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Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott's Disease. Clin Pract 2023; 13:155-165. [PMID: 36826156 PMCID: PMC9955044 DOI: 10.3390/clinpract13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott's disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott's disease, there is a lack of specific clinical diagnostic criteria for Pott's disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott's disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott's disease within this literature review.
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Kabashi-Muçaj S, Muçaj S, Gashi X, Dedushi-Hoti K, Shatri J, Dreshaj D, Pasha F. A follow-up case of relapsing tuberculous spondylodiscitis, complicated with soft-tissues abscess and percutaneous fistula. Radiol Case Rep 2022; 17:563-568. [PMID: 34987685 PMCID: PMC8693411 DOI: 10.1016/j.radcr.2021.11.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022] Open
Abstract
Spinal tuberculosis (Pott's disease) is a frequent manifestation of Mycobacterium tuberculosis infection. It manifests as destruction of 2 or more adjacent vertebral bodies followed with destruction of the intervertebral disc, leading to a condition known as spondylodiscitis. Tuberculous spondylodiscitis represents with back pain, fever, joint stiffness, loss of spinal mobility, neurological symptoms, vertebral body collapse, gibbus formation and kyphosis. Persistent Pott's disease might lead to soft tissues abscesses, frequently involving iliopsoas muscle. We, herein, present a 20 years long follow-up case of a Pott's disease patient. The patient got diagnosed as tuberculous spondylodiscitis, almost 10 years after first symptoms onset. She underwent frequent computed tomography and magnetic resonance scanning, with spinal spondylodiscitis being its only significant finding, while lung parenchyma and other organs were not infected. Patient got treated with multidrug anti-tubercular regimen for 18 months in 2 different periods of time; nonetheless she complicated with iliopsoas muscle abscess and percutaneous fistula. Early diagnosis and treatment of spinal tuberculosis (TB) are of great importance in ensuring a good clinical outcome. Delaying the diagnosis and proper management can lead to spinal cord compression, deformity and irreversible neurological complications. Thus, multidrug anti-tubercular therapy must be started timely and the duration of anti-tubercular therapy needs to be individualized. The decision to terminate anti-tubercular therapy should be based on clinical, radiological, pathological and microbiological indices, rather than being based on specific guidelines.
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Affiliation(s)
- Serbeze Kabashi-Muçaj
- Department of Radiology, University of Prishtina "Hasan Prishtina", Prishtine, Republic of Kosovo
- Clinic of Radiology, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
| | - Sefedin Muçaj
- National Institute of Public Health Str. Bulevardi i Dëshmorëve, nn 10000, Prishtine, Republic of Kosovo
| | - Xhavid Gashi
- Department of Spinal Surgery, Clinic of Orthopedics, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
| | - Kreshnike Dedushi-Hoti
- Department of Radiology, University of Prishtina "Hasan Prishtina", Prishtine, Republic of Kosovo
- Clinic of Radiology, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
| | - Jeton Shatri
- Clinic of Radiology, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
| | - Dardan Dreshaj
- Head and Neck Surgery Clinic, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
| | - Flaka Pasha
- Clinic of Radiology, University Clinical Center of Kosovo, Prishtine, Republic of Kosovo
- Department of Pharmacology and Toxicology and Clinical Pharmacology, University of Prishtina "Hasan Prishtina", Prishtine, Republic of Kosovo
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Li YW, Fung YW. A Case of Cervical Tuberculous Spondylitis: An Uncommon Cause of Neck Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neck pain is a common presentation to the emergency department. We report a case of cervical tuberculous spondylitis in an old lady with neck pain. She re-attended the emergency department because of progressive nocturnal pain and stiffness. X-ray of the cervical spine showed blurred endplate and prevertebral soft tissue swelling. CT cervical spine showed evidence of infective discitis. Surgical intervention and anti-tuberculosis therapy were given. The patient became bed-ridden and died of pneumonia two months later. Alarming clinical features and serial assessment of X-ray changes would help to look for potentially fatal differential diagnoses of neck pain.
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Chiappini E, Lo Vecchio A, Garazzino S, Marseglia GL, Bernardi F, Castagnola E, Tomà P, Cirillo D, Russo C, Gabiano C, Ciofi D, Losurdo G, Bocchino M, Tortoli E, Tadolini M, Villani A, Guarino A, Esposito S. Recommendations for the diagnosis of pediatric tuberculosis. Eur J Clin Microbiol Infect Dis 2016; 35:1-18. [PMID: 26476550 DOI: 10.1007/s10096-015-2507-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 10/07/2015] [Indexed: 01/10/2023]
Abstract
Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease.
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Aithala JP. Role of Percutaneous Image Guided Biopsy in Spinal Lesions: Adequacy and Correlation with MRI Findings. J Clin Diagn Res 2016; 10:RC11-5. [PMID: 27656517 DOI: 10.7860/jcdr/2016/20440.8377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although, MRI has increased our understanding of spinal pathologies, accurate diagnosis of spinal lesions need biopsy, so that early treatment can be initiated. AIM To evaluate the accuracy of biopsy, safety and yield of percutaneously done image guided spinal biopsy using a large bore needle and correlate between MRI findings and biopsy as well as the importance of various MRI findings in establishing the diagnosis. MATERIALS AND METHODS All spinal lesions after clinical and MRI evaluation were subjected to Jamshidi Needle biopsy using 11 gauge needles. Biopsy material was sent for culture/sensitivity, AFB smear and histopathological examination. The outcome assessment included percentage of patients in whom diagnosis was changed after biopsy, yield in biopsy and complications of biopsy. MRI findings, biopsy findings and final diagnosis were correlated to know the sensitivity and specificity of MRI and biopsy diagnosis. Logistic regression analysis was used to study the importance of each of MRI findings in making a diagnosis. RESULTS Forty five patients with spinal lesions underwent biopsy using an 11 gauge Jamshidi needle. Initial biopsy was inconclusive in 4 patients giving a positive yield in about 91.2% of cases and a repeat biopsy ensured conclusive report in all cases. Following biopsy there was a change in diagnosis in 8% cases. MRI showed sensitivity of 85.71% and specificity of 93.54% for the diagnosis of malignancy and sensitivity of 85.71% and specificity of 86.48% for the diagnosis of tuberculosis. In contrast, initial biopsy had sensitivity of 92.85% and specificity of 100% for the diagnosis of malignancy and sensitivity of 71.42% and specificity of 100 % for the diagnosis of infection. Logistic regression analysis showed good correlation between malignancy and posterior bugle in the vertebral body in the absence of a fracture (p = 0.007), involvement of pedicles and posterior elements (p = 0.001) and soft tissue extension (p = 0.002); there was good correlation between infection and epidural abscess (p<0.001) as well as paradiscal involvement (p<0.001). CONCLUSION Image guided biopsy done with good technique helps in accuracy of diagnosis thus ensuring the correct treatment at the earliest and has minimal complications. This study also shows that presence of epidural abscess and paradiscal involvement in MRI are highly suggestive of infection, while pedicle involvement and posterior bulge of vertebral body before the onset of pathological fracture are suggestive of malignancy, but all spinal lesions should be biopsied to confirm the diagnosis.
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Affiliation(s)
- Janardhana P Aithala
- Associate Professor, Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal University , Karnataka, India
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Joo EJ, Yeom JS, Ha YE, Park SY, Lee CS, Kim ES, Kang CI, Chung DR, Song JH, Peck KR. Diagnostic yield of computed tomography-guided bone biopsy and clinical outcomes of tuberculous and pyogenic spondylitis. Korean J Intern Med 2016; 31:762-71. [PMID: 27079327 PMCID: PMC4939487 DOI: 10.3904/kjim.2013.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 09/25/2013] [Accepted: 12/13/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to evaluate the efficacy of computed tomography (CT)-guided bone biopsy for the diagnosis of spinal infection and compared the clinical outcomes between tuberculous and pyogenic spinal infections. METHODS The retrospective cohort study included patients who received CT-guided bone biopsy at a tertiary hospital over the 13 years. RESULTS Among 100 patients, 67 had pyogenic spondylitis and 33 had tuberculous spondylitis. Pathogens were isolated from bone specimens obtained by CT-guided biopsy in 42 cases, with diagnostic yields of 61% (20/33) for tuberculous spondylitis and 33% (22/67) for pyogenic spondylitis. For 36 culture-proven pyogenic cases, Staphylococcus aureus was the most commonly isolated organism. Patients with pyogenic spondylitis more frequently presented with fever accompanied by an increase in inflammatory markers than did those with tuberculosis. Among all patients who underwent surgery, the incidence of late surgery performed one month after diagnosis was higher in patients with tuberculous infection (56.3%) than in those with pyogenic disease (23.3%, p = 0.026). CONCLUSIONS Results obtained by CT-guided bone biopsy contributed to prompt diagnoses of spinal infections, especially those caused by tuberculosis. Despite administration of anti-tuberculous agents, patients with tuberculous spondylitis showed an increased tendency to undergo late surgery.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon-Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Kyong Ran Peck, M.D. Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-0322 Fax: +82-2-3410-0064 E-mail:
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Abstract
Spinal infections are a spectrum of disease comprising spondylitis, diskitis, spondylodiskitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy, and myelitis. Inflammation can be caused by pyogenic, granulomatous, autoimmune, idiopathic, and iatrogenic conditions. In an era of immune suppression, tuberculosis, and HIV epidemic, together with worldwide socioeconomic fluctuations, spinal infections are increasing. Despite advanced diagnostic technology, diagnosis of this entity and differentiation from degenerative disease, noninfective inflammatory lesions, and spinal neoplasms are difficult. Radiological evaluations play an important role, with contrast-enhanced MR imaging the modality of choice in diagnosis, evaluation, treatment planning, interventional treatment, and treatment monitoring of spinal infections.
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Erdem H, Elaldi N, Batirel A, Aliyu S, Sengoz G, Pehlivanoglu F, Ramosaco E, Gulsun S, Tekin R, Mete B, Balkan II, Sevgi DY, Giannitsioti E, Fragou A, Kaya S, Cetin B, Oktenoglu T, DoganCelik A, Karaca B, Horasan ES, Ulug M, Inan A, Kaya S, Arslanalp E, Ates-Guler S, Willke A, Senol S, Inan D, Guclu E, Tuncer-Ertem G, Meric-Koc M, Tasbakan M, Senbayrak S, Cicek-Senturk G, Sırmatel F, Ocal G, Kocagoz S, Kusoglu H, Guven T, Baran AI, Dede B, Yilmaz-Karadag F, Kose S, Yilmaz H, Aslan G, ALGallad DA, Cesur S, El-Sokkary R, Bekiroğlu N, Vahaboglu H. Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study". Spine J 2015; 15:2509-17. [PMID: 26386176 DOI: 10.1016/j.spinee.2015.09.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/24/2015] [Accepted: 09/03/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
| | - Nazif Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Sani Aliyu
- Clinical Microbiology and Public Health Laboratory, Cambridge University Hospitals Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Gonul Sengoz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Filiz Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ergys Ramosaco
- University Hospital Center "Mother Teresa", Infectious Diseases Hospital, Tirana, Albania
| | - Serda Gulsun
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Birgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Dilek Yildiz Sevgi
- Department of Infectious Diseases and Clinical Microbiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Efthymia Giannitsioti
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - Archontoula Fragou
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Birsen Cetin
- Department of Infectious Diseases and Clinical Microbiology, Koc University School of Medicine, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Aygul DoganCelik
- Department of Infectious Diseases and Clinical Microbiology, Trakya University School of Medicine, Edirne, Turkey
| | - Banu Karaca
- Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Elif Sahin Horasan
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Ulug
- Department of Infectious Diseases and Clinical Microbiology, Private Umit Hospital, Eskisehir, Turkey
| | - Asuman Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Safak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Esra Arslanalp
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Selma Ates-Guler
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Sutcu Imam University, Kahramanmaras, Turkey
| | - Ayse Willke
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sebnem Senol
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Celal Bayar University, Manisa, Turkey
| | - Dilara Inan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ertugrul Guclu
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Gunay Tuncer-Ertem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meliha Meric-Koc
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - Seniha Senbayrak
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Gonul Cicek-Senturk
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training & Research Hospital, Ankara, Turkey
| | - Fatma Sırmatel
- Department of Infectious Diseases and Clinical Microbiology, Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Gulfem Ocal
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Sesin Kocagoz
- Department of Infectious Diseases and Clinical Microbiology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Hulya Kusoglu
- Department of Infectious Diseases and Clinical Microbiology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Tumer Guven
- Department of Infectious Diseases and Clinical Microbiology, Ankara Atatürk Training & Research Hospital, Ankara, Turkey
| | - Ali Irfan Baran
- Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey
| | - Behiye Dede
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Yilmaz-Karadag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hava Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Gonul Aslan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training & Research Hospital, Ankara, Turkey
| | - D Ashraf ALGallad
- Infection Control Unit, Zagazig University Hospitals, Az Zagazig, Egypt
| | - Salih Cesur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Rehab El-Sokkary
- Infection Control Unit, Zagazig University Hospitals, Az Zagazig, Egypt
| | - Nural Bekiroğlu
- Department of Biostatistics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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9
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Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S, Tekin R, Mete B, Balkan II, Sevgi DY, Giannitsioti E, Fragou A, Kaya S, Cetin B, Oktenoglu T, Celik AD, Karaca B, Horasan ES, Ulug M, Senbayrak S, Kaya S, Arslanalp E, Hasbun R, Ates-Guler S, Willke A, Senol S, Inan D, Güclü E, Ertem GT, Koc MM, Tasbakan M, Ocal G, Kocagoz S, Kusoglu H, Güven T, Baran AI, Dede B, Karadag FY, Yilmaz H, Aslan G, Al-Gallad DA, Cesur S, El-Sokkary R, Sirmatel F, Savasci U, Karaahmetoglu G, Vahaboglu H. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clin Microbiol Infect 2015; 21:1008.e9-1008.e18. [PMID: 26232534 DOI: 10.1016/j.cmi.2015.07.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 01/09/2023]
Abstract
We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.
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Affiliation(s)
- A Batirel
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - H Erdem
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - G Sengoz
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Pehlivanoglu
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Ramosaco
- Infectious Diseases Hospital, University Hospital Center "Mother Teresa", Tirana, Albania
| | - S Gülsün
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - R Tekin
- Dicle University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - B Mete
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - I I Balkan
- Istanbul University Cerrahpasa School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - D Y Sevgi
- Sisli Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - E Giannitsioti
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - A Fragou
- Department of Internal Medicine, Athens University Medical School, Attikon University General Hospital, Athens, Greece
| | - S Kaya
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - B Cetin
- Koc University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Oktenoglu
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - A D Celik
- Trakya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Edirne, Turkey
| | - B Karaca
- Izmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - E S Horasan
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
| | - M Ulug
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - S Senbayrak
- Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - S Kaya
- Diyarbakir Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
| | - E Arslanalp
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - R Hasbun
- The University of Texas Health Science Center at Houston, Medical School, Department of Infectious Diseases, Turkey
| | - S Ates-Guler
- Sutcu Imam University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kahramanmaras, Turkey
| | - A Willke
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - S Senol
- Celal Bayar University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Manisa, Turkey
| | - D Inan
- Akdeniz University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - E Güclü
- Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
| | - G T Ertem
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - M M Koc
- Kocaeli University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Kocaeli, Turkey
| | - M Tasbakan
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - G Ocal
- Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - S Kocagoz
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Kusoglu
- Acibadem University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - T Güven
- Ankara Atatürk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A I Baran
- Yuzuncuyil University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Van, Turkey
| | - B Dede
- Umraniye Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - F Y Karadag
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Yilmaz
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - G Aslan
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | | | - S Cesur
- Ankara Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - R El-Sokkary
- Medical Microbiology and Immunology, Infection Control Unit, Zagazig University, Zagazig, Egypt
| | - F Sirmatel
- Izzet Baysal University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - U Savasci
- Gulhane Medical Academy, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - G Karaahmetoglu
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Vahaboglu
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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10
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Computed Tomography-Guided Biopsy for Potts Disease: An Institutional Experience from an Endemic Developing Country. Asian Spine J 2015; 9:394-8. [PMID: 26097654 PMCID: PMC4472587 DOI: 10.4184/asj.2015.9.3.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/09/2014] [Accepted: 11/25/2014] [Indexed: 11/18/2022] Open
Abstract
Study Design A retrospective chart review. Purpose In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available. Overview of Literature CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little. Methods This study was conducted at the Neurosurgery section of Aga Khan University Hospital Karachi. All the patients with suspected Potts disease who underwent CT-guided biopsy during the 7 year period from 2007 to 2013 were included in this study. Details of the procedure, histopathology and microbiology were recorded. Results One hundred and seventy-eight patients were treated for suspected Potts disease during the study period. CT-guided biopsies of the spinal lesions were performed in 91 patients (51.12%). Of the 91 procedures, 22 (24.2%) were inconclusive because of inadequate sample (10), normal tissue (6) or reactive tissue (6). Sixty-nine biopsies were positive (75.8%). Granulomatous inflammation was seen in 58 patients (84.05%), positive acid-fast bacillus (AFB) smear in 4 (5.7%) and positive AFB culture in 12 patients (17.3%). All 91 cases in which CT-guided biopsy was performed responded positively to antituberculosis therapy (ATT). Conclusions 75.8% of the specimens yielded positive diagnoses. Granulomatous inflammation on histopathology was the commonest diagnostic feature. In this series, the rates of positive AFB smear and culture were low compared to previous literature.
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11
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Senanayake MP, Karunaratne I. A child presenting with tuberculous spondylitis in a single third cervical vertebra: a case report. J Med Case Rep 2014; 8:284. [PMID: 25150548 PMCID: PMC4147878 DOI: 10.1186/1752-1947-8-284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite a global reduction in tuberculosis, extrapulmonary tuberculosis is increasing. Spinal tuberculosis remains the commonest form of skeletal tuberculosis. Cervical spine involvement is rare but is the most dangerous form because of diagnostic difficulties and serious residual disability. We report a child who had single vertebral involvement of her third cervical vertebra which is extremely rare. To the best of our knowledge isolated third cervical vertebra involvement in a child by tuberculosis has not been reported previously. Difficulties in obtaining material for histology and bacterial culture from this critical location and how the diagnosis was reached despite these challenges are highlighted. CASE PRESENTATION A 10-year-old Sinhalese girl developed painful torticollis and 'cries during sleep'. She had received Bacillus Calmette-Guérin vaccine at birth, was well nourished, and had no loss of weight, anorexia or contact with tuberculosis. A plain radiograph of her neck showed a collapsed third cervical vertebra with no disc involvement. Magnetic resonance imaging confirmed isolated destruction of third cervical vertebra associated with prevertebral soft tissue swelling indenting the thecal sac without cord compression. Her chest radiograph was normal. There was peripheral lymphocytosis, elevated erythrocyte sedimentation rate, negative tuberculin (Mantoux) test, and negative QuantiFERON®-TB GoldIn-Tube assay. Invasive procedures to obtain tissue for histology, smear or culture were perceived by parents as dangerous due to surrounding critical structures and consent was denied. The differential diagnosis included spinal tuberculosis and unifocal Langerhan cell histiocytosis. Nocturnal symptoms and the prevertebral collection of soft tissue ('cold abscess') were characteristic of tuberculosis, and nonspecific findings of elevated erythrocyte sedimentation rate and lymphocytosis supported this diagnosis. An incidental finding of a calcified hepatic nodule when evaluating for multifocal histiocytosis was presumed to be tuberculous because schistosomiasis and visceral leishmaniasis were extremely rare in her country of residence, Sri Lanka. Empirical treatment with a 12-month course of antitubercular therapy resulted in clinical recovery and radiological healing. There was no kyphosis or neurological sequel. CONCLUSIONS This report highlights to clinicians the value of a high index of suspicion and careful history taking in spinal tuberculosis; and how a combination of nonspecific findings helped reach a clinicoradiological diagnosis.
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Affiliation(s)
- Manouri P Senanayake
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka
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12
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Garkowski A, Zajkowska A, Czupryna P, Łebkowski W, Letmanowski M, Gołębicki P, Moniuszko A, Ustymowicz A, Pancewicz S, Zajkowska J. Infectious spondylodiscitis - a case series analysis. Adv Med Sci 2014; 59:57-60. [PMID: 24797976 DOI: 10.1016/j.advms.2014.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 08/02/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis. MATERIALS/METHODS We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy. RESULTS There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed. CONCLUSIONS Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.
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13
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Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol 2012; 81:940-6. [DOI: 10.1016/j.ejrad.2011.01.125] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 11/24/2022]
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14
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Abstract
Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.
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Affiliation(s)
- Ravindra Kumar Garg
- Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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15
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Su SH, Tsai WC, Lin CY, Lin WR, Chen TC, Lu PL, Huang PM, Tsai JR, Wang YL, Feng MC, Wang TP, Chen YH. Clinical features and outcomes of spinal tuberculosis in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:291-300. [PMID: 20688289 DOI: 10.1016/s1684-1182(10)60046-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/30/2009] [Accepted: 07/29/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE The early diagnosis and appropriate management of spinal tuberculosis (TB) is challenging for clinicians. This study aimed to characterize the clinical features and factors affecting treatment outcomes. METHODS A retrospective study of patients with spinal TB over a 7-year period at a medical center in southern Taiwan was conducted. Clinical features, underlying diseases, laboratory results, imaging findings, therapy, treatment duration and outcomes were analyzed. RESULTS Forty-eight patients (24 men and 24 women) were diagnosed with spinal TB. Their mean age was 64.3 years. The most common presenting symptoms were backache, neurological deficits, and fever. The most common vertebral area involved was lumbar spine (41.7%). The mean number of vertebra involved was 2.46. Surgery was carried out on 30 patients (62.5%). Patients who had a longer duration of symptoms prior to diagnosis were more likely to have surgery (p = 0.03), and patients who received surgery had a more favorable outcome (p = 0.063). The mean treatment course was 11.4 +/- 3.7 months. A long course treatment did not contribute to favorable outcomes. Twenty-six patients had a favorable outcome and 11 had an unfavorable outcome. Factors associated with an unfavorable outcome included older age, limb weakness, incontinence, spinal kyphotic deformity, and spinal cord compression. CONCLUSION For elderly patients with chronic back pain in Taiwan, the differential diagnosis of spinal TB should be considered. Image studies and computed tomography-guided aspiration are helpful for early detection. Combined surgical intervention tended to have a more favorable outcome and longer treatment periods had no additional benefit.
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Affiliation(s)
- Shou-Hsin Su
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
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16
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Abstract
STUDY DESIGN Early diagnosis of vertebral infection (hematogenous or postsurgical) is necessary to choose a correct therapy and to minimize dramatic complications. All patients suspected to have vertebral infection underwent radiologic imaging and In-Biotin scintigraphy. OBJECTIVE Biotin is a growth factor used by many bacteria. The aim of our study is to use In-Biotin to diagnose vertebral infections. SUMMARY OF BACKGROUND DATA Magnetic resonance imaging, even if endowed with fairly good sensitivity and specificity, shows some limitations in the study of the onset of pathology and in postsurgical conditions. Conventional scintigraphic imaging, like bone scintigraphy with Tc-MDP, Ga-citrate scintigraphy, or Positron Emission Tomography with [F]FDG, are limited by relatively low specificity; the use of Streptavidin/In-Biotin scintigraphy, based on aspecific uptake of tracer in the site of infection, shows good results in term of sensibility and specificity but the use of heterologous protein might engender immunogenic reactions. METHODS All patients (pts) (n = 110) of the study underwent In-biotin scintigraphy 2 hours after intravenous injection of the tracer, 71 pts were suspected to have hematogenous vertebral infection (Group I) and 39 pts were suspected to have postsurgical infection (Group II). The reference for final diagnosis was either bacterial cultures, histopathologic analysis, and/or clinical/imaging follow-up for at least 1 year. RESULTS In-biotin scintigraphy showed a sensitivity of 84% and specificity of 98% in Group I and a sensitivity of 100% and specificity of 84% in Group II. CONCLUSION Our results showed that In-Biotin scintigraphy possess high diagnostic accuracy. This technique is easy to perform and requires short imaging time-point after intravenous tracer injection. Moreover if In-Biotin uptake is due only to high proliferation rate of bacteria presents in site of infection, it will be further investigated to discriminate definitely bacterial from sterile inflammation.
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GRAMMATICO L, BARON S, RUSCH E, LEPAGE B, SURER N, DESENCLOS J, BESNIER J. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect 2007; 136:653-60. [PMID: 17568478 PMCID: PMC2870846 DOI: 10.1017/s0950268807008850] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vertebral osteomyelitis (VO) is a rare event. To estimate the incidence of VO in France for 2002-2003, national hospital-discharge data were used. Hospital stays were categorized as definite, probable or possible VO. Unique patient identification numbers allowed the investigators to link patients with multiple hospital stays and to analyse data for individual patients. A sample of medical records was reviewed to assess the specificity of the VO case definition. In 2002-2003, 1977 and 2036 hospital stays corresponding to 1422 and 1425 patients (median age 59 years, male:female ratio 1.5) were classified as definite (64%), probable (24%) and possible (12%) VO. The overall incidence of VO was 2.4/100,000. Incidence increased with age: 0.3/100,000 (70 years). The main infectious agents reported were Staphylococcus spp. (38%) and Mycobacterium tuberculosis (31%). The most frequent comorbidities were septicaemia (27%) and endocarditis (9%). Three percent of patients died. A review of 90 medical records confirmed the diagnosis of VO in 94% of cases. Using a hospital database and a specific case definition, nationwide surveillance of VO is possible.
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Affiliation(s)
- L. GRAMMATICO
- CHRU de Tours, Service d'Information Médicale et Economie de la Santé, Tours, France
| | - S. BARON
- CHRU de Tours, Service d'Information Médicale et Economie de la Santé, Tours, France
- Author for correspondence: Dr S. Baron, CHRU de Tours, 37044 Tours Cedex, France. ()
| | - E. RUSCH
- CHRU de Tours, Service d'Information Médicale et Economie de la Santé, Tours, France
- Université François Rabelais Tours, France
| | - B. LEPAGE
- CHU de Poitiers, Service d'Information Médicale, Poitiers, France
| | - N. SURER
- CHU de Nantes, Service d'Information Médicale et Economie de la Santé, Nantes, France
| | | | - J. M. BESNIER
- Université François Rabelais Tours, France
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
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18
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Abstract
This article reviews the pathophysiology of spinal infection and its relevance for imaging. Magnetic resonance imaging (MRI) is the modality with by far the best sensitivity and specificity for spinal infection. The imaging appearances of spinal infection in MRI are outlined, and imaging techniques are discussed. The problems of clinical diagnosis are outlined. There is some emphasis on the MRI differentiation of pyogenic and nonpyogenic infection and on the differential diagnosis of spinal infection centered on the imaging presentation.
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Affiliation(s)
- Bernhard J Tins
- Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom.
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Steinmetz HW, Rutz C, Hoop RK, Grest P, Bley CR, Hatt JM. Possible Human–Avian Transmission of Mycobacterium tuberculosis in a Green-Winged Macaw (Ara chloroptera). Avian Dis 2006; 50:641-5. [PMID: 17274308 DOI: 10.1637/7609-041906r.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This report describes a case of Mycobacterium tuberculosis infection in a green-winged macaw (Ara chloroptera), confirmed by microbiologic and pathologic diagnostics, and notes a possible human-avian transmission. Clinical signs included cutaneous swellings, profound leukocytosis, and signs of osteomyelitis in the long bones. Proliferation consisted of several nodules with small greenish-caseous foci in cross-section and revealed a severe granulomatous inflammation with intralesional acid-fast rods. Mycobacterium tuberculosis was isolated from subcutaneous nodules and biochemically confirmed. The disease in avian species is of zoonotic importance.
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Affiliation(s)
- Hanspeter W Steinmetz
- Division of Zoo Animals, Exotic Pets and Wildlife, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
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20
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Abstract
The global increase of spinal infections is concomitant with the rise of its risk factors, including HIV/AIDS, diabetes mellitus, intravenous drug use, advanced age, and gunshot wounds to the spine. Because spinal infections have a wide span of presentation, early detection and differentiation are notoriously challenging. Current advances in laboratory and imaging techniques, such as polymerase chain reaction, fluorodeoxyglucose positron emission tomography, and 99mTc-ciprofloxacin scintigraphy, allow for better diagnostic rendering of the infection and its degree of spinal involvement. Less invasive surgical procedures and preventive surgical management have helped reduce spinal infection morbidities such as deformity and neurologic deficit. Although proper antibiotic regimen and correct surgical management are of vital importance to successful patient outcome, early detection remains the most critical factor.
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Affiliation(s)
- Frank L Acosta
- University of California, San Francisco, 505 Parnassus Avenue, M779, Box 0112, San Francisco, CA 94143, USA.
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21
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Abstract
Vertebral osteomyelitis (VO) is an infectious disease of the vertebral body that requires early diagnosis with identification of the infecting organism to direct antibiotic therapy. Most VO can be treated nonsurgically, but 10% to 20% of cases require open surgical treatment. Excellent clinical outcomes can be achieved with appropriate medical and surgical treatment.
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Affiliation(s)
- Jorge J Jaramillo-de la Torre
- The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine, Mayfield Clinic and Spine Institute, 222 Piedmont Avenue, Suite 3100, Cincinnati, OH 45267-0515, USA
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