[Brucella spondylodiscitis and factors associated with prognosis: a case series from Sétif, Algeria].

Abstract

Introduction and objectives: Spondylodiscitis is a serious and suggestive complication of brucellosis. Few studies have been devoted to it in Algeria, although the infection remains a public health problem. The aim of this study was to report the epidemiological and clinical aspects of brucellosis spondylodiscitis and to identify the neurological complications.

Material and methods: This is a descriptive analysis of a cohort of adult patients with Brucella spondylodiscitis, based on data collected from patient records recruited between January 2016 and December 2022.

Results: Thirteen females and 24 males with a mean age of 48 ± 15 years [21 to 71 years] were included in the study. Diagnosis was made on average 120 days ± 100 [30-360] after the onset of clinical symptoms. Commonly reported symptoms were: back pain (100%), fever (46%), sweating (70%), asthenia (84%), chills (22%), and weight loss (27%). Neurological complications were numerous and sometimes varied in the same patient: one case of paraplegia, three cases of paraparesis, six cases of sensory disturbances, and one case of sphincter disorders. Involvement of the lumbar spine was predominant, observed in 22 patients, including 15 at the L4-L5 level.In addition to discovertebral lesions, imaging revealed 27 cases of epiduritis, 13 cases of spinal cord compression, 25 cases of radicular compression, and pre- or para-vertebral and psoas abscesses.Two treatment regimens were used: doxycycline-cotrimoxazole-gentamycin (22 cases) and doxycycline-rifampicin-gentamycin (15 cases). At the end of the one-year post-therapeutic follow-up, we observed one relapse, sequelae of paraparesis, and sequelae of spinal pain in 12 patients.

Discussion and conclusion: This study has allowed us to observe prognostic elements. Early spinal imaging is essential to combat the excessive delay in diagnosis in our patients. There is no clear consensus in the scientific literature regarding neurological complications, such as epiduritis, and optimal treatment. The results of our study may contribute to the development of more personalized management algorithms.