Establishing the diagnosis of tuberculous vertebral osteomyelitis

Colmenero, Juan; Ruiz-Mesa, Juan D.; Sanjuán-Jiménez, Rocío; Sobrino, Beatriz; Morata, Pilar

doi:10.1007/s00586-012-2348-2

Cited by 92 publications

(71 citation statements)

References 63 publications

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“…In fact current literature reviews do not even mention platelets count in TB spondylitis as a consideration [5,7,17]. The fact that TB of the spine has a delayed presentation compared to pulmonary TB makes the diagnosis even more challenging.…”

Section: Discussionmentioning

confidence: 99%

Comparison of platelet count in tuberculosis spine to other spine pathology

Daniel

Dunn

2013

Eur Spine J

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Purpose Haematological markers currently used to investigate TB spine vary from WCC, Anaemia, ESR and CRP. Platelet count in TB spine as a marker has been inadequately investigated. Method In this retrospective review, Platelet count in TB spondylitis on admission was compared to patients undergoing other elective spinal surgery (control) preoperatively. Comparisons of the platelets with ESR and the effect of HIV on platelet count in TB spine were also evaluated. Results 160 TB spine patients showed statistically significant higher platelet count when compared to 210 patients in the control group (p \ 0.001). 52.5 % patients had a raised platelet count in the TB spondylitis group. Raised Platelet count had a sensitivity and specificity of 52.5 % and 86.2 %, respectively in TB spondylitis. ESR and platelet count had a Pearson correlation r = 0.31 (p \ 0.001). HIV however did not statistically show any difference in the platelet count (p = 0.12). Conclusion A raised platelet count in spinal pathology may be used as an inflammatory marker of TB spondylitis.

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Section: Discussionmentioning

confidence: 99%

Comparison of platelet count in tuberculosis spine to other spine pathology

Daniel

Dunn

2013

Eur Spine J

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“…12 Hadjipavlou et al in 2003 examined osteometabolic disorders in 68 patients, in whom a total of 71 biopsy samples were obtained and in whom a microbial diagnosis was established in 30 (44%). 15 Colmenero and associates 7,8 evaluated specifically for tuberculous osteomyelitis; in 2004, 7 they compared open to percutaneous biopsies and found 61.7% and 48% of samples to be positive, respectively. 7 Yang and coworkers compared endoscopic and percutaneous techniques for biopsy and reported a positive result in 90% (18/20 patients) using endoscopic biopsy and in 47% (15/32 patients) using percutaneous biopsy.…”

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confidence: 99%

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Garg

Kosmas

Young

et al. 2014

FOC

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Object Vertebral osteomyelitis has been reported to occur in approximately 0.2–2 cases per 100,000 annually. Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies. Different imaging modalities, from radiography and CT scanning to nuclear medicine imaging and contrastenhanced MRI, can be employed to evaluate for osteomyelitis. Although MRI has a strong sensitivity and specificity for vertebral osteomyelitis, obtaining histological and microbiological samples remains the gold standard in diagnosis. Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases. However, recent reports have questioned the percentage yield of image-guided percutaneous biopsy even when there is a high clinical suspicion for vertebral osteomyelitis. Methods After obtaining institutional review board approval, the authors performed a chart review of patients who had undergone image-guided percutaneous bone biopsies at University Hospitals Case Medical Center in Cleveland, Ohio. Data were filtered for patients in whom a biopsy sample of a vertebral body/disc was obtained. A total of 213 procedures were performed, of which clinicians indicated a concern for infection in 84, infection or neoplasm in 13, and a noninfectious etiology (the majority being neoplasms) in the remaining 116. Results Histological examination provided positive results in 25 (41.0%) of the 61 samples collected for suspected cases of osteomyelitis. Microbiology samples were less predictive, with only 16 of the 84 samples collected, or 19.0%, yielding a positive result. In 10 patients there were positive blood and/or urine cultures. Of these, 8 samples (80%) demonstrated the same pathogen identified by biopsy (for the remaining 2 positive systemic cultures, no pathogen was identified by the percutaneous intervention). In other words, half of the 16 cases that provided microbiological results from biopsy demonstrated the same results by systemic cultures. However, 89 (76.7%) of the 116 samples collected with the primary concern of neoplasm yielded results. Conclusions Image-guided percutaneous biopsy for vertebral osteomyelitis demonstrates an extremely low probability of identifying specific microbes. Blood or urine cultures concurrently identified culprit pathogens in 50% of positive biopsy cultures. Therefore, in only 8 (9.5%) of 84 biopsies did the biopsy results provide additional information to clinicians as to the pathological microorganism present and how treatment might need to be adjusted.

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“…It is necessary for the differential diagnosis of brucellar, pyogenic and tuberculous spondylodiscitis. Colmenero et al [8] also reported that if there was no clear evidence of causative agent, the vertebral biopsy should be performed. In the presented case we have isolated the bacteria for diagnosis using biopsy.…”

Section: Dear Editormentioning

confidence: 99%

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

Karagöz¹,

İrvem²,

Çomoğlu³

et al. 2018

mjima

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Dear Editor,Brucella species can cause a zoonotic infection brucellosis which may affect multiple tissues in the body including musculoskeletal system. Vertebral brucellosis is relatively common in the patients who have musculoskeletal involvement and should be diagnosed rapidly in the endemic regions. Early diagnosis and appropriate antimicrobial therapy combined with surgery are associated with an excellent prognosis; otherwise, delay in diagnosis increases the rate of morbidity and mortality [1] . Isolation of the microorganism from the tissue sample establishes the definite diagnosis and this is also necessary for the differential diagnosis. In this paper we aim to report a patient who presented to our clinic with spondylodiscitis and epidural abscess due to brucellosis.A 46-year-old female patient admitted to our setting with fever for 4 months, chills, and sweating which was exaggerated at night. She also had complaints of lower back pain lasting 2.5 months in addition to fatigue, lack of appetite, and weight loss. She had history of stockbreeding and ate unpasteurized dairy products. On physical examination, her body temperature was 37.5 °C, pain with local pressure was detected on the lumbar vertebrae, and her motor deficit grade was 2/5. The rest of general and neurological examinations were normal. The patient's laboratory test results were as follows: white blood cell count: 4590/mm 3 ; hemoglobin: 9.6 g/dL; hematocrit: 29.2%; erythrocyte sedimentation rate: 95 mm/h; C-reactive protein: 5.9 mg/L (normal, 0 to 0.8 mg/L); and a normal other blood biochemistry profile. The total serum protein, albumin, and globulin were also normal. There was no reversal of the albumin/ globulin ratio, and the Rose Bengal test was positive. The Wright agglutination test for Brucella was also positive at a titer of 1/2560. However, the patient was not tested by the 2-mercaptoethanol. Magnetic resonance imaging (MRI) of the spine was consistent with the diagnosis of spondylodiscitis. The height of the Intervertebral disc between L5-S1vertebrae was decreased in addition to signal abnormality on the vertebral corpus and vertebral endplates in MRI (Figure 1, 2). An epidural abscess, 54x22 mm in size, extending from the posterior of the L5 and S1 vertebrae to the paravertebral space and an abscess, 3x2 cm in size, on the anterior prevertebral space were identified. Upon laminectomy, a purulent epidural and prevertebral mass were evacuated. After decompression, the motor deficit was improved and the pain was relieved. On the Gram stain of the Anahtar Kelimeler: Bakteriyel enfeksiyonlar, Bruselloz, tedavi, epidural apse, dekompresyon cerrahisi

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Establishing the diagnosis of tuberculous vertebral osteomyelitis

Cited by 92 publications

References 63 publications

Comparison of platelet count in tuberculosis spine to other spine pathology

Comparison of platelet count in tuberculosis spine to other spine pathology

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

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