Nonspecific Diskitis in Children

Ryöppy, Soini; Jääskeläinen, J; Rapola, Juhani; Alberty, Anne

doi:10.1097/00003086-199312000-00018

Cited by 37 publications

(26 citation statements)

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“…The literature reports variable rates of culture for disc biopsies in children of all ages with discitis, with a positive rate of culture between 0% and 67%. 9,11 In the two large series of patients of all age groups studied by Wenger et al 1 and Speigel et al, 2 a pathogen was cultured in 67% (6 of 9) and 27% (4 of 15) of cases, respectively. This is evidence of a probable microbial cause for discitis, but in only one series of 16 children of all age groups was a routine operative biopsy performed.…”

Section: 3mentioning

confidence: 95%

Discitis in young children

Brown¹,

Hussain²,

McHugh³

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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Discitis is uncommon in children and presents in different ways at different ages. It is most difficult to diagnose in the uncommunicative toddler of one to three years of age. We present 11 consecutive cases. The non-specific clinical features included refusal to walk (63%), back pain (27%), inability to flex the lower back (50%) and a loss of lumbar lordosis (40%). Laboratory tests were unhelpful and cultures of blood and disc tissue were negative.MRI reduces the diagnostic delay and may help to avoid the requirement for a biopsy. In 75% of cases it demonstrated a paravertebral inflammatory mass, which helped to determine the duration of the oral therapy given after initial intravenous antibiotics.At a mean follow-up of 21 months (10 to 40), all the spines were mobile and the patients free from pain. Radiological fusion occurred in 20% and was predictable after two years. At follow-up, MRI showed variable appearances: changes in the vertebral body usually resolved at 24 months and recovery of the disc was seen after 34 months.

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Section: 3mentioning

confidence: 95%

Discitis in young children

Brown¹,

Hussain²,

McHugh³

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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“…The indication for more invasive procedures such as biopsy or needle aspiration is currently not established. The literature shows success rates for needle aspiration and open biopsy in identifying the causative organism that ranges from 0 to 63% [3][4][5][6]. However, due to the surgical and anaesthetic risks, these interventions are still not standard diagnostic procedures for most authors.…”

Section: Introductionmentioning

confidence: 99%

Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report

Ceroni

Cherkaoui

Kaelin

et al. 2010

Journal of Children's Orthopaedics

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As the result of improved bacteriological techniques, Kingella kingae is a slow-growing Gram-negative coccobacillus that is emerging as an important cause of spondylodiscitis in children younger than 3 years of age. The high pharyngeal carrier rates of this slow-growing Gram-negative coccobacillus combined with the low incidence of identified K. kingae infections is possibly explained by a low virulence of this bacterium. The use of specific real-time polymerase chain reaction (PCR) on blood samples and throat swabs opens new prospects in the bacteriological investigations of young children suspected to have spondylodiscitis, an approach that could prevent, in the future, unnecessary invasive interventions.

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“…This is of particular importance in infections caused by anaerobic bacteria that are often resistant to antimicrobials used to empirically treat diskitis. This was the case in our second patient, who was infected by iskitis, an inflammation of the intervertebral disk, is generally attributable to Staphylococcus aureus [1][2][3][4][5] and rarely Staphylococcus epidermidis, Kingella kingae, [7][8][9] Enterobacteriaciae, 5,6 and Streptococcus pneumoniae. 10 In many cases, no bacterial growth is obtained from infected intervertebral discs.…”

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confidence: 96%

“…10 In many cases, no bacterial growth is obtained from infected intervertebral discs. 1,[3][4][5]11,12 Although anaerobic bacteria were recovered from adults with spondylodiscitis, 13-16 these organisms were not reported before from children. The recovery of anaerobic bacteria in children with diskitis is reported.…”

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confidence: 99%

Two Cases of Diskitis Attributable to Anaerobic Bacteria in Children

Brook

2001

Pediatrics

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ABSTRACT. Diskitis, an inflammation of the intervertebral disk, is generally attributable to Staphylococcus aureus and rarely Staphylococcus epidermidis, Kingella kingae, Enterobacteriaciae, and Streptococcus pneumoniae. In many cases, no bacterial growth is obtained from infected intervertebral discs. Although anaerobic bacteria were recovered from adults with spondylodiscitis, these organisms were not reported before from children. The recovery of anaerobic bacteria in 2 children with diskitis is reported.Patient 1. A 10-year-old male presented with 6 weeks of low back pain and 2 weeks of low-grade fever and abdominal pain. Physical examination was normal except for tenderness to percussion over the spine between thoracic vertebra 11 and lumbar vertebra 2. The patient had a temperature of 104°F. Laboratory tests were within normal limits, except for erythrocyte sedimentation rate (ESR), which was 58 mm/hour. Blood culture showed no growth. Magnetic resonance imaging with gadolinium contrast revealed minimal inflammatory changes in the 12th thoracic vertebra/first lumbar vertebra disk. There was no other abnormality. A computed tomography (CT)-guided aspiration of the disk space yielded bloody material, which was sent for aerobic and anaerobic cultures. Gram stain showed numerous white blood cells and Gram-positive cocci in chains. Cultures for anaerobic bacteria yielded heavy growth of Peptostreptococcus magnus, which was susceptible to penicillin, clindamycin, and vancomycin. The patient was treated with intravenous penicillin 600 000 units every 6 hours for 3 weeks, and then oral amoxicillin, 500 mg every 6 hours for 3 weeks. The back pain resolved within 2 weeks, and the ESR returned to normal at the end of therapy. Follow-up for 3 years showed complete resolution of the infection.Patient 2. An 8-year-old boy presented with low back pain and low-grade fever, irritability, and general malaise for 10 days. He had had an upper respiratory tract infection with sore throat 27 days earlier, for which he received no therapy. The patient had a temperature of 102°F, and physical examination was normal except for tenderness to percussion over the spine between the second and fourth lumbar vertebrae. Laboratory tests were normal, except for the ESR (42 mm/hour). Radiographs of the spine showed narrowing of the third to fourth lumbar vertebra disk space and irregularity of the margins of the vertebral endplates. A CT scan revealed a lytic bone lesion at lumbar vertebra 4, and bone scan showed an increase uptake of 99m technetium at the third to fourth lumbar vertebra disk space. CT-guided aspiration of the disk space yielded cloudy nonfoul-smelling material, which was sent for aerobic and anaerobic cultures. Gram stain showed numerous white blood cells and fusiform Gram-negative bacilli. Anaerobic culture grew light growth of Fusobacterium nucleatum. The organism produced ␤-lactamase and was susceptible to ticarcillin-clavulanate, clindamycin, metronidazole, and imipenem. Therapy with clindamycin 450 mg every 8 hours w...

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Nonspecific Diskitis in Children

Cited by 37 publications

References 0 publications

Discitis in young children

Discitis in young children

Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report

Two Cases of Diskitis Attributable to Anaerobic Bacteria in Children

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