■由布鲁氏菌感染引起的脊柱炎是一种罕见但具有挑战性的疾病,其成功的治疗取决于及时的诊断和适当的治疗。本研究报告两例典型的胸腰布病脊柱炎病例,强调实时聚合酶链反应(实时PCR)检测和手术干预的关键作用。
■病例1涉及一名49岁的男牧羊人,有6个月的发烧史(40°C),严重的胸部和背部疼痛,2周下肢活动受限伴夜间加重。体格检查显示T9和T10棘突有压痛和搏击痛,下肢有2级肌肉力量.CT显示T9和T10椎骨骨破坏,椎间隙变窄,而MRI显示T9-T10椎骨的异常信号,椎管脓肿,和脊髓压迫。玫瑰红平板凝集试验呈阳性。病例2是一名59岁的男子,他抱怨严重的胸腰椎背痛伴发热(39.0°C),行走受限2个月。他的体重减轻了2.5公斤,并且有与绵羊密切接触的历史。玫瑰红测试呈阳性,MRI显示L1和L2椎骨的炎性改变。诊断和治疗:实时PCR证实布鲁氏菌感染。术前使用多西环素进行抗菌治疗,利福平,头孢他啶-舒巴坦至少给药2周。手术治疗包括椎间孔切开术辅助清创术,减压,内固定,全身麻醉下植骨.术后组织病理学检查,HE和革兰氏染色进一步证实了诊断。结果:在干预后的最后一次随访(4-12周),两名患者均经历了显着的疼痛缓解并恢复正常的下肢运动。
■实时PCR检测为疑似布鲁氏菌病脊柱炎病例提供了有价值的诊断见解。手术治疗有助于控制感染,脊髓减压,恢复稳定,构成必要和有效的治疗方法。在这种情况下,及时的诊断和全面的管理对于取得有利的结果至关重要。
UNASSIGNED: Spondylitis caused by Brucella infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study
reports two typical cases of thoracic and lumbar brucellosis spondylitis, highlighting the pivotal roles of real-time polymerase chain reaction (real-time PCR) detection and surgical intervention.
UNASSIGNED: Case 1 involved a 49-year-old male shepherd who presented with a 6-month history of fever (40°C), severe chest and back pain, and 2-week limited lower limb movement with night-time exacerbation. Physical examination revealed tenderness and percussion pain over the T9 and T10 spinous processes, with grade 2 muscle strength in the lower limbs. CT showed bone destruction of the T9 and T10 vertebrae with narrowing of the intervertebral space, whereas MRI demonstrated abnormal signals in the T9-T10 vertebrae, a spinal canal abscess, and spinal cord compression. The Rose Bengal plate agglutination test was positive.
Case 2 was a 59-year-old man who complained of severe thoracolumbar back pain with fever (39.0°C) and limited walking for 2 months. He had a 2.5 kg weight loss and a history of close contact with sheep. The Rose Bengal test was positive, and the MRI showed inflammatory changes in the L1 and L2 vertebrae. Diagnosis and treatment: real-time PCR confirmed Brucella infection in both cases. Preoperative antimicrobial therapy with doxycycline, rifampicin, and ceftazidime-sulbactam was administered for at least 2 weeks. Surgical management involved intervertebral foraminotomy-assisted debridement, decompression, internal fixation, and bone grafting under general anesthesia. Postoperative histopathological examination with HE and Gram staining further substantiated the diagnosis. Outcomes: both patients experienced significant pain relief and restored normal lower limb movement at the last follow-up (4-12 weeks) after the intervention.
UNASSIGNED: Real-time PCR detection offers valuable diagnostic insights for suspected cases of brucellosis spondylitis. Surgical treatment helps in infection control, decompression of the spinal cord, and restoration of stability, constituting a necessary and effective therapeutic approach. Prompt diagnosis and comprehensive management are crucial for favorable outcomes in such cases.