1/58. Spinal epidural abscess associated with epidural catheterization: report of a case and a review of the literature.We describe a 53-year-old man who developed a catheter-related epidural abscess 8 days after left upper lobectomy for lung cancer. methicillin-resistant staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. magnetic resonance imaging was essential for the diagnosis of epidural abscess and for determining the extent of spread. The patient was treated by laminectomy and administration of appropriate antibiotics, with almost complete recovery, except for urinary retention. A literature search yielded 29 additional cases of catheter-related epidural abscess. The median duration of catheterization was 4 days and the median time to onset of the clinical symptoms after catheter placement was 8 days. Eleven of the 30 patients had some underlying disorders, including malignancy or herpes zoster, or were receiving steroids. Nine of the 10 patients with thoracic epidural abscess had persistent neurological deficits, whereas 12 of the 15 patients with lumbar epidural abscess showed a full recovery after treatment. Surgical decompression was not required in six patients without significant neurological deficits, who recovered following antibiotic treatment (four patients) or percutaneous drainage (two patients). Thoracic catheters are associated with a disproportionately high incidence of epidural abscess and persistent neurological sequelae following treatment.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
2/58. Brucellar spinal epidural abscess.Spinal epidural abscesses account for approximately one of every 10, 000 admissions to tertiary hospitals. The midthoracic vertebrae are the most frequently affected, whilst the cervical spine is involved in fewer patients. Staphylococcus aureus is identified as the cause in most cases of epidural abscess; other bacteria responsible include Gram-negative bacteria, streptococcus species and brucella species. We report the case of a patient with cervical spondylodiscitis at level C4-C5 and an epidural abscess which was compressing the spinal cord and the retropharyngeal space. The previous symptoms of brucellosis were atypical. We discuss the clinical manifestations, diagnosis, treatment and prognosis of the case.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
3/58. Neonatal cervical osteomyelitis with paraspinal abscess and Erb's palsy. A case report and brief review of the literature.An unusual case of pyogenic cervical osteomyelitis is reported in a newborn who immediately after birth had no movements in the left shoulder. There was a fullness in the left cervical region. Left Erb's palsy due to an unrecognized birth trauma was diagnosed in a peripheral hospital. Later, the child developed fever and a significant swelling in the left cervical region. On transfer to our institution, the x-rays of the cervical spine, ultrasound and computed tomography (CT) established the diagnosis of C(6) cervical osteomyelitis and paraspinal abscess which extended to the posterior triangle of the neck. The abscess was drained, and the lamina and lateral mass of the C(6) vertebra were debrided. Staphylococcus aureus was grown from the pus. The patient was put on long-term antibiotics to which he responded very well, and he became asymptomatic. In the immediate post-operative period, some movements at the left shoulder were noted, and at 6-month follow-up in the out-patient clinic, the child was virtually normal with near-complete regeneration of the C(6) lamina and lateral mass.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
4/58. aspergillus vertebral osteomyelitis in a child with a primary monocyte killing defect: response to GM-CSF therapy.We report the first case of vertebral aspergillosis in a child with a primary defect in monocyte killing, an extremely rare immunodeficiency The diagnosis of defective monocyte killing was made by an in vitro assay that showed normal killing of Staphylococcus aureus by the patient's neutrophils but impaired killing by his monocytes. Importantly, the extensive granulomatous infection that involved the vertebral column, posterior mediastinum, pleura, and lung was not responsive to aggressive treatment with a combination of liposomal amphotericin b. intralesional amphotericin b. itraconazole, and granulocyte transfusions. Dramatic clinical and radiological improvement was only seen after the addition of granulocyte macrophage-colony stimulating factor (GM-CSF) to his treatment regimen. The use of GM-CSF in the treatment of invasive aspergillosis in immunocompromised patients requires further evaluation.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
5/58. Hematogenous pyogenic facet joint infection of the subaxial cervical spine. A report of two cases and review of the literature.Two cases of hematogenous, pyogenic, subaxial cervical facet joint infection are reported, and the literature is reviewed. Infection of the cervical facet joint is a rarely diagnosed condition; only one case has been reported in the literature. Lumbar facet joint infections are also rare but more commonly reported. Approximately one fourth of facet joint infections in the lumbar spine are complicated by epidural abscess formation, which can lead to a neurological deficit. Because of the paucity of reports on cervical facet joint infections, the clinical characteristics of this entity are not well known. Both patients presented with an acute onset of unilateral neck pain that radiated into the ipsilateral shoulder. Frank radicular pain was initially absent. Unilateral upper-extremity motor weakness that was attributed to associated epidural abscess or granulation tissue formation was also demonstrated in both patients. leukocyte count and erythrocyte sedimentation rate were elevated in both cases. magnetic resonance imaging was necessary to obtain an accurate diagnosis. Staphylococcus aureus was identified as the offending pathogen in both cases. Decompressive surgery and antibiotic therapy were required to cure the condition. One patient recovered completely and the other sustained a permanent motor deficit. Hematogenous cervical facet joint infection is a rare clinical entity that has many characteristics in common with the more-common lumbar homolog. All three reported cases, however, have been complicated by epidural abscess or granulation tissue formation that has led to a neurological deficit. This finding suggests that a facet joint infection in the cervical spine may have a less benign clinical course than that in the lumbar spine.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
6/58. A Staphylococcus aureus paraspinal abscess associated with epidural analgesia in labour.A case is described in which a parturient developed a Staphylococcus aureus paraspinal abscess following epidural analgesia in labour. We compared this case with other reported cases of paraspinal abscesses in obstetric patients. The presentation, diagnosis and management of these cases were reviewed. Anaesthetists need to be aware that non-spinal-epidural abscesses can occur in patients with an associated labour epidural.- - - - - - - - - - ranking = 5keywords = aureus (Clic here for more details about this article) |
7/58. Vertebral osteomyelitis and prosthetic joint infection due to Staphylococcus simulans.Staphylococcus simulans, a coagulase-negative staphylococcus, is a common animal pathogen that is rarely encountered in human infections. We describe a 70-year-old man who developed multifocal vertebral osteomyelitis and late prosthetic joint infection caused by this pathogen. The patient was a farmer who had daily contact with cows and drank unpasteurized milk, although the portal of the pathogen's entry remains speculative. culture of the vertebral disk biopsy specimen and cultures during resection arthroplasty yielded S. simulans. A review of the literature suggests that S. simulans may be more virulent than other species of coagulase-negative staphylococci. Accurate identification of S. simulans isolates would facilitate studies to further define its pathogenic role in human infections.- - - - - - - - - - ranking = 7.8352788465826keywords = staphylococcus (Clic here for more details about this article) |
8/58. Spinal osteomyelitis and diskitis: a rare complication following orthotopic heart transplantation.We describe a 55-year-old man who developed spinal osteomyelitis and diskitis 14 months after orthotopic heart transplantation. The infective organism was Staphylococcus aureus and the patient was successfully treated with flucloxacillin and fusidic acid.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
9/58. Recurrent pyogenic vertebral osteomyelitis associated with type 2 diabetes mellitus.We report a case of recurrent pyogenic vertebral osteomyelitis associated with type 2 diabetes mellitus. A 51-year-old male was admitted to our hospital because of lumbago and general fatigue, with multiple ulcers on the soles of his feet. Staphylococcus aureus was isolated from peripheral blood and the foot ulcers, and 67Gallium scintigram showed abnormal isotope uptake, accumulated at the lower thoracic spine. Antibiotics were administered and the patient underwent intensive insulin therapy. magnetic resonance imaging (MRI), performed after the levels of c-reactive protein decreased to 0.0 mg/dl, indicated old inflammatory changes at the Th8-Th9 spine and antibiotics were stopped. Unexpectedly, 8 days later the patient complained of lumbago with fever again, and MRI showed acute inflammatory changes at the same lesion site. This case report suggests that it is important for complementary antibiotic therapy to continue after signs of inflammation have disappeared in cases of pyogenic vertebral osteomyelitis.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
10/58. Pyogenic vertebral osteomyelitis.Pyogenic vertebral osteomyelitis is a disease of adults that should be distinguished from true disk space infection. It is due to a hematogenous seeding (either venous or arterial) of the subchondral bony elements of the vertebral body. The disk space is involved secondarly, later in the course of the disease. The underlying bacteremia is from another focus of infection, frequently in the urinary tract. Disk space infection in adults is caused by direct violation of the disk, most commonly at the time of surgical excision of the nucleus pulposus. The bony elements of both adjacent vertebral bodies are secondarily involved. The clinical feature common to both types of infection is back pain that generally begins insidiously and then gradually increases in severity and becomes continuous and is accompanied by marked muscle spasm. The sedimentation rate is always increased; it decreases only with resolution of the infection. The diagnosis of vertebral infection is often not suspected because fever and leukocytosis generally are absent. The most common organism is Staphylococcus aureus, although gram-negative bacterial infections also occur. Bacteriologic diangosis should be sought in each case by blood cultures (generally negative with postoperative disk space infection) or percutaneous needle biopsy. Soft tissue abscesses may require open debridement and drainage. Treatment of both types consists of rest, immobilization, and specific antibiotic treatment. The prognosis for resolution of the infectious process within six to nine months, with adequate treatment, is excellent.- - - - - - - - - - ranking = 1keywords = aureus (Clic here for more details about this article) |
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