If you have a fever and back pain after eating skewers, beware of brucellosis spondylitis!

Author: Zhang Qiang, Chief Physician, Beijing Ditan Hospital, Capital Medical University

Reviewer: Ren Dajiang, Chief Physician of the Seventh Medical Center of the General Hospital of the Chinese People's Liberation Army

In the past, people working in related occupations were prone to brucellosis (brucellosis), such as cattle and sheep slaughterers, or herdsmen and veterinarians in pastoral areas. They were the most common group of brucellosis patients.

Now with the development of economy and animal husbandry, people eat more beef and mutton. For example, in summer everyone likes to eat grilled lamb skewers. If they are not cooked well, it can easily cause brucellosis.

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Brucellosis is a zoonotic infectious disease caused by contact with infected animals such as cattle, sheep, pigs, dogs, or a history of contact with pastoral areas and infection with Brucella.

Brucella is a Gram-negative bacterium without a capsule and highly contagious. It has strong resistance and can survive on the surface of animals or soil for weeks or months at normal temperatures. If there is a history of contact with the above, it is easy to cause infection in humans.

Studies have shown that it takes 6 minutes to kill this bacteria at around 80°C. Therefore, before eating skewers, we must pay attention to fully heating them to a certain degree before eating, otherwise it is easy to cause brucellosis.

The typical symptom of brucellosis is high fever, and it is a wave fever. That is, the fever continues to be high, above 39 degrees Celsius, and the fever subsides in about a week, and then suddenly reappears. This is the typical manifestation of brucellosis.

In addition, its typical symptoms include pain in the muscles and joints of the limbs, and imaging may show some pathological manifestations of the spine and joints.

However, these typical symptoms are rarely seen now. Patients often do not have a high fever, or even no fever, or a low fever. This may be due to the timely use of some drugs or the mutation of the pathogenic bacteria, so the symptoms of patients are becoming less and less typical.

Patients with brucellous spondylitis also experience pain in the chest, waist and back, and this pain is often very severe, and they may even be unable to walk. This is different from general intervertebral disc disease or sprains.

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It is currently believed that the severe pain in the lower back and back experienced by brucellosis patients is due to the bacteria being retained in this area, growing and multiplying, causing spinal instability and inflammatory stimulation resulting in severe pain. This is also a characteristic of brucellosis spondylitis.

Diagnosis of brucellosis spondylitis requires many tests, including blood tests to confirm infection with Brucella. Commonly used tests include brucellosis agglutination test, blood culture, and some inflammatory indicators, such as erythrocyte sedimentation rate and whether C-reactive protein is elevated. In addition, for patients with difficult diagnosis, metagenomic testing can also help diagnose brucellosis.

Imaging examinations are also very important. The most commonly used are spinal X-rays (DR) and CT three-dimensional reconstruction examinations to determine whether there is spinal damage. Spinal magnetic resonance imaging mainly looks at the scope and degree of intervertebral disc lesions, whether there are paravertebral abscesses, etc., which is especially helpful for early diagnosis.

Some patients also need to undergo electromyography to help determine the extent of nerve damage. If there is a brain and spinal cord lesion, cerebrospinal fluid examination and head magnetic resonance imaging are also required. Sometimes the diagnosis of brucellotic spondylitis is still quite troublesome, otherwise it is easy to misdiagnose.

Brucellosis spondylitis can be very harmful if not treated in time. It often damages the spine starting from the intervertebral disc, causing inflammation of the intervertebral disc, which can cause severe pain. It is very difficult for patients to turn over and move, and in severe cases, they are bedridden.

If the damage to the intervertebral disc gradually worsens, and then some damage occurs to the upper and lower vertebrae, it will cause damage and deformation of the vertebral bodies of the spine. If the diseased tissue compresses the surrounding spinal cord and nerves, it will cause some nerve and spinal cord symptoms, including paralysis, pain in the limbs, numbness, and weakness, and eventually cause difficulty walking and incontinence.

Moreover, once these patients develop the above-mentioned neurological symptoms, treatment and recovery will be very difficult because the spinal cord and nerves have been compressed.

Of course, if treated actively, most patients with brucellotic spondylitis can be cured through medication, and only a few require surgical treatment.

Studies have shown that the incidence of brucellosis affecting the spine is relatively high, ranging from 20% to 50%, but the symptoms vary. Most cases are mild, with some pain or discomfort in the chest, waist, back, and neck, or weakness, and rarely develop into severe damage to the spine.

Most patients can get good results if they take enough anti-brucellosis drugs and take them for a long enough time. If they do not take the drugs as prescribed by the doctor, their condition may worsen.

For a small number of patients, due to drug resistance or severe illness, medication is ineffective, and there is severe pain in the chest, waist and back, and even neurological symptoms, limb pain, numbness, weakness or paralysis. Imaging examinations show that the vertebral bones are severely damaged or accompanied by abscesses, and the spine cannot support the body, so surgical treatment may be required.

For patients with milder forms of brucellous spondylitis, minimally invasive surgical methods can be used, but for patients with severe damage, lesion debridement and spinal internal fixation are required.