More on enterococcal osteoarticular infections: vertebral osteomyelitis

Zamora, A.; Flórez, JP; Vidal, F.; Richart, C

doi:10.1093/rheumatology/36.10.1132

Cited by 11 publications

(8 citation statements)

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“…Infective discitis due to enterococci has been reported on six previous occasions since 1969, each one associated with advanced age (8). The patient described herein was also elderly, had underlying medical problems, and may have been immunosuppressed secondary to steroid therapy.…”

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confidence: 75%

Vertebral Osteomyelitis Caused by Enterococcus raffinosus

2001

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Enterococcus raffinosus is a rare isolate in clinical specimens. A case of vertebral osteomyelitis caused by E. raffinosus in an elderly patient is described and confirms this organism to be an opportunistic human pathogen. CASE REPORTA 73-year-old woman presented with severe back pain and bilateral weakness and numbness in the legs. In addition, the patient had fecal incontinence for 24 h and had not passed urine for 2 days. During the preceding 4 weeks, she had experienced midthoracic back pain requiring increasing amounts of analgesia but had no difficulty walking and no altered sensation in the legs. No other symptoms of note were elicited. There was a history of rheumatoid arthritis, osteoarthritis (requiring bilateral knee replacements), ischemic heart disease, and a crush fracture of a thoracic vertebra (T5) following a fall 2 years previously. Among other medications, the patient was taking long-term low-dose prednisolone (5 mg once daily).On examination, the patient was febrile (38.2°C) and had flaccid paralysis of the legs, a palpable bladder, and a grade 3 ejection systolic murmur. There were no other symptoms of endocarditis, and the patient was hemodynamically stable. An initial diagnosis of osteoporotic vertebral collapse and spinal cord compression was made. In view of the fever, blood and, later, urine cultures were taken. Hematological investigations revealed a hemoglobin level of 10.9 g/dl, a platelet count of 201 ϫ 10 9 /liter, and a white cell count of 7.6 ϫ 10 9 /liter. C-reactive protein was at 334 mg/liter. Plain roentgenograms of the spine showed wedging of thoracic vertebrae T6 and T7. Magnetic resonance imaging confirmed partial collapse of the T6 and T7 vertebral bodies, causing kyphosis and cord compression consistent with osteoporotic collapse. The patient was taken quickly to the operating room on the day of admission to decompress the spinal cord. During surgery, foul-smelling material was removed from the T6 and T7 vertebral bodies and sent for microscopy and culture. Anterior excision of the vertebral bodies was performed, and rib strut grafting (using the patient's own ribs, rather than a metal prosthesis) was used to bridge the bone defect, because of the clinical suspicion of infection. Gram-positive cocci were seen in stained tissue, and cephradine and fusidic acid were commenced as empirical antibiotic therapy. On the first postoperative day, blood cultures became positive with an Enterococcus species. Antibiotic susceptibilities were determined by E-test (AB Biodisk, Solna, Sweden), and the results are shown in Table 1. A history of penicillin allergy was given, and the therapy was therefore changed to intravenous vancomycin and metronidazole. On the fifth postoperative day, the vertebral body tissue specimens also grew an Enterococcus species. Metronidazole was discontinued when anaerobic cultures were negative. Urine cultures were negative on two occasions. Postoperative progress was slow: an intermittent low-grade fever and shivering episodes persisted, and the C-reactiv...

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confidence: 75%

Vertebral Osteomyelitis Caused by Enterococcus raffinosus

2001

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“…Although rare, it can cause brain abscess and subdural empyema 5 11) . Also it can cause discitis, vertebral osteomyelitis, and SEA 2 16 18 20) . We could not find any exclusive case report or case series of SEA due to E. faecalis in MEDLINE search.…”

Section: Discussionmentioning

confidence: 99%

“…While this normally does not cause disease in the intestine, it can be pathogenic when infecting sites outside of the gut 19) . In the neurosurgical field, although rare, it can cause brain abscess, subdural empyema, discitis, osteomyelitis, and SEA 2 5 11 16 18 20) . They are one of the pathogens of gas-containing infections in the extremities, such as non-clostridial gas gangrene and necrotizing fascitis 6) .…”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

Bang

Cho

2015

Korean J Spine

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Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.

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“…Enterococci-related spondylodiscitis is uncommon, and only a few cases have been reported to date (1,13). It is possible to witness hematogenous spread by arterial route to the vertebral bodies.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Vertebral Osteomyelitis Developing After Enterococcal Bacteremia in a Geriatric Patient

Ülçay¹,

Karagöz²,

Aribal³

et al. 2014

Turk J Phys Med Rehab

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Vertebral osteomyelitis and discitis are rare entities. Although enterococci are a major cause of bacteremia and infective endocarditis, hematogenous enterococcal vertebral osteomyelitis has rarely been reported. In this article, a geriatric case is presented who had visited our hospital with complaints of "distorting back pain" and weakness in the legs and who had been diagnosed with vertebral osteomyelitis caused by enterococcus faecalis. In this case, the lesion of the patient was not distinguished from the metastasis with imaging studies, and the definitive diagnosis was confirmed by open tissue biopsy. As a result, bacteremic patients with back pain must be considered for vertebral osteomyelitis/discitis. Although imaging with MRI or a tissue biopsy will be helpful to confirm the diagnosis, open tissue biopsy and bone biopsy are more effective and crucial options for making a definitive diagnosis in some cases. Key Words: Vertebral osteomyelitis, spondylodiscitis, Enterococcus faecalis ÖzetVertebra osteomiyeliti ve diskiti nadir görülen bir hastalıktır. Enterokoklar bakteriyemi ve infektif endokarditlerin majör nedenleri arasında yer alsalar da, hematojen yayılımlı enterokokal vertebral osteomiyelit olguları çok az sayıda rapor edilmiştir. Bu yazıda, şiddetli bel ağrısı ve ayaklarda güçsüzlük yakınmaları ile hastanemize başvuran ve Enterococcus faecalis'in neden olduğu vertebral osteomiyelit tanısı alan geriatrik bir olgu sunulmaktadır. Olgumuzda, hastamızın belindeki lezyon görüntüleme yöntemleri ile metastaz ve malignitelerden ayırt edilememiş ve kesin tanı açık doku biyopsi işlemi ile konmuştur. Sonuç olarak; bel ağrısı yakınması olan bakteriyemik hastaların ayırıcı tanıları arasında vertebral osteomiyelit bulunmalıdır. Manyetik rezonans görüntüleme (MRG) ya da doku biyopsileri tanı için yardımcı olsalar da, açık doku biyopsi ve kemik biyopsileri bazı olguların tanısında daha etkili ve önemli seçeneklerdir.

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More on enterococcal osteoarticular infections: vertebral osteomyelitis

Cited by 11 publications

References 0 publications

Vertebral Osteomyelitis Caused by Enterococcus raffinosus

Vertebral Osteomyelitis Caused by Enterococcus raffinosus

Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

A Rare Case of Vertebral Osteomyelitis Developing After Enterococcal Bacteremia in a Geriatric Patient

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