Infection Spinal epidural abscess due to Brucella AYkVnGfrgqlq, MD a, 4 , Baki S. Albayrak, MD a , Evlin Gfrgqlq, MD c ,O ¨ mer Tural, MD a , Tamer Karaaslan, MD a , Orhan Oyar, MD b , Mesut YVlmaz d Departments of a Neurosurgery and b Radiology, University of Suleyman Demirel, School of Medicine, 32260, Isparta, Turkey c Department of Infectious Disease, Isparta State Hospital, 32100, Isparta, Turkey d Department of Infectious Disease, University of Istanbul, School of Medicine, C ¸apa, Turkey Received 17 August 2005; accepted 29 October 2005 Abstract Background: Brucellar spinal epidural abscess (SEA) is a rarely encountered clinical entity during the course of the systemic Brucella infection. Methods: We reported 9 patients diagnosed with Brucellar SEA with a mean follow-up of 20 months. Spinal epidural abscess was detected by magnetic resonance imaging in all cases. Brucella diagnosis was established by specific blood tests. Patients were administered antibiotics for a duration of 6 to 12 weeks. Results: Spinal epidural abscess was localized in lumbar region in 6 patients, dorsal in 2 patients, and cervical in 1 patient. Abscess mimicked disk herniation clinically in 3 patients. Although neurologic examination was normal in 6 patients, we detected motor deficit in 3 patients. Symptoms regressed in all patients but 1 after the institution of antibiotic regimens, and all recovered fully without any sequel. Surgical drainage of abscess was performed in 1 patient. Conclusions: Proper antibiotic regimens in required doses and duration should be the primary treatment in Brucellar SEA. The criteria for terminating antibiotic therapy are clinical recovery and dissolution of abscess images radiologically. Lastly, should any neurologic deterioration be detected during the course of medical treatment, surgical decompression is to be considered. D 2006 Elsevier Inc. All rights reserved. Keywords: Antibiotic therapy; Brucella; Spinal epidural abscess 1. Introduction Brucellosis is a systemic infectious disease, caused by a nonencapsulated, nonmotile, gram-negative bacilli belong- ing to the genus Brucella . This disease is a zoonosis transmitted to humans from infected animals such as goats, sheep, cows and dogs [3,8,11]. Although brucellosis is a controlled disease in developed countries, its prevalence is not exactly known in developing ones and still remains as a serious health problem. The prevalence is higher in Mediterranean area, the Arabian Peninsula, Mexico, and Central and South America [6,25]. Brucellosis is endemic in Turkey. During last decade (between 1991 and 2000), approximately 9000 cases yearly were reported to Turkish Ministry of Health (incidence, 14/100 000). A screening of general population for seropositivity (Wright test, positive at N 1/160; n = 1054/58 707, 1.8%) reveals a much higher rate in Turkey [6,24]. Up to 50% of cases with brucellosis may have spinal involvement that is mostly seen as spondylitis [2,11], whereas abscess formation is very rare. In the present study, 9 cases of Brucellar SEA are discussed from the point of clinical and laboratory findings, diagnostic evaluations, and treatment methods particularly. 2. Patients and methods We evaluated 9 patients (3 men and 6 women with the mean age of 62.5 years) who were treated with the diagnosis 0090-3019/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2005.10.019 Abbreviations: CRP, C-reactive protein; CSF, cerebral spinal fluid; MRI, magnetic resonance imaging; SEA, spinal epidural abscess; WBC, white blood cell. 4 Corresponding author. Sqleyman Demirel Bulvary ´ 101 Cadde No 73 Sener Apt A Blok, Kat 3 Daire 5 32100 Isparta, Turkey. Fax: +90 246 2327350. E-mail address: askingorgulu@hotmail.com (A. Gfrgqlq). Surgical Neurology 66 (2006) 141 – 147 www.surgicalneurology-online.com