Konya İlinde Osteoartiküler Tutulumlu Bruselloz Olguları

Giriş: Bruselloz birçok organ ve dokuyu tutabilen sistemik bir infeksiyondur. En sık etkilenen sistemlerden biri kasiskelet sistemidir. Hastalık sakroiliit, periferik artrit, spondilit, paraspinal apse, bursit, osteomyelit gibi tablolarla ortaya çıkabilmektedir. Çalışmamızın amacı Konya ilinde brusellozlu olgularda osteoartiküler tutulumun oranlarını, tiplerini, klinik özelliklerini değerlendirmek ve osteoartiküler tutulumu olmayan grupla aradaki farkları belirlemektir. Materyal ve Metod: Çalışmamıza Haziran 2003–Haziran 2014 tarihleri arasında bruselloz tanısı ile başvuran 316 hasta alındı. Bruselloz tanısı uygun klinik belirti ve bulguların varlığında, pozitif Brucella Standart Tüp Aglutinasyon testi (1/160 titre) ve/veya kan kültüründe Brucella spp. bakterisinin üremiş olması ile konuldu. Osteoartiküler sistem komplikasyonlarının tanısı uygun fizik muayene bulguları varlığında radyolojik tanı yöntemleri ile saptanan bulgulara göre konuldu. Bel ağrısı, sakroiliak eklem ağrısı ve sırt ağrısı olan olgularda lomber vertebra, sakral vertebra veya torakal vertebra magnetik rezonans inceleme tetkikleri yapıldı. Bulgular: 129 hastada (%40,8) osteoartiküler tutulum gözlendi. (%52 kadın, %48 erkek). En sık bulaş yolu olarak, 97 (%75) olguda hayvancılıkla uğraşma ve/veya pastörize edilmemiş süt ve süt ürünleri tüketimi öyküsü- özellikle taze peynir- mevcuttu. Ortalama yaş 4618 yıldı. En sık osteoartiküler tutulum olarak sakroiliit saptandı. (n: 68, %52,7). Sakroiliitlerin %70,5’i bilateraldi. Sakroiliiti takiben, spondilodiskit 50 (%38,7), periferik artrit 20 (%15,5), bursit 1 (%0,8) olguda saptandı. Osteoartiküler tutulumu olan olgulara en az üç ay medikal tedavi verildi. Sonuç: Brusellozda osteoartiküler tutulum oranları ve tutulum yerleri bölgeden bölgeye farklılık gösterebilmektedir. Çalışmamızda Konya ilinde en sık tutulumun sakroiliit olduğunu gösterdik. Bu hastalık sakroiliit ve spondilodiskit semptomları ya da eklem ağrıları olan olgularda ayırıcı tanıda mutlaka yer almalıdır.

Anahtar Kelimeler:

Bruselloz, osteoartiküler tututlum

Osteoarticular Involvement among Brucellosis Cases in Konya City

Purpose: Brucellosis is a systemic disease that can affect many organs and tissues. Musculoskeletal system is one of the most commonly affected systems. Disease may present itself with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis or osteomyelitis. The objective of the present study was to determine the frequency, types and clinical features of osteoarticular involvement among cases with brucellosis in Konya city and to establish the differences between patients with and without osteoarticular involvement. Material and Methods: Three hundred and sixteen patients with Brucellosis who presented between June 2003 and June 2014 were included in the study. Brucellosis was diagnosed by positive Brucella Standard Agglutination Test (1/160 titer) and/or growth of Brucella spp. in blood culture addition to the presence of clinical signs and findings. Diagnosis of osteoarticular system complications was established by physical examination and radiological findings obtained by diagnostic imaging tools. Magnetic resonance images of the thoracic, lumbar or sacral vertebrae were acquired in patients with back pain, low back pain and sacro-iliac joint pain. Results: Osteoarticular involvement was noted in 129 patients (40.8%) (females: 52% and males: 48%). The most common route of transmission was employment in farming and/or consumption of un-pasteurized milk or dairy products, especially fresh cheese, in 97 (75%) cases. Mean age was 4618 years. Sacroiliitis was the most frequent osteoarticular involvement (n: 68, 52.7%), 70.5% of which were bilateral. Sacroiliitis was followed by spondylodiscitis in 35 (38.7%), peripheral arthritis in 20 (15.5%), bursitis in 1 (0.8%) cases. Patients with osteoarticular involvement received medical treatment for at least three months. Discussion: Ratio and anatomical region of osteoarticular involvement in brucellosis shows variability among areas. In the present study, we demonstrated that sacroiliitis was the most common form in Konya city. This disease should be included in differential diagnosis in patients with symptoms of sacroiliitis, spondylodiscitis or those with articular pain.

Keywords:

Brucellosis, osteoarticular involvement,

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