1/251. Cryptococcoma of the sacrum.Cryptococcoma of the sacrum was the initial presentation of systemic cryptococcosis in a patient on chronic steroid therapy for autoimmune hepatitis. The bone lesion was the only overt manifestation of systemic cryptococcal disease, which preceded other clinical manifestations and led to the subsequent diagnosis of systemic infection.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/251. Purulent osteomyelitis of the cervical spine with epidural abscess. Operative treatment by means of dorsal and ventral approach.The present case concerns an acute purulent osteomyelitis with an epidural abscess, located particularly in the intervertebral foramen between C5 and C6, which led to infection by staphylococci of the adjacent vertebral arches and vertebral bodies. An obstruction of the CSF passage was discovered by myelography at the level between C5 and C6. The bony tissue changed by inflammation was removed as far as possible by laminectomy. After irrigation of the epidural space with antibiotics and after control of the severe inflammation, the vertebral bodies C6 and C7 which were destroyed by the spreading inflammatory granulations, could be removed by a ventral approach 4 weeks later. The defect was filled with spongiosa chips. After immobilisation in a plaster shell and Crutchfield extension for 8 weeks the patient was slowly mobilized. A fusion of the vertebral bodies C5 and C6, C6/C7 and C7/C1 was achieved. A dislocation of the cervical spine did not occur and the patient recovered completely except for a paresis of the right hand. Treatment of this very rare and severe case was only possible by a combined dorsal and ventral procedure on the cervical spine.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
3/251. Pyogenic vertebral osteomyelitis caused by campylobacter fetus subspecies fetus. A case report.STUDY DESIGN: Clinical observation of a patient. OBJECTIVES: To present the clinical features of an unusual infection of the spine caused by campylobacter fetus subspecies fetus and to suggest treatment. SUMMARY OF BACKGROUND DATA: This is only the second reported case of pyogenic vertebral osteomyelitis caused by campylobacter fetus subspecies fetus. methods: A 66-year-old man had pain of the left lower extremity. Radiologic examination revealed an epidural mass associated with destruction of the L5-S1 vertebral bodies. RESULTS: biopsy of the epidural mass was performed, and culture yielded campylobacter fetus subspecies fetus. After intravenous antibiotics, oral doxycycline and erythromycin were given for 5 months. At 9 months after antibiotic treatment was completed, the patient's condition was stable. CONCLUSIONS: Prolonged oral administration of doxycycline and erythromycin was curative in this patient.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
4/251. actinomycosis of the central nervous system: surgical treatment of three cases.Three cases of actinomycotic brain infection are described, 2 of which manifested as cerebral abscess, the third as epidural empyema. Complete resolution of the infection was always achieved by means of surgical treatment and prolonged antibiotic therapy. The cases reported emphasize the importance of a combined approach in the treatment of this unusual cause of brain infection.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
5/251. Pyogenic osteomyelitis of the spine in the elderly: three cases of a synchronous non-axial infection by a different pathogen.STUDY DESIGN: A retrospective chart review of patients over 65 years of age treated at the spine Care Unit for pyogenic vertebral osteomyelitis. OBJECTIVES: To assess the reliability of peripheral blood, urine and sputum cultures in the treatment of pyogenic vertebral osteomyelitis in the elderly. SETTING: Study performed at the spine Care Unit, Meir Hospital, Kfar-Saba, israel. methods: The Meir hospital records were searched for patients over 65 years of age, treated at the spine Care Unit for pyogenic vertebral osteomyelitis. charts, culture results and imaging studies were reviewed. A medline literature search was performed to survey the literature regarding pyogenic vertebral osteomyelitis in the elderly with emphasis on diagnostic imaging modalities and surgical treatment. RESULTS: Three patients were identified with concurrent peripheral infection by a different organism than the organism causing the vertebral osteomyelitis. Delay in correct diagnosis led to neurologic impairment in all patients and surgical treatment was performed in all three to drain the epidural abscess, decompress the spinal cord and obtain direct tissue culture. Following decompression and epidural abscess evacuation, one patient has functionally recovered and was ambulating with a cane, two patients did not recover and remained paraparetic and ambulate in a wheelchair. CONCLUSIONS: Pyogenic vertebral osteomyelitis in the elderly can be caused by a different pathogen than that isolated from blood, sputum or urine cultures. In the elderly, a biopsy of the vertebral lesion should be obtained for susceptibility studies prior to conservative treatment with bracing and intravenous antibiotics.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
6/251. actinomycosis--an unusual case of an uncommon disease.actinomycosis is an uncommon disease caused by organisms of the actinomyces genus. These organisms are commonly found in the mucous membranes but do not cause infection unless there is disruption of the membranes, as occurs, for example, during dental trauma or abdominal surgery. Use of an IUD is also a risk factor for pelvic actinomycosis. The disease is usually insidious and is often mistaken for other conditions. Treatment of the infection, once diagnosed, is a regimen of long-term antibiotics such as penicillin, clindamycin, and others. Our patient had pelvic and sacral actinomycosis without any of the traditional risk factors for infection.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
7/251. cryptococcosis of thoracic vertebra simulating tuberculosis: diagnosis by fine-needle aspiration biopsy cytology--a case report.A rare case of cryptococcosis of sixth thoracic vertebra (T6) along with pulmonary involvement in an old diabetic patient is presented. The infection resulted in lytic lesion of T6 vertebra and girdle pain. A computerized tomographic (CT) guided fine-needle aspiration biopsy (FNAB) cytology was performed, which showed encapsulated fungal spores of cryptococcus neoformans with granulomatous reaction, later confirmed by fungal culture.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
8/251. Iatrogenic Mycobacterium infection after an epidural injection.STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the mass and identification of the causative agent by histologic and microbiologic studies. SUMMARY OF BACKGROUND DATA: Spinal pain, caused by an infective mass, developed in a 39-year-old man 3 months after an epidural injection for low back pain. methods: Exploratory surgery was performed to remove the mass, and histologic and microbiologic studies were conducted. RESULTS: The inflammatory mass was excised successfully, and several specimens were examined for bacteriologic presence. Histologic examination of the excised specimen showed chronic granulomatous inflammation, and subsequent microbiologic studies cultured an acid- and alcohol-fast bacillus that was later identified as mycobacterium fortuitum. CONCLUSION: A review of the literature shows that this is a particularly uncommon micro-organism.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
9/251. Spinal aspergillus osteomyelitis.aspergillus species are uncommon etiologic agents of vertebral osteomyelitis. We describe two patients with lumbar vertebral aspergillosis precipitated by the use of corticosteroids and review 39 cases in the literature. The mean age of the population was 40.04 years. There was male predominance (78% of cases), mainly lumbar involvement (53.7%), and monomicrobial nature of infection; 65.8% of the patients had predisposing factors, while 34.1% had none. Back pain (53.6% of cases) was the predominant symptom, while neurological deficits were present in 29.2% of the patients. White blood cell counts were elevated in 12.2% of the patients, and erythrocyte sedimentation rates were >40 mm/h in 39%. The overall recovery rate was 68.3%, and the mortality rate was 26.8%. Although aspergillus osteomyelitis is primarily treated medically, certain cases may require surgical intervention.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/251. Primary hydatid disease of the spine: an unusual cause of progressive paraplegia. Case report and review of the literature.Although rare, spinal hydatid disease is a manifestation of hydatid infestation. The authors present the report of a patient who presented with primary spinal hydatid disease. This disease is often misdiagnosed as tuberculous spondylitis, and thus patients may subsequently receive inappropriate treatment. The patient in this case presented, with an increasing weakness in the lower limbs, to a different clinic from an area in india where hydatid infections are endemic. The infection was misdiagnosed as tuberculous spondolytis based on evaluation of plain x-ray films, and the patient underwent antituberculous chemotherapy and a posterior surgical decompressive procedure. The patient presented to the authors' clinic with increasing paraparesis 1.5 years later. Radiographs and a magnetic resonance image of the spine were obtained, which strongly suggested hydatid disease. Examination of serum levels confirmed the diagnosis. The patient underwent a decompressive procedure of the spine in which stabilization was performed. Postoperatively her paraparesis resolved, and good control over the disease was achieved by chemotherapy. The authors conclude that primary spinal hydatid disease of the spine, although a rare manifestation, should be considered in the differential diagnosis in patients with infectious and destructive lesions of the spine in regions in which the disease is endemic. Advanced imaging studies should be performed to diagnose the disease. Early decompressive surgery with stabilization of the spine, in addition to adjuvant chemotherapy, is the treatment of choice for these patients.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
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