Diagnostic Difficulties in Bacterial Spondylodiscitis

Abstract

Objective: To analyze aspects related to the diagnostic difficulty in patients with bacterial spondylodiscitis. Methods: Cross-sectional observational study with retrospective data collected in the period from March 2004 to January 2014.Twenty-one patients diagnosed with bacterial spondylodiscitis were analyzed. Results: Women were the most affected, as well as older individuals. Pain in the affected region was the initial symptom in 52% of patients, and 45.5% of the patients had low back pain, and those with dorsal discitis had back pain as the main complaint; the patients with thoracolumbar discitis had pain in that region, and only one patient had sacroiliac discitis. The average time between onset of symptoms and treatment was five months. The lumbar segment was the most affected with 11 cases (52%), followed by thoracolumbar in 24%, dorsal in 19% of cases and a case in the sacroiliac segment. Only seven patients had fever. Pain in the affected level was coincidentally the most common symptom. Conclusions: Early diagnosis of bacterial spondylodiscitis remains a challenge due to the nonspecific signs and symptoms reported by the patient and the wide variability of laboratory results and imaging. The basis for early diagnosis remains the clinical suspicion at the time of initial treatment.

Subacute Low Back Pain: infectious spondylodiscitis with epidural and psoas abscess

“…The clinical symptoms of infectious spondylodiscitis are nonspecific. [2][3][4] Fever is often missing, [2] laboratory findings can be mild. [2][3][4] Recognition of the condition is difficult and often delayed as a result of its rarity.…”

“…[2][3][4] Fever is often missing, [2] laboratory findings can be mild. [2][3][4] Recognition of the condition is difficult and often delayed as a result of its rarity. [2][3][4] In our case, with special regard to the bilateral psoas abscess, the bilateral paravertebral injections received by the patient a few weeks earlier, are strongly suspected as the root cause.…”

Pyogenic Cervical Spondylodiskitis: Case Report and Current Literature Review

“…The most significant findings are the presence of leukocytosis usually under 12,000 U / dL (sensitivity 27.2%) [13,14]. Considered of greater diagnostic value although paradoxically with less diagnostic specificity, are ESR and CRP.…”

“…Serial blood cultures (2 blood cultures, in 2 different times) with antibiogram is a practical tool in the setting of pyogenic SD pharmacological treatment [15,16]. Positive cultures are reported with isolation of the causative agent only in 50% of cases [13]. Uroanalysis with uroculture is mandatory in the case of hematogenous SD suspicion, since thje urinary tract it is the most common originating site [16].…”

“…Uroanalysis with uroculture is mandatory in the case of hematogenous SD suspicion, since thje urinary tract it is the most common originating site [16]. Fine-needle aspiration CAT scan guided biopsy is considered at the time to be the goal standard for isolation of the causative agent upon clinical suspicion of pyogenic SD and negative radiology and blood cultures studies, being positive in up to 63% of all cases [13,16].…”