A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis

Background Infection of bones and joints remains one of the most commonly described complications of brucellosis in humans and is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. We aimed to systematically review the literature and perform a meta-analysis to estimate the global prevalence of osteoarticular brucellosis (OAB). Methodology Major bibliographic databases were searched using keywords and suitable combinations. All studies reporting the incidence and clinical manifestations of osteoarticular brucellosis in humans, and demonstrated by two or more diagnostic methods (bacteriological, molecular, serological, and/or radiographic) were included. Random model was used, and statistical significance was set at 0.05% Principal findings A total of 56 studies met the inclusion criteria and were included in the systematic review and meta-analysis. There was an evidence of geographical variation in the prevalence of osteoarticular disease with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Thus, brucellosis patients have at least a 27% chance of developing osteoarticular disease. Conclusions The prevalence of OAB is not dependent on the endemicity of brucellosis in a particular region. Hence, further research should investigate the potential mechanisms of OAB, as well as the influence of age, gender, and other socioeconomic factor variations in its global prevalence, as this may provide insight into associated exposure risks and management of the disease. Author summary Brucellosis continues to be a global public health concern. It is caused by facultative, intracellular Brucella species. The most commonly described complication of brucellosis in humans is the infection of bones and joints, which is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. In this current study, we systematically reviewed the literature and performed a meta-analysis to estimate the global prevalence of osteoarticular brucellosis. We demonstrated an evidence of geographical variation in the prevalence of osteoarticular brucellosis with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Therefore, the prevalence of osteoarticular brucellosis is not dependent on the endemicity of brucellosis in a particular region, and brucellosis patients have at least a 27% chance of developing osteoarticular disease.