Two Cases of Diskitis Attributable to Anaerobic Bacteria in Children

Abstract

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...

Spondylodiscitis. Case reports

“…Chandresanan y col. aislaron Staphyloccocus aureus en 5 pacientes de 16 estudiados (10) . En la serie de Gribble de 20 pacientes estudiados, (13) sólo se aisló en un caso Staphyloccocus aureus ; en el estudio de Tapia Moreno, de 18 pacientes estudiados se aislaron gérmenes en 2 casos, uno del hemocultivo (Saphyloccocus aureus) y en otro del (3) absceso del psoas (Salmonella sp) , también se ha (9,14) descrito casos por bacilos anaeróbicos . La dificultad en obtener el aislamiento de un agente microbiano como ocurrió en nuestros dos casos, en que los hemocultivos fueron negativos, plantea la necesidad de incorporar en el futuro el estudio por PCR a fin de obtener un mayor acercamiento etiológico de la espondilodiscitis en nuestro medio.…”

Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

“…Fusobacterium infections of the spine are very rare with only 15 previously reported cases in the literature [20][21][22][23][24][25][26][27][28][29][30][31][32]. So far, these infections were limited to two-, three-or fourlevel spondylodiscitis located mainly in the lumbar area.…”

Spondylodiscitis Due to Clostridium ramosum Infection in an Immunocompetent Elderly Patient

“…Spondylitis and spondylodiscitis due to anaerobic bacteria are rarely reported. In the literature, cases of infective discitis have been published on 12 previous occasions, each one associated with an immunocompromised status (6,9,11,13,15,19,23,25,28 ). The source of the isolate is not known.…”