Isolation of Brucella abortus biovar 1 from human lumbar disc bulging: a case report of brucellar discitis

Whole-genome sequencing for genetic diversity analysis of Iranian Brucella spp. isolated from humans and livestock

Brucellosis is one of the most common zoonoses in the Middle East. It is causing economic losses to the livestock industry and has a great public health concern. Little is known about the genetic diversity and distribution of brucellae in Iran. Therefore, forty Brucella spp. strains (B. abortus and B. melitensis) isolated from animals and humans were analyzed by whole genome sequencing (WGS) technology using single nucleotide polymorphism (SNP) analysis and core genome multilocus sequence typing (cgMLST). Brucella isolates were obtained from lymph nodes (cows and camels), milk (cows, camels and sheep), and aborted foetus samples (sheep and goats), as well as cerebrospinal fluid and blood of humans. The isolates were originating from thirteen provinces of Iran and isolated between 2015 and 2020. According to in-silico MLST, ST8 and ST2 were the most frequent sequence types in B. melitensis and B. abortus, respectively. Based on phylogeographic reconstruction using cgSNP analysis, the investigated Iranian B. melitensis strains belonged to the American and Mediterranean lineages of the B. melitensis phylogeny. Furthermore, cgSNP analysis revealed a similarity between Iranian B. abortus isolates and strains from Iraq and Egypt. Therefore, the origin of the Iranian strains can be suggested to be strains from neighboring and Middle East countries. Moreover, cgMLST analysis showed that the Iranian B. melitensis strains were closely relative to strains recovered from sheep and humans in Iraq, Afghanistan, Syria, Turkmenistan, and Pakistan. In the current panel of strains, cgMLST and cgSNP analysis provided an appropriate and accurate tool for effective traceback analyses for Brucella spp. from Iran. The results of cgSNP and cgMLST helped to understand the geographic distribution and interspecies transmission of Iranian strains and highlight the importance of specific brucellosis control measures in Iran with regard to the One-Health approach.

One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study

Background

This study aimed to assess the clinical efficacy of one-stage posterior surgery combined with anti-Brucella therapy in the treatment of lumbosacral brucellosis spondylitis (LBS).

Methods

From June 2010 to June 2020, the clinical and radiographic data of patients with LBS treated by one-stage posterior surgery combined with anti-Brucella therapy were retrospectively analyzed. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry Disability Index scores (ODI) were used to evaluate the clinical outcomes. Frankel’s classification system was employed to access the initial and final neurologic function. Fusion of the bone grafting was classified by Bridwell’s grading system.

Results

A total of 55 patients were included in this study with a mean postoperative follow-up time of 2.6 ± 0.8 years (range, 2 to 5). There were 40 males and 15 females with a mean age of 39.8 ± 14.7 years (range, 27 to 57). The Brucella agglutination test was ≥ 1:160 in all patients, but the blood culture was positive in 43 patients (78.1%). A statistical difference was observed in ESR, CRP, VAS, ODI, and JOA between preoperative and final follow-up (P < 0.05). Neurological function was significantly improved in 20 patients with preoperative neurological dysfunction after surgery. According to Bridwell’s grading system, the fusion of bone grafting in 48 cases (87.2%) was defined as grade I, and grade II in 7 cases (12.7%). None of the infestation recurrences was observed.

Conclusion

One-stage posterior surgery combined with anti-Brucella therapy was a practical method in the treatment of LBS with severe neurological compression and spinal sagittal imbalance.

Isolation of Brucella melitensis from Lumbar Vertebrae in Patient with Initial Misdiagnosis: A Rare Case with Spinal Epidural Abscess, Spinal Stenosis, and Brain Lesion

Introduction: Brucellar spondylodiscitis is among the most typical forms of osteoarticular involvement that still challenges clinicians and scientists for early diagnosis. Case Presentation: We describe the isolation of Brucella melitensis from vertebrae in a man with spondylodiscitis who had osteoarthritis as an underlying condition. The patient showed negative results on blood samples' serological, molecular, and culture tests and had low-back pain, restricted lumbar movements, headache, poor appetite, and fatigue for the past nine months. He had a history of regular ingestion of raw cow milk and milk products for a long time. First, he was misdiagnosed as lumbar disc herniation and then underwent nonsteroidal anti-inflammatory drugs and myorelaxants treatment. The lack of fast diagnosis and appropriate treatment led to severe complications of the disease. Three months after the first magnetic resonance imaging (MRI), the findings of the second MRI without intravenous contrast showed right lateral recess and canal stenosis at L4 - L5 with narrowing the thecal sac at the disc space. Abnormal enhancement of the endplates at L4 - L5 with relating epidural space-enhancing tissue in the setting of spondylodiscitis and the associated epidural abscess was seen behind L4. Moreover, extensive high signal abnormalities in paraspinal tissues at L3, L4, L5, S1, S2, and S3 were notable. The diagnosis was approved by isolating B. melitensis biovar 1 from the culture of the vertebrate body. The Brucella isolate was characterized by Bruce-ladder PCR, AMOS PCR, and classical biotyping. The patient was treated successfully with surgical intervention and triple-antibiotic, including oral doxycycline 100 mg/12 h plus oral rifampin 300 mg/12 h for three months and intramuscular streptomycin 1 g daily for the first two weeks. The patient’s general condition and low-back pain were remarkably improved in the follow-up. Conclusions: Patient histories and a series of different diagnostic procedures such as MRI, serology, molecular, and cultural tests are essential to make a rapid and accurate diagnosis of brucellar spondylodiscitis, thereby reducing the delay for brucellar spondylodiscitis treatment.