Brucellosis referred to as brucellosis, also known as Mediterranean flaccid fever Malta fever wave fever or wave fever is a zoonotic systemic infectious disease caused by Brucella abortus and is characterized by prolonged fever, excessive sweating, arthralgia, and hepatosplenomegaly, etc. After infection with Brucella abortus, the bacteria produce bacteremia and toxaemia in the human body, involving various organs. Chronic inactivity stage invades most of the spinal column and the joints, and the motor system, except for the invasion of spinal column, but also invade the sacrum-iliac. The spine and large joints motor system in addition to the spine can also invade the sacroiliac and shoulder joints. Pathogenesis Germs from the skin or mucous membranes invade the body with the lymphatic fluid to the lymph nodes by phagocytosis if the phagocytes failed to kill the bacteria, the bacterial growth and reproduction in the cell to form a local primary foci of the disease in this stage is known as lymphatic migration stage equivalent to the latent period of the bacterial growth and reproduction of a large number of reassurance in the phagocytes, resulting in phagocytic rupture and then a large number of circumference of the bacterial entry into the lymphatic fluid and the bloodstream to form a bacteremia in the bloodstream. Bacteria are phagocytosed by phagocytes in the blood stream and carried with the blood stream to the whole body where they multiply in the mononuclear-phagocytic system in the liver, spleen, lymph nodes, bone marrow, etc. to form multiple foci. When the bacteria released from the foci exceed the phagocyte’s phagocytosis capacity, they will grow and multiply in the extracellular blood stream. The clinical heart presents with a clear sepsis later on. Under the stopping effect of the factors in the body, some are destroyed and die to release endotoxins. Some of them are destroyed and die to release endotoxin and other components of the bacterial body, resulting in clinical and for not only bacteremia sepsis but also toxemia manifestations endotoxin in the pathogenic damage to reclinical symptoms of temperament is currently believed to play an important role in response to the body’s immune function is normal in Beijing, through the cellular immunity and humoral immunity to remove the bacteria and be cured, if immune dysfunction or infected with a large amount of virulent bacteria, then some of the bacteria escape the immune and can be phagocytosed. Part of the bacteria escape the immune and can be phagocytosis into the formation of new infected foci of phagocytes into various tissues and organs, some people call the stage of multiple foci after a certain period of time after the bacterial growth and reproduction of the infected foci again into the bloodstream, resulting in the recurrence of the disease medical care histopathological damage to a wide range of clinical manifestations of the Shanghai also diversified so that the first repeated to become the body of the chronic infections. Clinical manifestations character patients often flaccid low-grade fever fatigue night sweats loss of appetite anemia in some cases also appeared in the lungs gastrointestinal tract subcutaneous tissues testes epididymis ovaries gallbladder kidney and brain infection can be familiar with liver and spleen lymph node enlargement multiple wandering generalized muscular and joint pains later costs manifested as skeletal involvement which spinal spine involvement is the most common, especially lumbar vertebrae invasion sites appear persistent lumbar and lower back pain localized pressure pain percussion pain with muscle spasm and spinal activity. Pain with muscle spasm spinal movement is limited often in a fixed position sometimes local lymph node rupture after the lumbar psoas muscle abscess and even paraplegia due to epidural abscess lesions in different parts of the spinal column manifested by the corresponding nerve root radicular pain or spinal cord compression symptoms several times easy to misdiagnose as septic spondylitis spinal tuberculosis or intervertebral disc herniation laboratory tests in the meal: pathogen isolation test tube agglutination test complement conjugation clinical test anti-human globulin Positive tests can be extremely high seen to help confirm the diagnosis and differential prescribing diagnosis. Complications The most serious hospitalized complication of brucellosis is meningitis and myocarditis although the incidence is low but it is very early baby danger so in the quality of the treatment of brucellosis at the same time should pay attention to the discovery of complications and transplantation of treatment is limited can be appropriately prolonged hypertherapy refusal time. Auxiliary examination experience (a) laboratory examination such as blood picture white blood cells half of the registered normal or mild reduction of lymphocytes relative or absolute increase in classification can be up to more than % of the blood sedimentation in all phases of the growth rate of long time patients have mild or moderate anemia. Bacteriological examination is normal Very good patients blood bone marrow breast milk uterine secretions can be done bacterial culture acute period positive rate is high chronic tension period low bone marrow specimens than blood specimens positive rate is high. (ii) serum agglutination test (Wright’s test) test tube method is more sensitive patient life more in the second week of the positive reaction: the above has too much diagnostic value in the course of the disease, the potency of the incremental times and above the greater significance of the normal solution to the human can have a low titer of the agglutinin; some infectious diseases of the false-positive rate of up to more than %, such as rabbit fever the agglutination of the potency of the elevated; injection of cholera vaccine can be false-positive; inoculated with Brucella vaccines, the agglutination potency of live bacteria can also be higher than %. Brucella vaccination people also increase agglutination potency diagnosis temperament should pay attention to analyze as soon as possible in addition to the fame due to the antibody IgAIgGIgM amount of different ratios, such as the high content of IgA can appear in the useful patient serum low dilution for negative high dilution counter-positive so-called technology before the band phenomenon Beijing, therefore, when doing the experiment should be to increase the patient’s special serum dilution range. Differential diagnosis Brucella spondylitis spinal tuberculosis septic spondylitis clinical manifestations of the three have fever fatigue persistent low back pain lower back pain and radiating pain imaging manifestations of vertebral bone destruction early vertebral osteoporosis late sclerosis hyperplasia narrowing of the vertebral spinal space and other similarities, so it is easy to misdiagnosis of the three will be differentiated as follows: (a) the clinical fever of Brucella spondylitis can be manifested as flaccid fever pain intense Only limited to the affected lumbar region around the severity of pain between the other two kinds of spondylitis between most of the lumbar vertebrae without spinal cord injury symptoms of pus obtained by puncture manifested pink wash water-like blood tests often intervene between normal and abnormal. (b) Spinal tuberculous spondylitis often manifested as low-grade fever pain can be very severe, most of the relatively mild pain severity is lower than the other two diseases lumbar vertebrae, the highest incidence can occur in the whole body of the spinal column, and about % of the patients can show symptoms of spinal cord compression, and the pus obtained by puncture is yellowish, yellowish, rice-tickle-like, and blood routine can be normal. (C) the acute phase of septic spondylitis manifestation of extreme high fever can reach more than one degree of pain severe pain severe when close to the bed pace of contact with the bed movement can cause severe convulsions pain is the most serious of the three kinds of spondylitis most of the lumbar vertebrae do not have symptoms of spinal cord injury pus manifested as a thin viscous purulent liquid blood routine serious abnormalities. Borrelia burgdorferi spondylitis spinal tuberculosis purulent spondylitis in terms of etiology clinical manifestations and imaging has its characteristic manifestations also has many similarities clinical diagnosis needs to be combined with the history clinical manifestations epidemiological characteristics and imaging features comprehensive judgment to confirm the diagnosis needs to rely on pathology and serological culture diagnosis. Disease treatment Brucella spondylitis is mainly treated with medication, and in a few cases, surgical treatment or minimally invasive surgery is performed under medication control. non-surgical treatment (a) basic treatment and symptomatic treatment ① rest acute fever patients should rest in bed in addition to the toilet generally should not get out of bed activities; intermittent indoor activities should not be too much; ② diet should be increased nutrition to give high-calorie multivitamin easy to digest food and give enough water and electrolytes; ③ sweating should be dried in a timely manner to avoid the wind and change clothes once a day warm bath; ④ high fever can be used in the physical method The person who has high fever can use physical methods to reduce the temperature persistently can also use antipyretic; headache and insomnia with aspirin and phenobarbital, etc.; ⑤ health care personnel should comfort the patient and do a good job to build confidence in the patient’s ideological work. (B) antibiotic treatment principle according to the results of drug sensitivity to choose long-term adequate amount of combined multi-pathway administration of antibiotics before according to the WHO sixth joint communiqué of the principle of tetracycline + streptomycin; or according to the program of similar drugs replacement therapy; the current ideal program is: ① first-line drugs: oral doxycycline d intramuscular injection of streptomycin d or gentamicin d instead of streptomycin. ② second-line drugs: oral doxycycline + rifampicin d the application of this program in this group, generally a course of treatment each interval d pay attention to review the liver and kidney function of each course of weeks at the same time add SMZ/TMP and intravenous injection of penicillin antibiotics with strong penetration of intervertebral disc tissues until Borrelia burgdorferi agglutination test is negative, and then continue to apply Chinese traditional Chinese medicine: choose to eliminate wind and dampness to support the correct and consolidate the blood and blood stasis to alleviate the paralysis of the Chinese traditional Chinese medicine with the Western medicine. Surgery Surgery (a) After a course of drug treatment, symptoms do not improve with the following indications: ① paraspinal abscess or lumbar psoas abscess; ② intervertebral disc destruction; ③ spinal instability; ④ spinal cord or nerve root compression; ⑤ accompanied by other bacterial mixed infection. (b) Surgical method according to the spinal tuberculosis foci removal method to implement Mycobacterium bovis spondylitis foci removal surgery surgical route depends on the site of the lesion; (c) Surgical content includes: removal of inflammatory granulomatous tissue abscess necrotic discs and destruction of the cartilage to lift the spinal cord or nerve root compression cause of stabilization of the spinal column structure; (d) intraoperative foci removal after the release of sensitive antibiotics; (e) postoperative drug therapy and local braking The treatment of minimally invasive spine is not to be ignored. Minimally invasive treatment Doctors with experience in minimally invasive spinal tuberculosis treatment can choose minimally invasive treatment of spinal tuberculosis to treat the disease. (a) Indications: (i) the pain is not relieved by drug treatment alone; (ii) there is an abscess around the intervertebral disc. (ii) Minimally invasive methods: CT-guided intra-lesion puncture and placement of tubes for drainage and irrigation and flushing. (C) minimally invasive combined with internal fixation methods: for purely minimally invasive treatment of spinal instability after the patient can be implemented percutaneous pedicle root nailing can be cured, especially combined with percutaneous internal fixation technology, unless not to carry out minimally invasive technology, almost do not need to open the surgical method.