Brucellar spinal epidural abscess of cervical location: Report of four cases

Spinal epidural abscesses account for 1 or 2 of every 10,000 hospital admis sions, Staphylococcus aureus being the bacterium most frequently involved. Brucellosis is a disorder of worldwide distribution, relatively frequent in South America and in Mediterranean countries in Europe and Africa. Whilst in the USA only 200 cases are reported every year, in Spain it is the most frequent zoonosis. This systemic disease seldom produces spondylodiscitis w hich in a minority of cases may be complicated by spinal epidural abscesses , in general of lumbar location. The purpose of this article is to analyse 4 cases of brucellar spinal epidural abscess of cervical location and diagn osed in the Province of Teruel, Spain, an endemic area for the disease, thr ough 10 consecutive years (1990-1999). We consider noteworthy the following facts: the first case was a technical employee who acquired the infection in our laboratory of microbiology, the second presented with an extensive p urulent collection invading prevertebral and retropharyngeal regions, the t hird case was cured only with antibiotics without residual deficits. In the fourth case we were not able to demonstrate spondylodiscitis accompanying the epidural abscess at the C-2-C-6 levels. We discuss especially the epide miological aspects of brucellosis, the existence of epidural abscess withou t spondylodiscitis, the clinical manifestations, the diagnosis by mea ns of magnetic resonance imaging, specific serological tests for Brucella, antib iotic treatment and the prognosis of our cases. Copyright (C) 2001 S. Karge r AG, Basel.