Differentiation of Typical Features Between Fungal Spondylitis and Brucellar Spondylitis on CT and New Applications of CT Values in Diagnosis of Spinal Infections

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2025 Feb 20

PMID 39976694

Authors

Haoran Qi

Jun Qi

Rongpan Dang

Jingyu Wang

Hongdong Tan

Jing Li

Affiliations

Soon will be listed here.

Abstract

Purpose: The low positive rate of microorganism culture and nonspecific clinical manifestations increase the difficulty of diagnosing spinal infection. To date, no studies have reported differences in radiological manifestations between fungal spondylitis (FS) and brucellar spondylitis (BS). This may lead to severe misdiagnosis. In this study, we aimed to investigate the typical radiological features of these two types of spondylitis and evaluate the application of computed tomography (CT) values in their diagnosis.

Methods: A total of 59 elderly patients with 119 infected vertebrae were included. 44 patients with 91 infected vertebrae were included in the BS group, and 15 patients with 28 infected vertebrae were included in the FS group. Differences in radiological features and parameters were compared by using the Mann-Whitney U test, χ test or Fisher's exact test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency of the radiological parameters and CT values.

Results: Framework destruction was a typical imaging feature in patients with FS (p < 0.001). In contrast, patients with BS were more prone to concave destruction (p = 0.002), corner destruction (p = 0.010) and severe marginal osteosclerosis (p < 0.001). The longitudinal erosion ratio (AUC = 0.948) and CT value (AUC = 0.789) exhibited excellent diagnostic utility.

Conclusions: The degree of bone destruction and severity of osteosclerosis significantly differed between the two types of spondylitis. Measuring the CT value and erosion ratio facilitates increased diagnostic accuracy and efficiency.

References

Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos E . The new global map of human brucellosis. Lancet Infect Dis. 2006; 6(2):91-9. DOI: 10.1016/S1473-3099(06)70382-6. View

Franco M, Mulder M, Gilman R, Smits H . Human brucellosis. Lancet Infect Dis. 2007; 7(12):775-86. DOI: 10.1016/S1473-3099(07)70286-4. View

Herrick J, Lederman R, Sullivan B, Powers J, Palmore T . Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis. 2014; 14(6):520-6. PMC: 4498663. DOI: 10.1016/S1473-3099(13)70270-6. View

Memish Z, Balkhy H . Brucellosis and international travel. J Travel Med. 2004; 11(1):49-55. DOI: 10.2310/7060.2004.13551. View

Liu Z, Gao L, Wang M, Yuan M, Li Z . Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis. Emerg Microbes Infect. 2023; 13(1):2290839. PMC: 10878345. DOI: 10.1080/22221751.2023.2290839. View

Pappas G, Akritidis N, Bosilkovski M, Tsianos E . Brucellosis. N Engl J Med. 2005; 352(22):2325-36. DOI: 10.1056/NEJMra050570. View

Cho C, Goto M . Spinal Brucellosis. N Engl J Med. 2018; 379(17):e28. DOI: 10.1056/NEJMicm1803513. View

Henderson R . Brucellosis in the dairy-farming community and allied workers of Worcestershire. Lancet. 1967; 2(7511):353-7. DOI: 10.1016/s0140-6736(67)90192-4. View

Zhong Z, Yu S, Wang X, Dong S, Xu J, Wang Y . Human brucellosis in the People's Republic of China during 2005-2010. Int J Infect Dis. 2013; 17(5):e289-92. DOI: 10.1016/j.ijid.2012.12.030. View

10.

Colmenero J, Ruiz-Mesa J, Plata A, Bermudez P, Martin-Rico P, Queipo-Ortuno M . Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis. 2008; 46(3):426-33. DOI: 10.1086/525266. View

11.

Pourbagher A, Pourbagher M, Savas L, Turunc T, Demiroglu Y, Erol I . Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. AJR Am J Roentgenol. 2006; 187(4):873-80. DOI: 10.2214/AJR.05.1088. View

12.

Solera J, Lozano E, Martinez-Alfaro E, Espinosa A, Castillejos M, Abad L . Brucellar spondylitis: review of 35 cases and literature survey. Clin Infect Dis. 1999; 29(6):1440-9. DOI: 10.1086/313524. View

13.

Chappuis F, Alirol E, DAcremont V, Bottieau E, Yansouni C . Rapid diagnostic tests for non-malarial febrile illness in the tropics. Clin Microbiol Infect. 2013; 19(5):422-31. DOI: 10.1111/1469-0691.12154. View

14.

Eda Y, Funayama T, Tatsumura M, Koda M, Yamazaki M . Candida Spondylitis Considered as Microbial Substitution After Multiple Surgeries for Postoperative Lumbar Spine Infection. Cureus. 2021; 13(5):e14995. PMC: 8202443. DOI: 10.7759/cureus.14995. View

15.

Shimizu J, Yoshimoto M, Takebayashi T, Ida K, Tanimoto K, Yamashita T . Atypical fungal vertebral osteomyelitis in a tsunami survivor of the Great East Japan Earthquake. Spine (Phila Pa 1976). 2014; 39(12):E739-42. DOI: 10.1097/BRS.0000000000000317. View

16.

Frazier D, Campbell D, Garvey T, Wiesel S, Bohlman H, Eismont F . Fungal infections of the spine. Report of eleven patients with long-term follow-up. J Bone Joint Surg Am. 2001; 83(4):560-5. View

17.

Gamaletsou M, Rammaert B, Brause B, Bueno M, Dadwal S, Henry M . Osteoarticular Mycoses. Clin Microbiol Rev. 2022; 35(4):e0008619. PMC: 9769674. DOI: 10.1128/cmr.00086-19. View

18.

Liu X, Zheng M, Sun J, Cui X . A diagnostic model for differentiating tuberculous spondylitis from pyogenic spondylitis on computed tomography images. Eur Radiol. 2021; 31(10):7626-7636. DOI: 10.1007/s00330-021-07812-1. View

19.

Zhang G, Zhang H, Hu X, Xu D, Tang B, Tang M . Clinical application value of metagenomic next-generation sequencing in the diagnosis of spinal infections and its impact on clinical outcomes. Front Cell Infect Microbiol. 2023; 13:1076525. PMC: 9945583. DOI: 10.3389/fcimb.2023.1076525. View

20.

Luzzati R, Giacomazzi D, Danzi M, Tacconi L, Concia E, Vento S . Diagnosis, management and outcome of clinically- suspected spinal infection. J Infect. 2009; 58(4):259-65. DOI: 10.1016/j.jinf.2009.02.006. View