Non-pyogenic infections of the spine

Skaf, Ghassan; Kanafani, Zeina A.; Araj, George F.; Kanj, Souha S.

doi:10.1016/j.ijantimicag.2010.03.023

Cited by 66 publications

(63 citation statements)

References 76 publications

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“…For instance, Al-Tawfiq and Ghandour 7 reported a case of Cryptococcus vertebral osteomyelitis and Levine et al8 reported a case of Scedosporium vertebral osteomyelitis, both in immunocompetant patients. In the present study, the pre-operative CRP was normal in Patient 9 . Thus, while fungal infection of the spine and host immune system function are usually closely related, there are exceptions to the typical patient profile.…”

Section: Discussionsupporting

confidence: 50%

Untitled

2011

JHN Journal

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IntroductionFungal vertebral osteomyelitis (FVO) is an uncommon but aggressive disease that may cause spinal instability, neurological insult, and possibly death. Little data about treatment strategies and patient outcomes exist. A retrospective review of medical and surgical management with follow-up of this disease was performed. MethodsA retrospective review was conducted of patients with FVO treated with surgery and pharmacotherapy at a single institution over a 7-year period (1999 to 2006). Patients were included in analysis if they had biopsy and radiographically confirmed vertebral fungal infection. Analysis was constructed through office and medical records. Specific data points included age, gender, microbiology, treatment, clinical presentations and outcomes. ResultsNine patients with FVO were identified (5 females and 4 males) ranging in age from 42 to 77 years (mean=57 years). Advanced age (n=4) and previous spine surgery (n=4) were the most commonly identified risk factors for FVO. Candida species (n=7), Aspergillus fumigatus (n=2), and Saccharomyces cerevisiae (n=1) pathogens were identified. The average pre-operative erythrocyte sedimentation rate (ESR) was 83.2 mm/hr (normal range is 0 to 20 mm/hr) and C-reactive protein (CRP) was 6.9 mg/dL (normal range is 0 to 1.2 mg/dL). Surgical debridement and stabilization procedures were performed in all 9 patients. The average antifungal prescription duration was 21 weeks. Revision surgical procedures (n=5) were the most commonly identified treatment complication, and the average duration between the initial surgery and the first subsequent procedure was 3.5 months (range, 3 weeks to 9 months). In comparison to pre-operative ASIA Impairment Scores, patient neurological status was improved (n=4) or stable (n=3) at latest follow-up. Average follow-up duration was 19 months. There was no mortality. ConclusionsAggressive surgical treatment with concurrent pharmacotherapy can successfully treat FVO and prevent neurological injury. Repeat surgeries are common in patients with progressive vertebral degeneration or persistent infection.

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Section: Discussionsupporting

confidence: 50%

Untitled

2011

JHN Journal

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“…54 Neuroimaging guided-needle biopsy from the affected site is the gold standard technique for the early histopathological diagnosis of spinal tuberculosis. 38 CT-guided needle biopsy usually yields sufficient material either from the spine itself or from an adjacent abscess.…”

Section: Cytological and Microbiological Confirmationmentioning

confidence: 99%

Spinal tuberculosis: A review

Garg

Somvanshi

2011

The Journal of Spinal Cord Medicine

631

660

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Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

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“…Image-guided biopsy is considered useful for both distinguishing between infected and non-infected lesions via pathologic examination and identifying microorganisms such as Mycobacterium tuberculosis, Brucella species, and fungi, which are difficult to detect via blood culture and serologic examination [13]. In the present study, one patient had PVO caused by Mycobacterium tuberculosis.…”

Section: Discussionmentioning

confidence: 70%

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

Kamono¹,

Kabeya²,

Sohara³

et al. 2017

J Med Microb Diagn

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Identifying the causative pathogens in patients with pyogenic vertebral osteomyelitis is important for optimizing antibiotic therapy. Thus, we examined patient characteristics and investigated the efficacy of the combined use of blood culture and image-guided biopsy culture for identifying the causative pathogens of pyogenic vertebral osteomyelitis. A case series study was conducted in hospitalized patients who were diagnosed with pyogenic vertebral osteomyelitis using electronic medical records. Twenty-three patients who had undergone both blood culture and image-guided biopsy to determine the causative pathogens were identified. Detailed patient characteristics were identified, and the detection rate of a causative pathogen was 57% using either blood or biopsy specimen culture. By combining the results of each culture, the detection rate was increased to 83%. We described the detailed characteristics of patients with pyogenic vertebral osteomyelitis from whom both blood and biopsy specimen cultures were obtained. We found that the combined use of blood culture and biopsy specimen culture is useful for enhancing the detection of causative pathogens in patients with pyogenic vertebral osteomyelitis.

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Non-pyogenic infections of the spine

Cited by 66 publications

References 76 publications

Untitled

Untitled

Spinal tuberculosis: A review

The Etiology of Pyogenic Vertebral Osteomyelitis and Evaluation of Biopsy Specimen Cultures in Hospitalized Patients

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