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PubMed1988

False negative bone scans in pediatric sepsis of the axial skeleton.

The early diagnosis of disk space infections and sacroiliitis in children can be difficult because of protean presenting symptoms, nonspecific laboratory studies, and normal plain films. Technetium phosphate scintigraphy has been reported as a diagnostic method with an accuracy of up to 100% in some series. In this case report we present two patients with negative technetium bone scans in the face of active infection, illustrating the need to pursue the diagnosis using other modalities.

Discitis↗
PubMed1988

[Juvenile nonspecific spondylodiscitis].

In the case of an 11-years old boy, diagnosis "Juvenile Spondylodiscitis" finally was established by MRI. X-Ray investigation was negative and bone scintigraphy was interpreted negative or not conclusive. In recently published studies using MRI for diagnosis of spondylodiscitis in children younger than six years, a typically MCR signal of involved disc and vertebral body was found at a stage of investigation when bone scintigraphy had already also been conclusive. In our case, the patient was a little bit older and may be because of this, scintigraphy was negative. The different vertebral blood perfusion situation of the older child seems to disadvantage scintigraphy to MRI in diagnosis of spondylodiscitis.

Child↗
PubMed1994

[Spondylodiscitis in subacute bacterial endocarditis. Apropos of a case].

Occurring of spondylodiscitis as first manifestation of bacterial endocarditis in an uncommon condition. About fifty cases are reported in the literature. Such association makes imperious the regular examination of the heart of patients with spondylodiscitis and spine radiography when a vertebral pain is found to be present in patients with bacterial endocarditis. An additional case is her by reported.

Discitis↗
PubMed1995

Disseminated opportunistic fungal disease in dogs: 10 cases (1982-1990).

Medical records of 10 dogs in which fungal infection was diagnosed between 1982 and 1990 were reviewed. In each dog, infection was determined to be caused by a single species of fungus, either Aspergillus terreus, Penicillium sp, Paecilomyces sp, Chrysosporium sp, or Pseudallescheria boydii. Nine dogs were German Shepherd Dogs; 1 was a German Shepherd Dog cross, and 9 were females. The most common clinical signs were signs of neck or back pain (9 dogs), weight loss (7 dogs), anorexia (6 dogs), pyrexia (6 dogs), paresis (3 dogs), and paralysis (3 dogs). All 10 dogs had evidence of multiple sites of diskospondylitis. Urine sediment was examined in 6 dogs, and all 6 had fungal hyphae. Urine samples from these dogs produced a medium to heavy pure growth of fungi when placed on Sabaraud's medium. Predisposing causes were not identified in any of the dogs. Four dogs were euthanatized immediately after diagnosis because of paralysis or paresis. The other 6 dogs were treated, and 4 of the 6 received itraconazole. One dog was euthanatized for an unrelated problem after 21 months of treatment; 1 dog was still alive after 4 years of continuous treatment with itraconazole. The other 4 dogs were euthanatized because of eventual paralysis or paresis. Our results suggest that German Shepherd Dogs are predisposed to infection with opportunistic fungi, possibly because of a specific inability to mount an effective response. This predisposition needs to be further studied.

Animals↗
PubMed1995

Low-velocity gunshot wounds to the spine with an associated transperitoneal injury.

Twenty-nine patients who incurred a transperitoneal low-velocity gunshot wound to their spine were evaluated for the occurrence of spinal infectious complications. All patients underwent an exploratory laparotomy to determine the extent of viscera involvement. No attempt was made to debride the involved spinal area, and the bullet was not removed unless it was easily accessible. Of the 21 patients with a parenchymal and/or noncolonic viscous injury, 17 (77%) were treated with intravenous (i.v.) antibiotics for a minimum of 5 days the remainder received treatment for a maximum of 48 h. All 8 patients with colonic injuries received a minimum of > or = 5 days of antibiotic treatment. Follow-up averaged 44.9 months (range 3-144 months). Only 1 (4.7%) patient with either a noncolonic or parenchymal perforation developed an infectious complication (subdiaphragmatic abscess); two patients (25%) with colonic perforations developed a psoas abscess. No patient developed a spinal infection. This study suggests that patients who sustain a transperitoneal low-velocity gunshot wound to their spine do not need to undergo spinal debridement and may be treated with parenteral antibiotics. Any course of broad-spectrum antibiotics for 5 days appears to minimize infectious complications. Bullet removal and missile tract debridement of the spine is not routinely necessary.

Adolescent↗
PubMed1993

[Candida albicans spondylodiscitis].

Infections by Candida sp. have increased notably and cause not only local but also systemic infections. It is rarely mentioned as an etiologic agent of osteomyelitis. Two cases of candidiasic spondylodiscitis are presented with the first being in a 33 year old intravenous drug using male who consulted for mechanical lumbar pain. Spondylodiscitis L2-L3 was observed upon radiological study. Aspiration puncture was carried out and the cultures were negative. Surgical biopsy was performed with spondylodiscitis and an abscess in the spine being observed. C. albicans was isolated in the culture. Pathological study confirmed the diagnosis. Cutaneous and sternocostal involvement was also concommitantly presented. The patient was treated with amphotericin B with a favorable evolution. The second case was in a 35 year old male with burns over 65% of his body due to a laboral accident. Three months after admission the patient presented lumbar pain irradiating to the groin and thigh. Bone destruction of the second lumbar vertebra and an abscess of the right psoas were observed upon CT scan. Puncture biopsy was performed and C. albicans was isolated. Histopathologic study demonstrated osteomyelitis by Candida sp. Treatment with amphotericin B was started. Posteriorly urea and creatinine was raised. Treatment was continued with fluconazole with good therapeutic response.

Adult↗
PubMed1995

[MR imaging of infected spondylodiskitis: interval signal change in vertebral body (including enhanced image of vertebral body)].

A retrospective evaluation of MRI was carried out in 22 patients with spondylodiskitis. Low signal intensity on T1-weighted images and high or low signal intensity on T2-weighted images were observed. Sixteen patients underwent follow-up examinations after the initial examination. Various signal changes in the vertebral body were recognized. The longer the period of follow-up, the less abnormal the signal intensity became on both T1- and T2-weighted images. Several cases showed no change in signal intensity. In all of 17 patients re-examined after injection of Gd-DTPA, infected vertebral bodies were enhanced. We classified the enhancing patterns of infected vertebral bodies in three types: A) homogeneous, B) homogeneous with strong enhancement adjacent to the end plate, C) inhomogeneous. Pyogenic spondylodiskitis tended to show patterns A or B, and tuberculous spondylodiskitis pattern C. The enhancement effect disappeared after normalization or remission of laboratory findings. In two cases, the enhancement effect remained even after laboratory findings became normal. Contrast MRI was useful for understanding infectious state.

Adolescent↗
PubMed1995

[Spondylodiscitis caused by Fusobacterium nucleatum. Apropos of a case].

Spondylodiscitis is rarely caused by anaerobic germs and occurs mainly in patients weakened by another infection. We report a case of Fusobacterium nucleatum spondylodiscitis in a 63-year-old man. This is the third such report and the second in a non-immunodepressed patient. The clinical presentation and laboratory findings in this type of spondylodiscitis vary little from those produced by other germs. Magnetic resonance imaging is the most useful diagnostic tool for spondylodiscitis. The germ is isolated from a discal puncture aspirate in 66% of the cases but can also be obtained from blood cultures. Anaerobic germs are usually sensitive to penicillin or cephalosporins.

Discitis↗
PubMed1995

[Osteoarticular infections caused by Streptococcus agalactiae. Report of 4 cases].

BACKGROUND: Streptococcus agalactiae (group B streptococcus) is a rare etiology of osteoarticular infection in adults. In a literature review (Medline-Embase plus) up until may 1994, we have found only 51 cases. In most patients, diabetes mellitus, liver disease or long-term steroid therapy were documented. METHODS: Four adult patients with osteoarticular infection due to S. agalactiae from two Galician hospitals were studied from January 1988 to October 1994: prepatellar bursitis (one case), septic monoarthritis (2 cases) and psoas abscess associated to cervical spondylodiscitis and oligoarthritis (left sternoclavicular and left hip joints). RESULTS: In the first patient, a young woman with prepatellar bursitis, a previous local trauma was recorded. The second case, a man with septic arthritis of right knee, had degenerative disease of the knees and a prostatic adenocarcinoma. In the third patient, a diabetic woman with septic arthritis of the left shoulder, vulvovaginitis due to Candida albicans was found. The last patient suffered vertebral osteomyelitis of the cervical spine (C3-C4), arthritis of the left sternoclavicular and hip joints and abscess of the ipsilateral psoas. The evolution was favourable in the four cases. CONCLUSIONS: Although uncommon, osteomyelitis and arthritis caused by group B streptococcus should be considered as opportunistic pathogen in adults with debilitating conditions. Early recognition and prompt institution of adequate therapy can help avoid joint destruction and severe complications.

Adult↗