1/101. Cervical spondylodiscitis after removal of a fishbone. A case report.STUDY DESIGN: A case report of cervical spondylodiscitis after removal of a lodged fishbone. OBJECTIVES: To present a rare case of cervical spondylodiscitis and to inform the readers that a lodged fishbone can give rise to this complication after its removal. SUMMARY OF BACKGROUND DATA: In the literature, only one mention of this complication was found. methods: The literature, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Prolonged antibiotic treatment and immobilization of the cervical spine resulted in a cure of the spondylodiscitis. CONCLUSIONS: After removal of a lodged fishbone, a cervical spondylodiscitis is possible, but this is a very rare complication. In this patient, conservative treatment resulted in a cure of the infection. Successive magnetic resonance imaging investigations showed the extent of the destruction of the vertebral bodies and disc very well, as well as the curation of the spondylodiscitis after 5 months.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/101. Vertebral aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease.aspergillus osteomyelitis of the spine with acute diskitis has been well documented in immunocompromised hosts but is rare in immunocompetent patients. Predisposing factors to infection are prolonged neutropenia, hematologic malignancies, chemotherapy, history of prior spinal trauma or surgery, allograft transplantation, or any condition requiring the use of long-term immunosuppressive agents or systemic corticosteroids. patients with chronic obstructive pulmonary disease (COPD) treated with systemic corticosteroids for either long-term management or frequent exacerbations are at potential risk for such infections. patients with severe COPD treated primarily with inhaled corticosteroids are considered immunocompetent. This report describes 2 cases of aspergillus osteomyelitis with acute diskitis in apparently immunocompetent patients with COPD who, aside from brief courses of systemic corticosteroids, were using inhaled corticosteroid therapy. One patient was treated with intravenous amphotericin b alone, whereas the other received amphotericin b and underwent surgical debridement. Both have done well and were symptom free at 6-month follow-up.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
3/101. Surgical treatment of aspergillus spondylodiscitis.Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. Spinal instrumentation can be of help in maintaining or restoring spinal stability and maintaining spinal alignment. In our four patients the aspergillus spondylodiscitis was successfully eradicated and fusion achieved. In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
4/101. enterobacter agglomerans spondylodiscitis: a possible, unrecognized complication of tetracycline therapy.STUDY DESIGN: This case report describes infection in a lumbar disc in a healthy young man with an organism of low pathogenicity. The patient was taking a prolonged course of antibiotics at the time the infection occurred. OBJECTIVE: To describe this unique case of infective spondylodiscitis. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, spinal infection with enterobacter agglomeranshas never been reported. This organism is a transient gut colonizer, and may have established itself secondary to the patient's prolonged ingestion of tetracycline for acne. methods: This 22-year-old farmer had spontaneous lumbar back pain. Radiologic investigations showed an abnormality in the L4-L5 disc region, and together with other investigations, were suggestive of infection. The diagnosis was confirmed by surgical aspiration. RESULTS: Antibiotic therapy was administered, and the patient made a complete recovery. Follow-up radiographs showed a complete loss of the L4-L5 disc space with only minimal bone destruction. CONCLUSION: A unique cause of infective lumbar discitis is presented. Several features of this case are unusual. The magnetic resonance findings were not readily diagnostic. The cultured organism is usually nonpathogenic. The infection may have been secondary to prolonged tetracycline therapy.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
5/101. The role of laparoscopic biopsies in lumbar spondylodiscitis.Infection of an intervertebral disk is a serious condition. diagnosis often is elusive and difficult. It is imperative to obtain appropriate microbiological specimens before initiation of treatment. The authors describe a 51-year-old woman with lumbar spondylodiscitis that was because of infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging confirmed the diagnosis, but computed tomography-guided fine needle biopsy did not provide adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of propionibacterium acnes infection. The authors believe that this minimally invasive procedure should be performed when computed tomography-guided fine needle biopsy does not provide a microbiologic diagnosis in spondylodiscitis.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
6/101. Two cases of diskitis attributable to anaerobic bacteria in children.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 degrees 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 degrees 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 beta-lactamase and was susceptible to ticarcillin-clavulanate, clindamycin, metronidazole, and imipenem. Therapy with clindamycin 450 mg every 8 hours was given parenterally for 3 weeks and orally for 3 weeks. Back pain resolved within 2 weeks. A 2-year follow-up showed complete resolution and no recurrence. This report describes, for the first time, the isolation of anaerobic bacteria from children with diskitis. The lack of their recovery in previous reports and the absence of bacterial growth in over two third of these studies may be caused by the use of improper methods for their collection, transportation, and cultivation. Proper choice of antimicrobial therapy for diskitis can be accomplished only by identification of the causative organisms and its antimicrobial susceptibility. 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 F nucleatum, which was resistant to beta-lactam antibiotics. The origin of the anaerobic bacteria causing the infection in our patient is probably of endogenous nature. The presence of abdominal pain in the first child may have been attributable to a subclinical abdominal pathothology. The preceding pharyngitis in the second patient may have been associated with a potential hematogenous spread of F nucleatum. P magnus has been associated with bone and joint infections. This report highlights the importance of obtaining disk space culture for aerobic and anaerobic bacteria from all children with diskitis. Future prospective studies are warranted to elucidate the role of anaerobic bacteria in diskitis in children.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
7/101. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
8/101. The role of laparoscopic biopsies in lumbar spondylodiscitis.The infection of an intervertebral disk is a serious condition. The diagnosis often is elusive and difficult to make. It is imperative to have appropriate microbiologic specimens before the initiation of treatment. We report the case of a 51-year-old woman with lumbar spondylodiscitis caused by infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging (MRI) scan confirmed the diagnosis, but computed tomography (CT)-guided fine-needle biopsy did not yield adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of propionibacterium acnes infection. We believe that this minimally invasive procedure should be performed when CT-guided fine-needle biopsy fails to yield a microbiologic diagnosis in spondylodiscitis.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
9/101. Vertebral infections caused by haemophilus aphrophilus: case report and review.OBJECTIVE: To review in detail clinical presentation, bacteriologic findings, associated conditions and treatment of haemophilus aphrophilus vertebral osteomyelitis and to compare them to a case we report herein. methods: A medline (National Library of medicine) search of the literature was performed by using the key words H. aphrophilus, spondylodiscitis, discitis, and vertebral osteomyelitis. The references of the case reports were examined for additional cases, especially those cited in older articles that had not been entered onto the bibliographic database. RESULTS: A case report of spondylodiscitis due to H. aphrophilus in a 35-year-old patient with a history of dental abscess 7 months before admission is presented. The patient responded well to treatment with ceftriaxone and ciprofloxacin. To date, only 14 cases of H. aphrophilus vertebral osteomyelitis have been reported. They are usually reported in middle-aged patients, usually male. Most recent cases have been treated with fluoroquinolones. Duration of treatment usually ranges from 1 to 3 months. CONCLUSIONS: H. aphrophilus is an uncommon cause of vertebral osteomyelitis. patients are regularly cured by antibiotic therapy, provided that a tissue biopsy is performed in order to isolate the causative bacterium.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
10/101. A definite case of spondylodiscitis caused by Streptococcus equisimilis.To shed light on the role of Streptococcus equisimilis (SE) in the pathogenesis of intervertebral disc infection, we report here a case of lumbar spondylodiscitis in a 37-year-old male caused by SE, with identification of this strain by cultures from L4-L5 lumbar disc biopsy. Intravenous therapy with penicillin and gentamycin combined with immobilization resulted in a rapid and complete recovery. The patient did not have underlying disease and showed no obvious history of exposure to animals. We conclude that SE may be responsible for both septic arthritis and spondylodiscitis.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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