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Revista da Sociedade Brasileira de Medicina Tropical

versão impressa ISSN 0037-8682versão On-line ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.52  Uberaba  2019  Epub 11-Abr-2019 

Images in Infectious Diseases

Histopathological findings of nucleus pulposus in lumbar brucellar spondylodiscitis

Yao zhang1 

Qiang Zhang1

Zheng Zeng2 

1Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

2Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

From November 2012 to March 2016, lumbar nucleus pulposus tissues were acquired from 30 patients with brucellar spondylodiscitis (BS) during surgical treatments. The histopathology of the nucleus pulposus tissues was assessed using hematoxylin and eosin (HE), acid-fast, periodic acid-Schiff (PAS), Gomori methenamine silver (GMS), and Giemsa staining. HE-stained sections showed that the nucleus pulposus had begun to crinkle, and extracellular matrix had decreased; however, collagen fibrils had begun to grow, thicken, and arrange themselves more irregularly in the matrix. The number of viable and necrotic cells decreased and increased, respectively. We also further confirmed that the tissues we acquired comprised just the nucleus pulposus, and not the annular fibrosus or transition zone (Figure 1). Furthermore, acid-fast staining showed no positive acid-fast bacillus (Figure 2 a1 and a2); PAS and GMS staining showed no positive fungi (Figure 2 b1, b2, c1, and c2); and Gram staining showed no positive bacteria (Figure 2 d1 and d2). However, 26/30 (86.7%) Giemsa-stained tissues were positive for Bacillus brevis (Figure 3). Histopathological examinations of nucleus pulposus of lumbar BS revealed characteristic features that are helpful for clinical diagnosis. Therefore, histopathological examinations should be considered as the main investigation method of choice for the diagnosis and management of BS, although conventional histopathological examinations show some difficulties in discriminating acute and other chronic forms of spondylodiscitis1-3.

FIGURE 1: Hematoxylin and eosin staining showed that the extracellular matrix had decreased, while collagen fibrils had begun to grow and become more irregularly arranged among the matrix (×200 and ×400). 

FIGURE 2: Acid-fast staining showed no positive acid-fast bacillus (a1 and a2, ×200 and ×400); periodic acid-Schiff staining showed no positive fungi (b1, b2, ×200 and ×400); gomori methenamine silver staining showed no positive fungi (c1 and c2, ×200 and ×400); and Gram staining showed no positive bacteria (d1 and d2, ×200 and ×400). 

FIGURE 3: Giemsa staining showed Bacillus brevis with aggregated distribution (×1000). 


This research was funded by the science foundation of Beijing Ditan Hospital Capital Medical University (No.DTQL201803).


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2. Yasar K, Pehlivanoglu F, Cicek G, Sengoz G. The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis. J Neurosci Rural Pract. 2012;3(1):17-20. [ Links ]

3. Hu T, Wu J, Zheng C, Wu D. Brucellar spondylodiscitis with rapidly progressive spinal epidural abscess showing cauda equina syndrome. Spinal Cord Ser Cases. 2016;2:15030. [ Links ]

Recebido: 17 de Março de 2018; Aceito: 18 de Julho de 2018

Corresponding Author: Qiang Zhang.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License