Escherichia coli Spondylodiscitis: A Case Report and Literature Review

Abstract

Introduction: Spondylodiscitis is an infectious inflammatory disease with the involvement of an intervertebral disk and adjacent vertebral bodies. Hematogenic spreading of microorganisms from an infectious site is the most common pathophysiologic cause of vertebral osteomyelitis. In this report, a case of Escherichia coli spondylodiscitis was described and a review of literature was also performed on cases with E. coli spondylodiscitis. Case Presentation: A 68-year-old woman referred to our hospital with a 2-month history of intermittent fever, weight loss, and low back pain. On physical examination, we found obvious bulging with the dimensions of 4 × 20 cm on about L1 -L4 vertebral area.Lumbosacral MRI revealed the evidence of L2 -L3 spondylodiscitis. She had positive blood and urine cultures with ciprofloxacinsensitive E. coli and successfully treated without surgery after 8 weeks. Nine articles (including 9 patients) regarding E. coli spondylodiscitis or vertebral osteomyelitis have been published from the 1st of January 1985 to the 10th of August 2019. In addition to these cases, here we report 10th case of E. coli vertebral osteomyelitis. Four patients were female and 6 were male. The mean age was 52 years with a range of 12 -69. Seven cases had a history of fever, and overall, fever and pain at the site of vertebral involvement were the most common symptoms. Conclusions: In our reported patient, returning to the patient's medical history and finding a previous urinary tract infection and E. coli bacteremia was crucial in helping to diagnose and treat the patient. In our review, 7 patients had positive blood cultures, a finding that emphasizes the diagnostic value of this test. Escherichia coli spondylodiscitis is a relatively rare disease that has usually a source of urinary tract infection and its clinical signs and symptoms are not distinguishable from vertebral osteomyelitis due to other agents and finally, blood culture can be helpful as a diagnostic method.

Persistent Bacteremia Due to Escherichia coli Vertebral Osteomyelitis

“…This case report concerns a patient with vertebral osteomyelitis caused by E. coli, which is not a common pathogen for osteomyelitis like Staphylococcus aureus and coagulase-negative staphylococci. Mohammadreza et al reviewed 10 cases of E. coli spondylodiscitis and found the most common origin of the infection was the urinary tract, accounting for at least 50% of cases [5]. However, our patient had no urological symptoms, and his urine culture was negative.…”

“…The most frequent pathogens are Staphylococcus aureus and coagulase-negative staphylococci [4]. Although uncommon, Escherichia coli (E. coli) can cause vertebral osteomyelitis [5]. We present the case of a patient with persistent bacteremia due to E. coli vertebral osteomyelitis.…”

Ureteric Stone-Related Escherichia coli Bacteraemia Associated with Spondylodiscitis

“…This contrasts with our case, as the spondylodiscitis responded well to antibiotic therapy, and no further intervention, including aspiration, was required. Salehi et al described a 68-year-old female with a 2-month history of low back pain, who was found to have E. coli positive urine cultures and spondylodiscitis, successfully treated with antibiotics [8]. Muller et al reported a 38-year-old female with severe left flank pain who developed an E. coli discitis, who was also treated with oral antibiotics [9].…”

Progressive Lower Back Pain With New-Onset Symptoms

“…5,6 It most often results from hematogenous seeding or direct inoculation at the time of spinal surgery or contiguous spread from an infection in the adjacent soft tissue. 7 Diagnosis is usually delayed due to the indolent nature of the seeding microorganism and an insidious course. 7e9 3.…”