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M49.1 - Brucellosis of the Spine | ICD-10
M49.1 is the ICD-10 code for brucellosis of the spine, a bacterial infection caused by Brucella species that affects the vertebral bones and discs.
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M49.1 is the ICD-10 code for brucellosis of the spine, a bacterial infection caused by Brucella species that affects the vertebral bones and discs.
What is M49.1?
The ICD-10 code M49.1 refers to brucellosis of the spine, also known as brucellar spondylitis. It is an infectious disease of the spine caused by bacteria of the genus Brucella. This condition represents one of the most common musculoskeletal complications of systemic brucellosis and is a significant cause of infectious spondylitis, particularly in endemic regions such as the Mediterranean, Middle East, and parts of Latin America and Central Asia.
Causes
Brucellosis is caused by gram-negative bacteria of the genus Brucella. The most clinically relevant species include:
- Brucella melitensis (primarily from sheep and goats)
- Brucella abortus (from cattle)
- Brucella suis (from pigs)
Human infection typically occurs through:
- Consumption of unpasteurized milk or dairy products
- Direct contact with infected animals or their secretions
- Inhalation of contaminated aerosols (occupational exposure in farmers, veterinarians, and slaughterhouse workers)
The spine is affected through hematogenous spread (via the bloodstream), with the lumbar spine being the most frequently involved region.
Symptoms
Brucellosis of the spine may present with the following signs and symptoms:
- Back pain, most commonly in the lower back, often the first and most prominent symptom
- Systemic symptoms including fever (often undulant or wave-like in pattern), night sweats, and chills
- Fatigue and unintentional weight loss
- Reduced spinal mobility and stiffness
- In severe cases: neurological deficits due to spinal cord or nerve root compression
Diagnosis
Diagnosis of brucellar spondylitis requires a combination of clinical assessment, laboratory investigations, and imaging:
- Blood culture: Detection of Brucella organisms in the blood
- Serology: Detection of antibodies using the Rose Bengal test, Wright agglutination test, or ELISA
- Imaging: MRI (magnetic resonance imaging) of the spine is the gold standard for visualizing disc involvement, vertebral endplate changes, and paraspinal abscesses; X-ray and CT provide complementary information
- Biopsy: Tissue sampling for microbiological and histological analysis may be performed in uncertain cases
Treatment
Treatment of brucellar spondylitis relies on combination antibiotic therapy, as monotherapy is associated with high relapse rates. Recommended regimens based on WHO guidelines include:
- Doxycycline (6 weeks) combined with Rifampicin (6 weeks)
- Alternatively: Doxycycline combined with Streptomycin or Gentamicin
- In complicated cases or with neurological involvement: triple therapy including a quinolone (e.g., Ciprofloxacin)
The total treatment duration is typically 3 to 6 months. Surgical intervention is rarely required but may be necessary in the presence of abscesses, spinal instability, or progressive neurological deficits.
Prognosis and Outlook
With prompt and adequate antibiotic treatment, the prognosis for brucellosis of the spine is generally favorable. Without treatment, the disease can lead to chronic back pain, vertebral deformity, or permanent neurological damage. Relapses are possible and may require a prolonged or repeated course of antibiotic therapy.
References
- World Health Organization (WHO): Brucellosis in Humans and Animals. WHO Press, Geneva, 2006.
- Turgut M, Gülsen Senyurt M, Osman A: Spinal Brucellosis: Turkish Experience Based on 452 Cases Published During the Last Century. Acta Neurochirurgica, 2006; 148: 1033–1044.
- Pappas G, Akritidis N, Bosilkovski M, Tsianos E: Brucellosis. New England Journal of Medicine, 2005; 352(22): 2325–2336.
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