Brucellar spondylitis: An update on the Diagnosis by the involvement of Essential/Toxic Elements

Background: The rate of Brucellosis is expanding in Iraq, and the definitive diagnosis still considered challenging. Brucellar spondylitis emerges from contamination with Brucella melitensis spp. which is the widely recognized Brucella species in Iraq. In this study we aim to evaluate the levels of some metals in the serum of brucellar spondylitis cases in comparison with control. Methods: A cross-sectional study conducted from June 2018 to August 2019, 41 patients underwent diagnosed by orthopaedic and spine surgeons based on their clinical manifestations. The collected samples from patients and controls were analyzed for metals using flame atomic absorption spectrometry. Results: The mean, standard error, 95% confidence interval, cut off value and p-value of the measurements were calculated. It was found that levels of some elements (Iron Fe, Copper Cu, Zinc Zn, Selenium Se, Aluminium Al and, Chromium Cr) were significantly elevated (p< 0.01) in sera of brucellar spondylitis patients when compared to control group. Whereas, Silicon (Si) level was significantly decreased (p< 0.01). Receiver operating characteristic curve (ROC) was used to illustrate the diagnostic ability of the binary classifier system. All tested elements showed very cleared threshold, which is help to identify a clear cut off value for each element. In sera of patients, all tested elements were organized in one cluster except Se, comparing to control, Se and Si were shifted from the mean cluster. Cu, Zn, and Cr levels appeared highly correlated to each other. Conclusions: there are possible relationships between brucellar spondylitis and alteration in some elements.