (eds) Histopathology of Bone and Joint Infections. Springer, Cham. https://doi.org/10.1007/978-3-031-54888-8_10
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