Musculoskeletal involvement in brucellosis in different age groups: a study of 195 cases

Brucellosis occurs naturally in domestic animals.It is still an important public health problem throughout the world, but principally, and in particular, in the Mediterranean region, including Turkey, the Arabian peninsula, the Indian subcontinent, Mexico, and parts of Central and South America [1-3].Human infection is contracted from infected animals and closely linked to poor animal husbandry methods, feeding habits, and hygiene standards [4].The disease typically attacks young and middle-aged adults, with a low incidence among infants and elderly patients [5][6][7].The clinical manifestations of brucellosis are protean and include rheumatic complaints in 20-85% of patients.Musculoskeletal complications are important owing to their high prevalence and also the associated functional sequelae [8,9].The prevalence and pattern of musculoskeletal involvement depend on the strain of Brucella infecting the individual, the patient's age and the duration of the disease [10][11][12][13][14][15][16][17][18][19].Comparative and statistical studies in large populations and in different age groups are therefore highly important.Although there are many reports on brucellosis in Objective: The aim of the present study was to determine the distribution and characteristics of arthritis in 195 patients with musculoskeletal involvement due to brucellosis in different age groups in the southeastern region of Turkey.Patients and methods: We carried out a retrospective analysis of 283 patients with brucellosis records and identified 195 with musculoskeletal involvement.Patients were classified into acutesubacute (<12 months) and chronic (>12 months) brucellosis.Patients were also classified into three age groups: <15 years old (group A), 15-45 years (group B), and over 45 years (group C).In addition, patients were classified into five subgroups according to type of arthritis: peripheral arthritis, polyarthritis, spondylitis, sacroiliitis, and spondylitis/sacroiliitis.Results: 195 (69%) of the 283 patients [138 female (49%), 145 male (51%)] had musculoskeletal involvement.Of the patients with musculoskeletal involvement 113 (58%) were female and 82 (42%) were male, ranging in age from 3 to 71 years (mean age 33.14 ± 15.03).Of 195 patients studied, 39 (14%) were <15 years old (group A), 122 (43%) were aged 15-45 (group B), and 34 (12%) were over 45 (group C).The most commonly affected joints were the sacroiliac joint in 108 patients (55%), peripheral joints in 106 (54%), and spondylitis in 60 (31%).Of 108 patients with sacroiliitis, 19 were in group A, 76 in group B, and 13 in group C. Bilateral sacroiliitis was less common in group B (23 patients) than in groups A (3) and C (3) (p <0.05).Spondylitis was more common in group B (18%).Sacroiliitis and polyarthritis were more common than other types of musculoskeletal involvement in females, whereas in males the distribution of all types was similar.In patients aged under 15 and 15-45, sacroiliitis and polyarthritis were common compared with other types of arthritis, but the distribution was similar in patients over 45. Conclusion:In southeastern Anatolia musculoskeletal involvement in brucellosis is frequent.The series presented suggests that musculoskeletal involvement in group A is higher than groups A and C. The prevalence of musculoskeletal involvement appears to differ according to age, sex and clinical type.