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World J Orthop. Feb 18, 2019; 10(2): 54-62
Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.54
Osteoarticular manifestations of human brucellosis: A review
Seyed Mokhtar Esmaeilnejad-Ganji, Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mokhtar Esmaeilnejad-Ganji, Department of Orthopedics, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mokhtar Esmaeilnejad-Ganji, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran
Seyed Mohammad Reza Esmaeilnejad-Ganji, Boston University School of Medicine, Boston, MA 02118, United States
ORCID number: Seyed Mokhtar Esmaeilnejad-Ganji (0000-0001-7562-0835); Seyed Mohammad Reza Esmaeilnejad-Ganji (0000-0003-4152-5324).
Author contributions: Esmaeilnejad-Ganji SM contributed to study design; Esmaeilnejad-Ganji SM and Esmaeilnejad-Ganji SMR contributed to data collection and writing the draft; Esmaeilnejad-Ganji SM contributed to manuscript revision; all authors approved the final version of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Seyed Mokhtar Esmaeilnejad-Ganji, MD, Associate Professor, Department of Orthopedics, Babol University of Medical Sciences, Ganjafrooz Street, Babol 47176-47745, Mazandaran, Iran. smsnganji@yahoo.com
Telephone: +98-11-32199936 Fax: +98-11-32190181
Received: November 14, 2018
Peer-review started: November 15, 2018
First decision: November 29, 2018
Revised: November 30, 2018
Accepted: December 17, 2018
Article in press: December 17, 2018
Published online: February 18, 2019

Abstract

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Key Words: Brucellosis, Brucella, Osteoarticular manifestations, Musculoskeletal pain, Bone, Joint

Core tip: The most frequent complication of brucellosis is osteoarticular involvement, with a rate of 10%-85%. Sacroiliac and spinal joints are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis. Brucellosis should be considered as a differential diagnosis for sciatica, back pain and septic arthritis in endemic regions.



INTRODUCTION

Brucellosis is the most common microbial zoonotic disease in the world and found endemically in most developed and developing countries. Brucella, an intracellular bacterium, causes brucellosis and Brucella melitensis spp. is the most common of the Brucella species[1-3]. This disease was first diagnosed in the Mediterranean area, where it received its initial name “Malta fever”[4]. Thousands of new cases of brucellosis are reported annually worldwide: its annual incidence per million population was reported to be 238.6 in Iran, 262.2 in Turkey, 214.4 in Saudi Arabia and 278.4 in Iraq[5]. Humans can acquire the infection mainly through occupational contact (e.g., veterinary, butcher, animal husbandry) or consumption of contaminated dairy products, especially milk, butter and cheese[6-8].

Brucellosis can involve the human body systemically. The most common clinical presentations of human brucellosis are fever, sweating, musculoskeletal pains, lymphadenopathy or hepatosplenomegaly[9,10]. The musculoskeletal system is particularly involved. Presentations of brucellosis are variable, deceptive and often non-specific, and they can mimic other infectious and non-infectious diseases[11-13].

For the diagnosis of brucellosis, after primary physical examination, serological tests [the Wright and 2-Mercaptoethanol (2-ME) tests], cultural and imaging methods (radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy) should be helpful[14,15]. To definitely diagnose brucellosis, the organism needs to be isolated from blood, bone marrow, wounds, purulent discharge or other body tissues and fluids, with culture or molecular/histological assessment[16-18]. In the present review, we have examined the literature concerning the osteoarticular manifestations of brucellosis, aiming to help physicians and orthopedic surgeons to provide better clinical management for these patients.

OSTEOARTICULAR MANIFESTATIONS

Osteoarticular involvement is the most frequent complication of brucellosis and can occur in 10% to 85% of the patients infected with the disease[19]. It is usually seen as sacroiliitis, spondylitis, osteomyelitis, peripheral arthritis, bursitis and tenosynovitis[15,20]. The type of skeletal involvement mainly depends on a patient’s age. This range of manifestations can lead patients to initially visit general practitioners, and ultimately orthopedic and rheumatology specialists. Variable clinical features and lack of specific symptoms often cause a delay in diagnosis of osteoarticular brucellosis.

Spinal brucellosis

The spine is one of the most common organs involved in brucellosis infection with a rate of 2%-54%, and the lumbar vertebrae are the most frequently affected[21,22]. It mainly manifests as spondylitis, spondylodiscitis and/or discitis. Back pain is the most common compliant in spinal brucellosis and reported by about half of the patients. Some patients with spinal brucellosis, who have back pain and sciatic radiculopathy, are misdiagnosed as having disease of an intervertebral disc and undergo surgery[23,24]. Given the high prevalence of backache, brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in the patients who are at occupational risk of brucellosis in endemic areas. Serological screening tests need to be conducted in all such patients[13,22,25,26], although serology may not be positive in all cases. A radionuclide scan can be a useful tool to determine the affected site[27,28]. MRI may be the best method to diagnosis and localize the cause of spondylodiscitis, epidural abscess, or compression on the spine and spinal nerves related to brucellosis. Epidural abscess is a rare complication of spinal brucellosis but can lead to severe outcomes, such as permanent neurological deficits, or even death if not treated timely.

Spondylitis

Spondylitis or vertebral osteomyelitis is inflammation and infection of vertebrae which has a prevalence rate of 2%-60% and mostly observed in men aged > 40 years old[22,29]. Lumbar (60%), sacral (19%) and cervical (12%) vertebrae were the most common affected sites, respectively, in a survey by Bozgeyik et al[30]. There are two types of spinal brucellosis, focal and diffuse. In focal involvement, osteomyelitis is localized in the anterior aspect of an endplate at the discovertebral junction, but in the diffuse type, osteomyelitis affects the entire vertebral endplate or the whole vertebral body[30,31]. Spondylitis is the dangerous complication of brucellosis due to its association with epidural, paravertebral and psoas abscess and potential resultant nerve compression. In one report, rapidly progressive spinal epidural abscess was observed following brucellar spondylitis, which was primarily misdiagnosed as a lumbar disc herniation[32]; delay in diagnosis and treatment were responsible for rapid progression of the disease. Another study reported a seronegative patient who developed a psoas abscess following brucellar spondylitis[33]. The basis of spondylitis diagnosis is microbiological or histopathological assessment of the tissue obtained by biopsy using a needle with computed tomography guidance. Epidural abscess is a rare complication of spondylitis and its diagnosis is difficult due to non-specific symptoms. Among the serological tests and radiological techniques, MRI is the most valuable method to diagnose spinal brucellosis or spinal epidural abscess[34,35]. MRI is also helpful to differentiate between pyogenic spondylitis and brucellar spondylitis[36].

Spondylodiscitis

This is simultaneous inflammation of vertebrae and disc, and usually occurs via hematogenous spread. It is the most severe form of osteoarticular involvement of brucellosis, because it makes a high rate of skeletal and neurological sequels despite therapy[32,37,38]. It is stated that 6%-85% of brucellosis osteoarticular involvements are related to brucellar spondylodiscitis. Lumbar (60%-69%), thoracic (19%) and cervical segments (6%-12%) are reported to be more involved in the spinal area[39-41]. Spondylodiscitis can be seen as single-focal and/or contiguous or non-contiguous multi-focal involvements. Multi-focal skeletal involvement in the spinal system was seen in 3%-14% of patients[41,42]. Radionuclide bone scintigraphy is an important technique in determination of musculoskeletal region of brucellosis. Increased uptake of the involved region on bone scintigraphy is more in favor of brucellar spondylodiscitis than tuberculous spondylodiscitis[43,44]. MRI is the choice for diagnosis of spondylodiscitis, epidural abscess and cord or root compression relevant to brucellosis[30,45,46]. In MRI, the lesion is found as destructive appearance (Pedro Pons’ sign) at antero-superior corner of vertebrae accompanied by prominent osteosclerosis, which is a pathognomonic finding[47,48]. Back pain is the main symptom of spondylodiscitis, however, it is not a specific symptom and usually leads to a delay in diagnosis and late treatment. Therefore, in the endemic regions, it is necessary to consider spondylodiscitis as a differential diagnosis for long-term cervical, lumbar and sacral pain (especially among elderly patients) and perform screening serological tests to achieve early diagnosis and prevent its late complications[49,50].

Discitis

The intervertebral disc can be infected without spondylitis, which is named discitis. In addition to back pain, disc herniation and sciatica can be described by the patient with discitis[51,52], therefore, this disease should be considered in the differential diagnosis of those symptoms. It was observed that the simultaneous existence of spondylolysis and spondylolisthesis with brucellar discitis caused misdiagnosis[53].

Sacroiliitis

Large joints, like sacroiliac, are the most common regions of musculoskeletal involvement of brucellosis[31]. Sacroiliitis, or inflammation of sacroiliac joint, has been observed in nearly 80% of patients with focal complications and more frequently in adults[31,46]. Its clinical symptoms (septic or reactive forms) mimic acute low back pain or lumbar disc herniation and the back pain may radiate into the tight, however, chronic sacroiliitis is associated with chronic back pain[54,55]. Although low back pain is the important symptom, 24% of the patients were asymptomatic in a study[56]. It is reported that the rate of sacroiliitis is high in those patients who are infected with B. melitensis spp.[15,57]. Both of unilateral and bilateral forms of brucellar sacroiliitis have been reported[56,58]. Sacroiliitis was also simultaneously seen with dactylitis, olecranon bursitis, humerus osteomyelitis and iliac muscle abscess, and with other systemic diseases, like endocarditis, pyelonephritis and thyroiditis[59-62]. A study showed that high-resolution MRI has a higher sensitivity than scintigraphy in the diagnosis of brucellar sacroiliitis[63].

Limbs

Brucellosis with peripheral skeleton involvement is less prevalent compared with vertebral features. It can manifest as arthralgia, enthesopathy, osteomyelitis, arthritis, bursitis, tendonitis and tenosynovitis[64-67]. Arthritis occurs in 14%-26% of the patients suffering from acute, sub-acute or chronic brucellosis[68,69]. Knee, hip and ankle joints are among the most common peripheral regions affected by brucellosis and these patients present with arthritis[15,70]. Shoulders, wrists, elbows, interphalangeal and sternoclavicular joints may also be involved[28,69,71]. Chronic knee arthritis along with osteomyelitis have also been reported[72,73]. Multiple joint arthritis caused by brucellosis was reported in 17% of patients in a study[74]. In children, monoarthritis is the most common type of musculoskeletal brucellosis that mostly involves hip and knee joints, but adjacent bone osteomyelitis may also exist simultaneously[15,75,76]. Brucellosis can involve the peripheral joints through septic (with presence of pathogen) and reactive (lack of the pathogen) mechanisms[64,77].

Septic arthritis caused by brucellosis has been reported in the literature and it has been recommended that patients with septic arthritis living in the endemic areas, be examined in terms of brucellosis[68,74,78]. Septic arthritis in brucellosis progresses slowly and starts with small pericapsular erosions. Blood culture is positive in 20%–70% of such patients. Although synovial fluid assessment is the most useful diagnostic method, the isolation of the pathogen from synovial fluid is not easy[79]. In relation to the diagnosis of purulent arthritis, it may be necessary to rely on bone marrow culture in those patients with negative serology[80-82].

Knee arthritis has obvious symptoms and is less difficult to diagnose and treat due to easy access. However, the diagnosis and treatment of hip arthritis is more difficult and delay in diagnosis and treatment may lead to serious and irreparable complications, such as dislocation and necrosis of the femoral head[73,83]. Brucellosis should be considered in the differential diagnosis for a patient presenting with knee or hip arthritis symptoms in endemic regions to prevent misdiagnosis and serious complications. For example, misdiagnosis due to serological false negative test and improper interference in surgery was reported about brucellar arthritis of hip[84]. Almajid reported a rare case of brucellar olecranon bursitis whose serology was negative, but the blood and aspirate cultures were positive[85]. Brucellar arthritis following implantation of artificial knee and hip joints has been reported, which the medications may not be enough and removing the prosthesis might be needed[86-88]. Due to the synovial involvement of the disease, pathological evidence may not be found on radiograph in the early phase of infection.

Other manifestations

Spondyloarthritis following brucellosis was reported[77]. Sternal osteomyelitis caused by B. melitensis was observed following median sternotomy[89]. In a study by Ebrahimpour et al[69], brucellosis was attributed to sternoclavicular (4.5%), wrist (2.4%), elbow (1.07%) and shoulder (0.6%) arthritis. Delay in the diagnosis of brucellosis results in prolong disease duration which can lead to osteomyelitis or osteolytic lesions. Brucellar osteomyelitis has been observed in closed femur fracture and a pathologic humerus fracture[90,91]. It was also seen in association with prosthetic extra-articular hardware[92]. We reported the first case of brucellar osteomyelitis of pubic symphysis, who was symptom free within two-year follow-up despite inappropriate initial antibiotherapy[93].

LABORATORY INVESTIGATIONS

Laboratory tests following physical examinations are essential in order to diagnose brucellosis. Serology is often positive in the patients. In the acute infection, immunoglobulin M (IgM) antibody firstly appears, followed by immunoglobulin G (IgG) and immunoglobulin A (IgA)[14,94,95]. The Wright test, which is a standard agglutination test (SAT), measures the total amount of IgM and IgG antibodies, and the 2-ME test measures IgG antibody. In the endemic regions, a SAT titer ≥ 1:160 and 2-ME titer ≥ 1:80 is in favor of brucellosis diagnosis[94,96,97]. Enzyme-Linked Immunosorbent Assay (ELISA) is another type of serological test, but has less sensitivity and specificity[98]. Polymerase chain reaction (PCR) is a molecular method which can be very useful due to its quick procedure and high sensitivity and specificity, if it is available[99].

TREATMENT

The main purpose of antimicrobial medications in brucellosis is to treat the disease and its symptoms and signs, and to prevent the relapse. Combinations of doxycycline, streptomycin, gentamicin, ciprofloxacin, ofloxacin, co-trimoxazole (trimethoprim plus sulfamethoxazole) and rifampicin are used for antibiotherapy[100-102]. No standard therapy exists for osteoarticular brucellosis and physicians prescribe drugs based on their experiences and conditions of the disease (the involved site, and being complicated/uncomplicated). Triple regimen containing streptomycin (1 g daily) plus doxycycline (100 mg twice daily) plus rifampin (15 mg/kg daily) over 6 months had 100% efficacy on brucellar spondylitis[21]. Similar results were found using this regimen[103,104]. In contrast, double therapy with doxycycline and rifampin was associated with relapses[19,104]. With respect to brucellar spondylitis, patients need a long-term anti-bacterial medication (usually at least three months), mainly aiming to prevent relapses. Those patients who failed antibiotic therapy or presented with progressive neurological deficit, need surgical intervention[34,105,106]. The rate of surgical drainage in spinal brucellosis was reported in the range of 7.6%-33%[107]. In case of abscess in those patients with spondylodiscitis, treatment duration will be prolonged and surgery may be needed[47].

CONCLUSION

Brucellosis has variable clinical features and osteoarticular manifestations are the most common. Sacroiliac and spinal joints are the most frequently involved regions. Monoarthritis (knee/hip), sacroiliitis and spondylitis predominate in children, adults and the elderly, respectively. In order to diagnose the disease, physical examinations, laboratory tests and imaging techniques are needed. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in the endemic regions. Radiological assessments would be very helpful in such cases. Patients whose big joints, bone and artificial joints are involved, may be referred to a rheumatology center. Considering that these patients usually need orthopedic evaluation and treatment, it is recommended to refer them to an orthopedic center in order to prevent adverse effects caused by delay in the treatment. Early and appropriate diagnosis and treatment of the disease is the key of success in management of the patients with the osteoarticular manifestation of brucellosis. This is feasible by an early collaboration of orthopedic surgeon with a specialist in infectious diseases.

Footnotes

Manuscript source: Unsolicited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: Iran

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P- Reviewer: Anand A, Papachristou G S- Editor: Ji FF L- Editor: A E- Editor: Wu YXJ

References
1.  Dean AS, Crump L, Greter H, Schelling E, Zinsstag J. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6:e1865.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 239]  [Cited by in F6Publishing: 259]  [Article Influence: 21.6]  [Reference Citation Analysis (0)]
2.  Roushan MR, Ahmadi SA, Gangi SM, Janmohammadi N, Amiri MJ. Childhood brucellosis in Babol, Iran. Trop Doct. 2005;35:229-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 18]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
3.  Seleem MN, Boyle SM, Sriranganathan N. Brucellosis: a re-emerging zoonosis. Vet Microbiol. 2010;140:392-398.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 408]  [Cited by in F6Publishing: 402]  [Article Influence: 26.8]  [Reference Citation Analysis (0)]
4.  Papathanassiou BT, Papachristou G, Hartofilakidis-Garofalidi. Brucellar spondylitis. Report of 6 cases. Acta Orthop Scand. 1972;43:384-391.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
5.  Al-Tawfiq JA. Therapeutic options for human brucellosis. Expert Rev Anti Infect Ther. 2008;6:109-120.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 37]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
6.  Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect. 2004;132:1109-1114.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 84]  [Cited by in F6Publishing: 104]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
7.  Zhang J, Sun GQ, Sun XD, Hou Q, Li M, Huang B, Wang H, Jin Z. Prediction and control of brucellosis transmission of dairy cattle in Zhejiang Province, China. PLoS One. 2014;9:e108592.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 31]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
8.  Adesokan HK, Alabi PI, Ogundipe MA. Prevalence and predictors of risk factors for Brucellosis transmission by meat handlers and traditional healers' risk practices in Ibadan, Nigeria. J Prev Med Hyg. 2016;57:E164-E171.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  Hasanjani Roushan MR, Ebrahimpour S, Moulana Z. Different Clinical Presentations of Brucellosis. Jundishapur J Microbiol. 2016;9:e33765.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 15]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
10.  Ahmadinejad Z, Abdollahi A, Ziaee V, Domiraei Z, Najafizadeh SR, Jafari S, Ahmadinejad M. Prevalence of positive autoimmune biomarkers in the brucellosis patients. Clin Rheumatol. 2016;35:2573-2578.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
11.  Zheng R, Xie S, Lu X, Sun L, Zhou Y, Zhang Y, Wang K. A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China. Biomed Res Int. 2018;2018:5712920.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 92]  [Article Influence: 15.3]  [Reference Citation Analysis (0)]
12.  Ulu-Kilic A, Metan G, Alp E. Clinical presentations and diagnosis of brucellosis. Recent Pat Antiinfect Drug Discov. 2013;8:34-41.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 46]  [Article Influence: 4.2]  [Reference Citation Analysis (0)]
13.  Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6:e1929.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 238]  [Cited by in F6Publishing: 260]  [Article Influence: 21.7]  [Reference Citation Analysis (0)]
14.  Galińska EM, Zagórski J. Brucellosis in humans--etiology, diagnostics, clinical forms. Ann Agric Environ Med. 2013;20:233-238.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 12]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
15.  Sanaei Dashti A, Karimi A. Skeletal Involvement of Brucella melitensis in Children: A Systematic Review. Iran J Med Sci. 2013;38:286-292.  [PubMed]  [DOI]  [Cited in This Article: ]
16.  Christopher S, Umapathy BL, Ravikumar KL. Brucellosis: review on the recent trends in pathogenicity and laboratory diagnosis. J Lab Physicians. 2010;2:55-60.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 81]  [Article Influence: 5.8]  [Reference Citation Analysis (0)]
17.  Traxler RM, Lehman MW, Bosserman EA, Guerra MA, Smith TL. A literature review of laboratory-acquired brucellosis. J Clin Microbiol. 2013;51:3055-3062.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 86]  [Cited by in F6Publishing: 94]  [Article Influence: 8.5]  [Reference Citation Analysis (0)]
18.  Araj GF. Update on laboratory diagnosis of human brucellosis. Int J Antimicrob Agents. 2010;36 Suppl 1:S12-S17.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 141]  [Cited by in F6Publishing: 148]  [Article Influence: 10.6]  [Reference Citation Analysis (0)]
19.  Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O, Turan H, Kazak E, Inan A, Duygu F, Demiraslan H, Kader C, Sener A, Dayan S, Deveci O, Tekin R, Saltoglu N, Aydın M, Horasan ES, Gul HC, Ceylan B, Kadanalı A, Karabay O, Karagoz G, Kayabas U, Turhan V, Engin D, Gulsun S, Elaldı N, Alabay S. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20:O75-O82.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 54]  [Article Influence: 4.9]  [Reference Citation Analysis (0)]
20.  Lampropoulos C, Kamposos P, Papaioannou I, Niarou V. Cervical epidural abscess caused by brucellosis. BMJ Case Rep. 2012;2012:pii: bcr2012007070.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
21.  Smailnejad Gangi SM, Hasanjani Roushan MR, Janmohammadi N, Mehraeen R, Soleimani Amiri MJ, Khalilian E. Outcomes of treatment in 50 cases with spinal brucellosis in Babol, Northern Iran. J Infect Dev Ctries. 2012;6:654-659.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 16]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
22.  Lim KB, Kwak YG, Kim DY, Kim YS, Kim JA. Back pain secondary to Brucella spondylitis in the lumbar region. Ann Rehabil Med. 2012;36:282-286.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
23.  Yuksel KZ, Senoglu M, Yuksel M, Gul M. Brucellar spondylo-discitis with rapidly progressive spinal epidural abscess presenting with sciatica. Spinal Cord. 2006;44:805-808.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 13]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
24.  Samini F, Gharedaghi M, Khajavi M, Samini M. The etiologies of low back pain in patients with lumbar disk herniation. Iran Red Crescent Med J. 2014;16:e15670.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 12]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
25.  Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018;391:2356-2367.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1769]  [Cited by in F6Publishing: 1985]  [Article Influence: 330.8]  [Reference Citation Analysis (0)]
26.  Andriopoulos P, Tsironi M, Deftereos S, Aessopos A, Assimakopoulos G. Acute brucellosis: presentation, diagnosis, and treatment of 144 cases. Int J Infect Dis. 2007;11:52-57.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 45]  [Article Influence: 2.5]  [Reference Citation Analysis (1)]
27.  Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular involvement in brucellosis: study of 196 cases in the Republic of Macedonia. Croat Med J. 2004;45:727-733.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
28.  Bosilkovski M, Zezoski M, Siskova D, Miskova S, Kotevska V, Labacevski N. Clinical characteristics of human brucellosis in patients with various monoarticular involvements. Clin Rheumatol. 2016;35:2579-2584.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 6]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
29.  Nickerson EK, Sinha R. Vertebral osteomyelitis in adults: an update. Br Med Bull. 2016;117:121-138.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 108]  [Cited by in F6Publishing: 111]  [Article Influence: 13.9]  [Reference Citation Analysis (0)]
30.  Bozgeyik Z, Aglamis S, Bozdag PG, Denk A. Magnetic resonance imaging findings of musculoskeletal brucellosis. Clin Imaging. 2014;38:719-723.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 29]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
31.  Arkun R, Mete BD. Musculoskeletal brucellosis. Semin Musculoskelet Radiol. 2011;15:470-479.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 12]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
32.  Hu T, Wu J, Zheng C, Wu D. Brucellar spondylodiscitis with rapidly progressive spinal epidural abscess showing cauda equina syndrome. Spinal Cord Ser Cases. 2016;2:15030.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 9]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
33.  Bozbaş GT, Ünübol Aİ, Gürer G. Seronegative brucellosis of the spine: A case of psoas abscess secondary to brucellar spondylitis. Eur J Rheumatol. 2016;3:185-187.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 5]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
34.  Reşorlu H, Saçar S, Inceer BŞ, Akbal A, Gökmen F, Zateri C, Savaş Y. Cervical Spondylitis and Epidural Abscess Caused by Brucellosis: a Case Report and Literature Review. Folia Med (Plovdiv). 2016;58:289-292.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
35.  Bagheri AB, Ahmadi K, Chokan NM, Abbasi B, Akhavan R, Bolvardi E, Soroureddin S. The Diagnostic Value of MRI in Brucella Spondylitis With Comparison to Clinical and Laboratory Findings. Acta Inform Med. 2016;24:107-110.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
36.  Li T, Li W, Du Y, Gao M, Liu X, Wang G, Cui H, Jiang Z, Cui X, Sun J. Discrimination of pyogenic spondylitis from brucellar spondylitis on MRI. Medicine (Baltimore). 2018;97:e11195.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 12]  [Article Influence: 2.0]  [Reference Citation Analysis (0)]
37.  Erdem H, Elaldi N, Batirel A, Aliyu S, Sengoz G, Pehlivanoglu F, Ramosaco E, Gulsun S, Tekin R, Mete B, Balkan II, Sevgi DY, Giannitsioti E, Fragou A, Kaya S, Cetin B, Oktenoglu T, DoganCelik A, Karaca B, Horasan ES, Ulug M, Inan A, Kaya S, Arslanalp E, Ates-Guler S, Willke A, Senol S, Inan D, Guclu E, Tuncer-Ertem G, Meric-Koc M, Tasbakan M, Senbayrak S, Cicek-Senturk G, Sırmatel F, Ocal G, Kocagoz S, Kusoglu H, Guven T, Baran AI, Dede B, Yilmaz-Karadag F, Kose S, Yilmaz H, Aslan G, ALGallad DA, Cesur S, El-Sokkary R, Bekiroğlu N, Vahaboglu H. Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study". Spine J. 2015;15:2509-2517.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 25]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
38.  Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007;25:188-202.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 130]  [Cited by in F6Publishing: 161]  [Article Influence: 10.1]  [Reference Citation Analysis (0)]
39.  Tekaya R, Tayeb MH, El Amri N, Sahli H, Saidane O, Mahmoud I, Abdelmoula L. THU0257 Brucella Spondylodiscitis: A Study of Nineteen Cases. Ann Rheum Dis. 2015;74:290.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
40.  Koubaa M, Maaloul I, Marrakchi C, Lahiani D, Hammami B, Mnif Z, Ben Mahfoudh K, Hammami A, Ben Jemaa M. Spinal brucellosis in South of Tunisia: review of 32 cases. Spine J. 2014;14:1538-1544.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 32]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
41.  Chelli Bouaziz M, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol. 2008;37:785-790.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 63]  [Cited by in F6Publishing: 67]  [Article Influence: 4.2]  [Reference Citation Analysis (0)]
42.  Mrabet D, Mizouni H, Khiari H, Rekik S, Chéour E, Meddeb N, Mnif E, Mrabet AB, Srairi HS, Sellami S. Brucellar spondylodiscitis affecting non-contiguous spine levels. BMJ Case Rep. 2011;2011:pii: bcr0120113788.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
43.  Colmenero JD, Ruiz-Mesa JD, Plata A, Bermúdez P, Martín-Rico P, Queipo-Ortuño MI, Reguera JM. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis. 2008;46:426-433.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 71]  [Cited by in F6Publishing: 76]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
44.  Bouaziz MC, Bougamra I, Kaffel D, Hamdi W, Ghannouchi M, Kchir MM. Noncontiguous multifocal spondylitis: an exceptional presentation of spinal brucellosis. Tunis Med. 2010;88:280-284.  [PubMed]  [DOI]  [Cited in This Article: ]
45.  Yang X, Zhang Q, Guo X. Value of magnetic resonance imaging in brucellar spondylodiscitis. Radiol Med. 2014;119:928-933.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 13]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
46.  Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. Eur J Radiol. 2008;67:153-158.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 26]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
47.  Mehanic S, Baljic R, Mulabdic V, Huric-Jusufi I, Pinjo F, Topalovic-Cetkovic J, Hadziosmanovic V. Osteoarticular manifestations of brucellosis. Med Arch. 2012;66:24-26.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 13]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
48.  Tuna N, Ogutlu A, Gozdas HT, Karabay O. Pedro Pons' sign as a Brucellosis complication. Indian J Pathol Microbiol. 2011;54:183-184.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
49.  Raptopoulou A, Karantanas AH, Poumboulidis K, Grollios G, Raptopoulou-Gigi M, Garyfallos A. Brucellar spondylodiscitis: noncontiguous multifocal involvement of the cervical, thoracic, and lumbar spine. Clin Imaging. 2006;30:214-217.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 24]  [Cited by in F6Publishing: 28]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
50.  Lebre A, Velez J, Seixas D, Rabadão E, Oliveira J, Saraiva da Cunha J, Silvestre AM. [Brucellar spondylodiscitis: case series of the last 25 years]. Acta Med Port. 2014;27:204-210.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 7]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
51.  Demirci I. Brucella diskitis mimicking herniation without spondylitis; MRI findings. Zentralbl Neurochir. 2003;64:178-181.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 9]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
52.  Yilmaz C, Akar A, Civelek E, Köksay B, Kabatas S, Cansever T, Caner H. Brucellar discitis as a cause of lumbar disc herniation: a case report. Neurol Neurochir Pol. 2010;44:516-519.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 8]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
53.  Guglielmino A, Sorbello M, Murabito P, Naimo J, Palumbo A, Lo Giudice E, Giuffrida S, Fazzio S, Parisi G, Mangiameli S. A case of lumbar sciatica in a patient with spondylolysis and spondylolysthesis and underlying misdiagnosed brucellar discitis. Minerva Anestesiol. 2007;73:307-312.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
54.  Ozgül A, Yazicioğlu K, Gündüz S, Kalyon TA, Arpacioğlu O. Acute brucella sacroiliitis: clinical features. Clin Rheumatol. 1998;17:521-523.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 0.4]  [Reference Citation Analysis (1)]
55.  Thoma S, Patsiogiannis N, Dempegiotis P, Filiopoulos K. A report of two cases of brucellar sacroiliitis without systemic manifestations in Greece. J Pediatr Orthop. 2009;29:375-379.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.3]  [Reference Citation Analysis (1)]
56.  Gheita TA, Sayed S, Azkalany GS, El Fishawy HS, Aboul-Ezz MA, Shaaban MH, Bassyouni RH. Subclinical sacroiliitis in brucellosis. Clinical presentation and MRI findings. Z Rheumatol. 2015;74:240-245.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
57.  Ariza J, Pujol M, Valverde J, Nolla JM, Rufí G, Viladrich PF, Corredoira JM, Gudiol F. Brucellar sacroiliitis: findings in 63 episodes and current relevance. Clin Infect Dis. 1993;16:761-765.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 50]  [Cited by in F6Publishing: 54]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
58.  Ozturk M, Yavuz F, Altun D, Ulubay M, Firatligil FB. Postpartum Bilateral Sacroiliitis caused by Brucella Infection. J Clin Diagn Res. 2015;9:QD07-QD08.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
59.  Mamalis IP, Panagopoulos MI, Papanastasiou DA, Bricteux G. [Sacroilitis and osteomyelitis of the humeral bone du to Brucella melitensis in an adolescent]. Rev Med Liege. 2008;63:742-745.  [PubMed]  [DOI]  [Cited in This Article: ]
60.  Turan H, Serefhanoglu K, Karadeli E, Timurkaynak F, Arslan H. A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis. Int J Infect Dis. 2009;13:e485-e487.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 7]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
61.  Acar A, Turhan V, Diktaş H, Oncül O, Cavuşlu S. [A case of brucellosis complicated with endocarditis, pyelonephritis, sacroileitis and thyroiditis]. Mikrobiyol Bul. 2009;43:141-145.  [PubMed]  [DOI]  [Cited in This Article: ]
62.  Batmaz IB, Tekin R, Sariyildiz MA, Deveci O, Cevik R. A Case of Brucellosis with simultaneous dactylitis and sacroiliitis. Journal of Medical Cases. 2012;3:304-307.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
63.  Bilgeturk A, Gul HC, Karakas A, Mert G, Artuk C, Eyigun CP. Can imaging modalities be used as follow-up criteria after brucellar sacroiliitis treatment? J Infect Dev Ctries. 2017;11:123-128.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
64.  Kazak E, Akalın H, Yılmaz E, Heper Y, Mıstık R, Sınırtaş M, Özakın C, Göral G, Helvacı S. Brucellosis: a retrospective evaluation of 164 cases. Singapore Med J. 2016;57:624-629.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 20]  [Article Influence: 2.2]  [Reference Citation Analysis (1)]
65.  Ismayilova R, Nasirova E, Hanou C, Rivard RG, Bautista CT. Patterns of brucellosis infection symptoms in azerbaijan: a latent class cluster analysis. J Trop Med. 2014;2014:593873.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
66.  Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7:775-786.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 606]  [Cited by in F6Publishing: 626]  [Article Influence: 39.1]  [Reference Citation Analysis (0)]
67.  Tekin R, Ceylan Tekin F, Ceylan Tekin R, Cevik R. Brucellosis as a primary cause of tenosynovitis of the extensor muscle of the arm. Infez Med. 2015;23:257-260.  [PubMed]  [DOI]  [Cited in This Article: ]
68.  Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report. J Med Case Rep. 2014;8:367.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 8]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
69.  Ebrahimpour S, Bayani M, Moulana Z, Hasanjani Roushan MR. Skeletal complications of brucellosis: A study of 464 cases in Babol, Iran. Caspian J Intern Med. 2017;8:44-48.  [PubMed]  [DOI]  [Cited in This Article: ]
70.  Geyik MF, Gür A, Nas K, Cevik R, Saraç J, Dikici B, Ayaz C. Musculoskeletal involvement of brucellosis in different age groups: a study of 195 cases. Swiss Med Wkly. 2002;132:98-105.  [PubMed]  [DOI]  [Cited in This Article: ]
71.  Mousa AR, Muhtaseb SA, Almudallal DS, Khodeir SM, Marafie AA. Osteoarticular complications of brucellosis: a study of 169 cases. Rev Infect Dis. 1987;9:531-543.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 124]  [Cited by in F6Publishing: 127]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
72.  Wernaers P, Handelberg F. Brucellar arthritis of the knee: a case report with delayed diagnosis. Acta Orthop Belg. 2007;73:795-798.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
73.  Ayaşlioğlu E, Ozlük O, Kiliç D, Kaygusuz S, Kara S, Aydin G, Cokca F, Tekeli E. A case of brucellar septic arthritis of the knee with a prolonged clinical course. Rheumatol Int. 2005;25:69-71.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 14]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
74.  Charalambides C, Papademetriou K, Sgouros S, Sakas D. Brucellosis of the spine affecting multiple non-contiguous levels. Br J Neurosurg. 2010;24:589-591.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
75.  Fruchtman Y, Segev RW, Golan AA, Dalem Y, Tailakh MA, Novak V, Peled N, Craiu M, Leibovitz E. Epidemiological, diagnostic, clinical, and therapeutic aspects of Brucella bacteremia in children in southern Israel: a 7-year retrospective study (2005-2011). Vector Borne Zoonotic Dis. 2015;15:195-201.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 16]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
76.  Alshaalan MA, Alalola SA, Almuneef MA, Albanyan EA, Balkhy HH, AlShahrani DA, AlJohani S. Brucellosis in children: Prevention, diagnosis and management guidelines for general pediatricians endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). IJPAM. 2014;1:40-46.  [PubMed]  [DOI]  [Cited in This Article: ]
77.  Gotuzzo E, Alarcón GS, Bocanegra TS, Carrillo C, Guerra JC, Rolando I, Espinoza LR. Articular involvement in human brucellosis: a retrospective analysis of 304 cases. Semin Arthritis Rheum. 1982;12:245-255.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 126]  [Cited by in F6Publishing: 131]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
78.  Elzein FE, Sherbeeni N. Brucella Septic Arthritis: Case Reports and Review of the Literature. Case Rep Infect Dis. 2016;2016:4687840.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
79.  Hasanoglu I, Guven T, Maras Y, Guner R, Tasyaran MA, Acikgoz ZC. Brucellosis as an aetiology of septic arthritis. Trop Doct. 2014;44:48-49.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 4]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
80.  Işeri S, Bulut C, Yetkin MA, Kinikli S, Demiröz AP, Tülek N. [Comparison of the diagnostic value of blood and bone marrow cultures in brucellosis]. Mikrobiyol Bul. 2006;40:201-206.  [PubMed]  [DOI]  [Cited in This Article: ]
81.  Velan GJ, Leitner J, Folman Y, Gepstein R. Brucellosis of the spine with a synchronous Staphylococcus aureus pyogenic elbow infection. Eur Spine J. 1997;6:284-285.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
82.  Lee KH, Kang H, Kim T, Choi S. A case of unusual septic knee arthritis with Brucella abortus after arthroscopic meniscus surgery. Acta Orthop Traumatol Turc. 2016;50:385-387.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
83.  Cerit ET, Aydın M, Azap A. A case of brucellar monoarthritis and review of the literature. Rheumatol Int. 2012;32:1465-1468.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
84.  Janmohammadi N, Roushan MR. False negative serological tests may lead to misdiagnosis and mismanagement in osteoarticular brucellosis. Trop Doct. 2009;39:88-90.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 8]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
85.  Almajid FM. A Rare Form of Brucella Bursitis with Negative Serology: A Case Report and Literature Review. Case Rep Infect Dis. 2017;2017:9802532.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
86.  Mortazavi SMJ, Sobhan MR, Mazoochy H. Brucella Arthritis Following Total Knee Arthroplasty in a Patient with Hemophilia: A Case Report. Arch Bone Jt Surg. 2017;5:342-346.  [PubMed]  [DOI]  [Cited in This Article: ]
87.  Lewis JM, Folb J, Kalra S, Squire SB, Taegtmeyer M, Beeching NJ. Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature. Travel Med Infect Dis. 2016;14:444-450.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 9]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
88.  Kasim RA, Araj GF, Afeiche NE, Tabbarah ZA. Brucella infection in total hip replacement: case report and review of the literature. Scand J Infect Dis. 2004;36:65-67.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 15]  [Cited by in F6Publishing: 12]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
89.  Chin YT, Krishnan M, Burns P, Qamruddin A, Hasan R, Dodgson AR. Brucella melitensis sternal osteomyelitis following median sternotomy. J Infect Chemother. 2014;20:574-576.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
90.  Abrahams MA, Tylkowski CM. Brucella osteomyelitis of a closed femur fracture. Clin Orthop Relat Res. 1985;194-196.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 6]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
91.  Luc M, Armingeat T, Pham T, Legré V, Lafforgue P. Chronic Brucella infection of the humerus diagnosed after a spontaneous fracture. Joint Bone Spine. 2008;75:229-231.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 5]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
92.  Navarro V, Solera J, Martínez-Alfaro E, Sáez L, Escribano E, Pérez-Flores JC. Brucellar osteomyelitis involving prosthetic extra-articular hardware. J Infect. 1997;35:192-194.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 9]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
93.  Mansoori D, Gangi EN, Touzet P. [Brucellosis of the pubic symphysis. Apropos of a case. Review of the literature]. Rev Chir Orthop Reparatrice Appar Mot. 1996;82:753-756.  [PubMed]  [DOI]  [Cited in This Article: ]
94.  Pabuccuoglu O, Ecemis T, El S, Coskun A, Akcali S, Sanlidag T. Evaluation of serological tests for diagnosis of brucellosis. Jpn J Infect Dis. 2011;64:272-276.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
95.  Al Dahouk S, Nöckler K. Implications of laboratory diagnosis on brucellosis therapy. Expert Rev Anti Infect Ther. 2011;9:833-845.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 94]  [Article Influence: 7.8]  [Reference Citation Analysis (0)]
96.  Roushan MR, Amiri MJ, Laly A, Mostafazadeh A, Bijani A. Follow-up standard agglutination and 2-mercaptoethanol tests in 175 clinically cured cases of human brucellosis. Int J Infect Dis. 2010;14:e250-e253.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 16]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
97.  Nielsen K, Yu WL. Serological diagnosis of brucellosis. Prilozi. 2010;31:65-89.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.0]  [Reference Citation Analysis (0)]
98.  Sanaei Dashti A, Karimi A, Javad V, Shiva F, Fallah F, Alaei MR, Angoti G, Pournasiri Z. ELISA Cut-off Point for the Diagnosis of Human Brucellosis; a Comparison with Serum Agglutination Test. Iran J Med Sci. 2012;37:9-14.  [PubMed]  [DOI]  [Cited in This Article: ]
99.  Wang Y, Wang Z, Zhang Y, Bai L, Zhao Y, Liu C, Ma A, Yu H. Polymerase chain reaction-based assays for the diagnosis of human brucellosis. Ann Clin Microbiol Antimicrob. 2014;13:31.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 31]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
100.  Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, Akdeniz H. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010;14:e469-e478.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 287]  [Cited by in F6Publishing: 292]  [Article Influence: 19.5]  [Reference Citation Analysis (0)]
101.  Ioannou S, Karadima D, Pneumaticos S, Athanasiou H, Pontikis J, Zormpala A, Sipsas NV. Efficacy of prolonged antimicrobial chemotherapy for brucellar spondylodiscitis. Clin Microbiol Infect. 2011;17:756-762.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 16]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
102.  Jia B, Zhang F, Lu Y, Zhang W, Li J, Zhang Y, Ding J. The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications. PLoS Negl Trop Dis. 2017;11:e0005577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 31]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
103.  Ulu-Kilic A, Sayar MS, Tütüncü E, Sezen F, Sencan I. Complicated brucellar spondylodiscitis: experience from an endemic area. Rheumatol Int. 2013;33:2909-2912.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 13]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
104.  Bayindir Y, Sonmez E, Aladag A, Buyukberber N. Comparison of five antimicrobial regimens for the treatment of brucellar spondylitis: a prospective, randomized study. J Chemother. 2003;15:466-471.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 27]  [Cited by in F6Publishing: 30]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
105.  Solera J, Lozano E, Martínez-Alfaro E, Espinosa A, Castillejos ML, Abad L. Brucellar spondylitis: review of 35 cases and literature survey. Clin Infect Dis. 1999;29:1440-1449.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 181]  [Cited by in F6Publishing: 193]  [Article Influence: 7.7]  [Reference Citation Analysis (0)]
106.  Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis. 2008;12:573-577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 45]  [Cited by in F6Publishing: 47]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
107.  Kaptan F, Gulduren HM, Sarsilmaz A, Sucu HK, Ural S, Vardar I, Coskun NA. Brucellar spondylodiscitis: comparison of patients with and without abscesses. Rheumatol Int. 2013;33:985-992.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 8]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]