Extradural guinea-worm abscess

Khwaja, Mohammed S.; Dossetor, J F; Lawrie, J. H.

doi:10.3171/jns.1975.43.5.0627

Cited by 12 publications

(4 citation statements)

References 4 publications

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“…The lower proportion of Staphylococcus aureus in the above mentioned publications from the 1990s on SEA patients from the USA could reflect a worldwide shift in bacteria in this age of antibiotics and isn't necessarily due to a predilection of certain subgroups of patients with SEA for other infectious agents. References 4,13,16,33,35,36,38,50,57,58,66,70,74,80,92,96,100,110,116,117,137,143,148,154,156,170,176,178,180,184,186,187,193,204,206,215,227,232,237,244,245,250,253,256,264,265,271,293,…”

Section: Causative Organismsmentioning

confidence: 99%

“…Two Nigerian patients had a 70-cm long worm that was operatively removed from the epidural space. In both cases, the worm was identified as Dracunculus medinensis, which is endemic in Africa [178], causing dracunculiasis (Medina or Guinea worm infection). Another case involved a cyst of Echinococcus granulosus located in the epidural space at Th11 in a 44-year-old man from New York [172].…”

Section: Causative Organismsmentioning

confidence: 99%

See 1 more Smart Citation

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Section: Causative Organismsmentioning

confidence: 99%

Section: Causative Organismsmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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“…54 Epidural abscesses involving unusual (Prevotella oris, Listeria myocytogenes, Candida albicans, and Mycobacterium avium intracellulare) 33 38 57 71 110 or even 'exotic' organisms such as Guinea worm appear to be on the increase. 59 Some argue that this is because of the greater prevalence of immune compromise secondary to HIV/AIDS or chemotherapy, but others suggest that it is due to changes in bacterial flora in the age of antibiotic therapy. 104…”

Section: Imagingmentioning

confidence: 99%

Epidural abscesses

Grewal¹,

Hocking²,

Wildsmith³

2006

British Journal of Anaesthesia

228

177

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Until recently epidural abscess was considered a rare, almost theoretical, complication of central nerve block, but anecdotal reports suggest that this is no longer the case. Thus a review of the risk factors, pathogenesis, clinical features and outcome of this condition is appropriate, the primary aim being to make recommendations on best anaesthetic practice to minimize the risk of this serious complication. A search of EMBASE(c), PUBMED(c) and MEDLINE(c) databases from 1966 to September 2004 was performed using several strategies, supplemented by reference list screening. Spontaneous epidural abscess is rare, accounting for 0.2-1.2 cases per 10,000 hospital admissions per year. Estimates of the incidence after central nerve block vary from 1:1,000 to 1:100,000. Risk factors (compromised immunity, spinal column disruption, source of infection) are present in the majority of patients, whether the condition is spontaneous or associated with central nerve block. Presentation is vague, fever and back pain usually preceding neurological deficit. Diagnosis requires a high index of suspicion and modern imaging techniques. Treatment involves early surgical drainage to prevent permanent deficit and high dose parenteral antibiotics chosen with bacteriological advice. Primary prevention depends on proper use of full aseptic precautions. Epidural abscess can be a catastrophic consequence of central nerve block. Early diagnosis will minimize permanent damage, but primary prevention should be the aim. There is a need for a large survey to indicate the true incidence to better inform the risk-benefit ratio for central nerve block.

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“…The most frequently reported neurologic manifestation is paraplegia due to spinal epidural involvement [55]. Although the diagnosis can be suggested by spinal calcifications on plain radiograph or an epidural lesion seen via myelography, definitive diagnosis can be made by gross or microscopic pathologic examination during surgical laminectomy [55][56][57]. A single case of median nerve involvement by forearm parasitic abscess has been reported [58].…”

Section: Dracunculiasis (Dracunculus Medinensis)mentioning

confidence: 99%