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At least 307 records · Page 17Linked to original sources
PubMed2001

Vertebral infections caused by Haemophilus aphrophilus: case report and review.

OBJECTIVE: To review in detail clinical presentation, bacteriologic findings, associated conditions and treatment of Haemophilus aphrophilus vertebral osteomyelitis and to compare them to a case we report herein. METHODS: A Medline (National Library of Medicine) search of the literature was performed by using the key words H. aphrophilus, spondylodiscitis, discitis, and vertebral osteomyelitis. The references of the case reports were examined for additional cases, especially those cited in older articles that had not been entered onto the bibliographic database. RESULTS: A case report of spondylodiscitis due to H. aphrophilus in a 35-year-old patient with a history of dental abscess 7 months before admission is presented. The patient responded well to treatment with ceftriaxone and ciprofloxacin. To date, only 14 cases of H. aphrophilus vertebral osteomyelitis have been reported. They are usually reported in middle-aged patients, usually male. Most recent cases have been treated with fluoroquinolones. Duration of treatment usually ranges from 1 to 3 months. CONCLUSIONS: H. aphrophilus is an uncommon cause of vertebral osteomyelitis. Patients are regularly cured by antibiotic therapy, provided that a tissue biopsy is performed in order to isolate the causative bacterium.

Adult↗
PubMed1993

["Inflammatory" disk degeneration. Magnetic resonance tomographic clinical picture].

Disc degeneration, if it appears relatively early, progresses rapidly with inadequate bone compensation for stabilisation of the area, or in the presence of anatomic variation of the vertebrae with short sagittal diameters, there may be tissue proliferation and edema in the bone marrow and vascular granulations within the disc. We demonstrated these changes in 17 patients by means of MRT which shows edema of the bone marrow and contrast enhancement within the disc. All these patients had severe symptoms. There were no significant neurological findings since in general there was no disc prolapse. The MRT characteristics of this condition are described and correlated with the clinical and radiological features. The use of Gd-DTPA and subtractive spin-echo and gradient-echo sequences in the differential diagnosis from infective discitis is discussed.

Adult↗
PubMed2003

Disseminated infection due to Scedosporium apiospermum in a patient with acute myelogenous leukemia.

A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.

Amphotericin B↗
PubMed1990

Bone scan and chemonucleolysis.

This study is based on 20 patients who underwent bone scanning before and after chemonucleolysis (CN) for a herniated lumbar disk. It shows that chymopapain, the proteolytic enzyme used for CN, does not induce early or late bone lesions of the adjacent vertebral plates. Abnormal uptake by one of the vertebral plates indicates a "chemical discitis." The pattern observed on the bone scan is different from the one presented by patients with bacterial spondylitis.

Chymopapain↗
PubMed1992

Human intradiscal levels with cefazolin.

The administration of prophylactic antibiotics for the prevention of discitis is common in the field of spinal surgery. The purpose of this study was to determine 1) whether cefazolin administered intravenously would result in detectable intradiscal levels; and 2) if so, what the proper timing of the antibiotic bolus should be to achieve optimal intradiscal concentrations. Forty human lumbar discs were obtained during the study period. All subjects received a preoperative bolus infusion of 2 g of cefazolin during a 3-5 minute period. Serum and intradiscal samples were obtained at intervals ranging from 6 to 220 minutes after the antibiotic infusion. The respective intradiscal concentrations of cefazolin were then determined, and the findings were as follows: 1) cefazolin does diffuse into the human disc in detectable concentrations; and 2) a critical time relationship exists (15-80 minutes after a bolus administration of cefazolin) for the optimal level of intradiscal antibiotics to be achieved.

Cefazolin↗
PubMed1997

Epidural abscess after lumbar discography. A case report.

STUDY DESIGN: The patient who suffered from pain in both lower legs and in whom discography was performed experienced a rare complication after discography. The findings and method of discography is described, as is usefulness of magnetic resonance imaging to image this rare complication. OBJECTIVES: To establish the possibility of getting a spinal epidural abscess after discography, how to make the diagnosis, and how to treat the complication. SUMMARY OF BACKGROUND DATA: Discitis after discography is a well-known complication, but epidural abscess is rare. METHODS: C-reactive protein concentration was measured and was more than 100 mg/L. Infection was suspected, and antibiotic therapy was started immediately. Magnetic resonance imaging was performed, and the diagnosis became clear. A laminotomy was performed. RESULTS: Symptoms due to epidural abscess disappeared soon after laminotomy. CONCLUSIONS: Some harmful and unpleasant complications are possible after discography. Antibiotic prophylaxis and stiletted needles should be used. Magnetic resonance imaging is the best radiologic procedure to image the complication, and surgery must be performed as soon as possible.

Abscess↗
PubMed2000

Enterobacter agglomerans spondylodiscitis: a possible, unrecognized complication of tetracycline therapy.

STUDY DESIGN: This case report describes infection in a lumbar disc in a healthy young man with an organism of low pathogenicity. The patient was taking a prolonged course of antibiotics at the time the infection occurred. OBJECTIVE: To describe this unique case of infective spondylodiscitis. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, spinal infection with Enterobacter agglomeranshas never been reported. This organism is a transient gut colonizer, and may have established itself secondary to the patient's prolonged ingestion of tetracycline for acne. METHODS: This 22-year-old farmer had spontaneous lumbar back pain. Radiologic investigations showed an abnormality in the L4-L5 disc region, and together with other investigations, were suggestive of infection. The diagnosis was confirmed by surgical aspiration. RESULTS: Antibiotic therapy was administered, and the patient made a complete recovery. Follow-up radiographs showed a complete loss of the L4-L5 disc space with only minimal bone destruction. CONCLUSION: A unique cause of infective lumbar discitis is presented. Several features of this case are unusual. The magnetic resonance findings were not readily diagnostic. The cultured organism is usually nonpathogenic. The infection may have been secondary to prolonged tetracycline therapy.

Acne Vulgaris↗
PubMed2003

The use of intradiscal antibiotics for discography: an in vitro study of gentamicin, cefazolin, and clindamycin.

STUDY DESIGN: In vitro determination of minimum inhibitory concentrations (MICs) of gentamicin, cefazolin, and clindamycin, alone and in combination with iohexol against laboratory strains of Eschericia coli B, Staphylococcus aureus, and Staphylococcus epidermidis. OBJECTIVE: To study the effects of iohexol on the efficacy of gentamicin, cefazolin, and clindamycin. SUMMARY OF BACKGROUND DATA: Prophylactic antibiotics have been advocated to prevent discitis following discography. Intravenous cefazolin administered before discography has been shown to penetrate the intervertebral disc. However, the use of systemic antibiotics for prophylaxis may lead to bacterial resistance. Intradiscal antibiotic administration is an attractive alternative to systemic antibiotic prophylaxis before discography, but there is no data documenting the efficacy of commonly used antibiotics in the presence of iohexol. METHODS: MICs were determined by adding standard concentrations of bacteria to serial dilutions of antibiotic with and without the addition of iohexol in Todd-Hewitt Broth medium. MICs were determined as the lowest concentration well that demonstrated inhibition of cell growth. RESULTS: Gentamicin, cefazolin, and clindamycin remain efficacious in the presence of iohexol. MICs were lower for cefazolin and gentamycin than for clindamycin. Iohexol alone also demonstrated some inhibition of cell growth. CONCLUSION: This study supports the use of intradiscal antibiotics for prophylaxis of disc space infection during discography. lntradiscal placement of antibiotic should obviate the need for systemic antibiotic prophylaxis and its attendant risk of generating antimicrobial resistance.

Anti-Bacterial Agents↗
PubMed2005

Anaerobic spondylodiscitis: case series and systematic review.

BACKGROUND: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. METHODS: Case reports and review of the literature. RESULTS: Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included Bacteroides species (12), Propionibacterium acnes (7), Peptococcus species (4), Peptostreptococcus species and Clostridium species (3 each), Corynebacterium diphtheroides and Fusobacterium species (2 each), and unspecified anaerobes (3). CONCLUSIONS: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.

Aged↗
PubMed1998

Spinal cervical infection: a case report and current update.

Cervical spine infection is a term used to encompass osteomyelitis, discitis and epidural abscess. Most cases are caused by Staphylococcus aureus but other organisms have been isolated. The most frequent source is hematogenous spread from a nearby or distant source. Diagnosis is often confusing. The most common symptom is worsening back or neck pain that increases with movement. Patients may have motor or sensory changes if there is compression of the nerve roots or spinal cord. If the condition is not treated promptly, it may progress to irreversible neurologic deficit. Positive blood cultures and an elevated erythrocyte sedimentation rate (ESR) may be seen. Radiologic findings may include a paravertebral swelling, a destruction of the vertebral end plates and adjacent portions of the bodies and disc space and the presence of an epidural mass. Treatment includes radical surgical intervention for debridement and decompression to stabilize the spine in conjunction with 8-12 weeks of intravenous antibiotics. Closed continuous local antibiotic irrigation with a gravity control outflow system has been used.

Abscess↗
PubMed2006

Acute red eye and back pain as a presentation for systemic illness: case report.

BACKGROUND: Acute red eye is a common presentation in both primary and secondary care. Presentation in combination with other systemic symptoms can indicate serious underlying pathology. CASE PRESENTATION: 73-year-old lady presenting with endogenous endophthalmitis and thoracic discitis secondary to sub-acute bacterial endocarditis. CONCLUSION: Acute red eye in combination with systemic symptoms requires immediate investigation. If endogenous endophthalmitis is diagnosed, a source of sepsis should be comprehensively investigated and referral made to individual specialties if necessary.

Acute Disease↗
PubMed1995

Complications of cervical discography: analysis of 4400 diagnostic disc injections.

Despite extensive experience with diagnostic cervical disc injection, the role of this procedure in the evaluation of patients with degenerative disc disease and severe neck pain remains controversial. Beyond the debate regarding its efficacy in identifying the site of cervical symptomatology and directing appropriate intervention are the potential morbidity and mortality associated with this diagnostic procedure. Discitis, subdural empyema, spinal cord injury, vascular injury, and prevertebral abscess have all been reported as complications of diagnostic cervical disc injection. Any meaningful assessment of the role of cervical discography in the evaluation of degenerative disc disease must include a determination of the risks inherent in the procedure. We retrospectively analyzed 4400 cervical disc injections in 1357 patients performed by an experienced radiologist between 1988 and 1993 to define the morbidity and mortality associated with discography. In addition, we reviewed the extant medical literature on the complications of this controversial procedure. This study demonstrates significant complications from diagnostic discography procedures occurring in less than 0.6% of the patients and 0.16% of the cervical disc injections.

Abscess↗
PubMedDate not supplied

The role of magnetic resonance imaging in the diagnosis of postoperative spondylodiscitis.

BACKGROUND: Spondylodiscitis, discitis associated with vertebral osteomyelitis may follow disc-removal surgery. A targeted successful treatment of spinal infections requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging provides precise information on correct topography, localization, propagation, and differential diagnosis of spinal infectious lesions. The aim of this study was to present magnetic resonance imaging (MRI) findings in patients with postoperative spondylodiscitis. METHODS: MRI was performed in 6 patients aged 29-50, with clinically suspected postoperative spondylodiscitis. Initial examination was performed 3-8 weeks after surgery and 3, 6, or 12 months after the treatment by antibiotics. Patients underwent MRI on a IT imaging unit (Siemens, Magnetom-Impact), including sagittal T1W and T2W images and axial T1W images before and after the administration of gadolinium contrast medium. RESULTS: MRI findings included: significantly decreased signal intensity with the loss of distinction between vertebral body and intervertebral disc space on T1W, increased signal intensity in the adjacent vertebral body and end-plates on T2W, contrast enhancement of vertebral body and disc space and paravertebral soft tissue changes. Follow-up examinations performed 3, 6, or 12 months after the treatment showed less abnormal signal intensities on both T1- and T2-weighted images. CONCLUSION: Postoperative spondylodiscitis is a rare but severe complication of lumbar disc surgery. Since conventional imaging techniques are not reliable for detecting spondylodiscitis in its early stages, MRI is of great significance in the diagnosis of postoperative spondylodiscitis.

Adult↗
PubMed2000

[Differential diagnosis of infective spondylodiscitis and erosive degenerative disk disease].

PURPOSE: To assess the value of imaging in the differential diagnosis of erosive intervertebral osteochondrosis (EIVO) versus infectious discitis (ID). MATERIALS AND METHODS: Twelve cases of EIVO and 30 cases of ID were reviewed to define the usefull signs for differential diagnosis on plain films, CT, and MR. RESULTS: No single sign is sufficient, but the association of several signs is suggestive of EIVO: discal vacuum phenomenom, well-defined sclerosis and erosions of vertebral endplates, high signal strip surrounding low signal of vertebral endplates on T1-weighted images. CONCLUSION: Imaging is helpful in difficult differential diagnosis of EIVO versus ID.

Adult↗
PubMed2000

[Tuberculosis spondylodiscitis in a neurological service in Nouakchott].

It is about a retrospective study dealing with the place of tuberculous spondylitis with discitis among medullary wounds hospitalized in our service from January 1995 to June 1998 and their medical care. Twenty reports have been done making: 30.30% of our medullary wounds. We have noted a male prevalence and precocity. The flaccido-spastic paraplegia with sensitive level prevails the clinical chart (45%) this in correlation with thoracic and lumbar localization predominance (75%) at the radiography. All patients have had for their benefit an anti-tuberculous treatment and eleven among them had also tetracosactide (synactène retard). This has allowed us to observe a quick recovery of the motor deficit for nine patients: 81.8% of the patients who have had the therapeutic association; 45% of the whole. No patient had an operation.

Antitubercular Agents↗
PubMedDate not supplied

Skeletal infections in cirrhotics.

There are few reports of skeletal infections in patients with cirrhosis. We present two such cases, both with alcoholic liver disease, seen over a period of one year. The first, a 46-year-old man, presented as pyrexia of unknown origin, and was found to have pyogenic discitis; he responded to antibiotic and surgery. The second, a 42-year-old man, presented with chest wall abscess and was diagnosed to have tubercular osteomyelitis; he expired despite treatment with non-hepatotoxic anti-tubercular drugs.

Adult↗
PubMed1990

Treatment of sciatica. A comparative survey of complications of surgical treatment and nucleolysis with chymopapain.

Chymopapain in the treatment of sciatica by chemonucleolysis has become widespread in the United States and Europe since the approval of this drug for general use by the Food and Drug Administration. Potentially, the increased use of this drug by surgeons with relatively little experience could be expected to cause an increase in the complication rate. This report analyzes the results of a questionnaire sent to surgeons in 316 departments who have recently treated a total of 43,662 patients with this technique. The complication rate was 3.7% (1606 incidents). Of these, 192 (0.45%) were severe. The study revealed that the frequency of severe allergic reactions is lower in Europe than in the United States. Twice the number of anaphylactic reactions occurred with local and neuroleptic anesthesia compared to local or general anesthesia alone. The risk of infectious discitis is low, but a strict sterile technique is mandatory. Neurologic complications were rare, but included 15 cauda equina, one meningeal hemorrhage, a case of epilepsy, and two cases of paraplegia. The rate of complications in this study is comparable to two previous studies; thus, the expected increase in complications has not occurred. For comparison, a survey of 2051 patients treated surgically showed a complication rate of 26% (534 incidents), including 86 (4.2%) severe complications. Among the surgically treated patients, there was a perioperative complication rate of 9.75% (200 incidents) and a postoperative complication rate of 14% (290 incidents), resulting in three deaths. Thus, the surgical treatment was responsible for six times the number of incidents and ten times more severe incidents than for patients treated by nucleolysis.

Adolescent↗
PubMedDate not supplied

[Destructive spondylopathy in chondrocalcinosis ("pseudospondylodiscitis")].

A case of degenerative spondylopathy in chondrocalcinosis (pseudospondylo-discitis) is presented. The incidence of vertebral involvement in chondrocalcinosis reported in the literature is reviewed. In approximately 4-10% of all cases of chondrocalcinosis the vertebral column is involved as well. Especially in elderly patients, a differential diagnosis based on clinical, radiological and laboratory findings must include infectious spondylodiscitis. In the presence of additional degenerative spondylolisthesis, as well as radiculopathy and/or symptoms of spinal stenosis, surgery is often performed. However, there are cases reported in which improvement occurs after spontaneous vertebral fusion without surgical intervention. If any vertebral change is detected that is suggestive of chondrocalcinosis, even in asymptomatic patients, it is recommended to obtain radiographs of other joints, for example, the knee and wrist, which are frequently also involved in chondrocalcinosis.

Aged↗