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Fletcher AM, Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn) 2024; 30:133-159. [PMID: 38330476 DOI: 10.1212/con.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Infectious myelopathy of any stage and etiology carries the potential for significant morbidity and mortality. This article details the clinical presentation, risk factors, and key diagnostic components of infectious myelopathies with the goal of improving the recognition of these disorders and guiding subsequent management. LATEST DEVELOPMENTS Despite our era of advanced multimodal imaging and laboratory diagnostic technology, a causative organism often remains unidentified in suspected infectious and parainfectious myelopathy cases. To improve diagnostic capability, newer technologies such as metagenomics are being harnessed to develop diagnostic assays with a greater breadth of data from each specimen and improvements in infection identification. Conventional assays have been optimized for improved sensitivity and specificity. ESSENTIAL POINTS Prompt recognition and treatment of infectious myelopathy decreases morbidity and mortality. The key diagnostic tools include serologies, CSF analysis, and imaging; however clinical presentation, epidemiologic risk factors, and history of recent illness are all vital to making the proper diagnosis because current laboratory and imaging modalities are often inconclusive. The cornerstone of recommended treatment is targeted antimicrobials with appropriate immune modulation, surgical intervention, supportive care, and interdisciplinary involvement, all of which further improve outcomes for patients with infectious myelopathy.
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Wen GJ, Chen J, Zhang SF, Zhou ZS, Jiao GL. Multiple sparganosis spinal infections mainly in the thoracic region: A case report. World J Clin Cases 2023; 11:8507-8511. [PMID: 38188209 PMCID: PMC10768500 DOI: 10.12998/wjcc.v11.i36.8507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Spinal infection with sparganosis is rarely seen, and multiple spinal infections with sparganosis in the thoracic spine have not been reported. CASE SUMMARY In this case report, a 56-year old male patient suffered from back pain for 3 mo. Computed tomography examination of the thoracic spine showed bone destruction of the T4-5 vertebral body, as well as the right pedicle and lamina of T5. Magnetic resonance imaging showed high signals on T2W1 images and fat-suppressed images in the right vertebral body of T4-5 and the right pedicle and lamina of T5, a high signal in the vertebral canal, and similar high signals in the paravertebral and subcutaneous regions of the whole spine. Puncture biopsy showed sparganosis. Following definite diagnosis, the patient was treated with debridement of T4-5 infected lesions under a microscope, bone grafting and internal fixation. Postoperatively, the patient's back pain symptoms were significantly relieved; the incision healed after one-stage treatment, and albendazole antiparasitic treatment was administered. CONCLUSION Puncture biopsy is the most reliable method to diagnose infection by sparganum. Removal of infected lesions under the microscope and albendazole for antiparasitic treatment are safe and effective.
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Affiliation(s)
- Gan-Jun Wen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Jinan University, Dongguan 523573, Guangdong Province, China
| | - Jian Chen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Jinan University, Dongguan 523573, Guangdong Province, China
| | - Shi-Fei Zhang
- Department of Orthopaedics, The Sixth Affiliated Hospital of Jinan University, Dongguan 523573, Guangdong Province, China
| | - Zhi-Sen Zhou
- Department of Orthopaedics, The Sixth Affiliated Hospital of Jinan University, Dongguan 523573, Guangdong Province, China
| | - Gen-Long Jiao
- Department of Orthopaedics, The Sixth Affiliated Hospital of Jinan University, Dongguan 523573, Guangdong Province, China
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Xiang H, Wang J, Tan D, Xiong Y, Huang P, Shen Y, Xu Y, Gong Z, Hu F, Xu C, Wu J, Liu W, Liu J, Wan H, Hong D, Xie H. The serum IgG antibody level as a biomarker for clinical outcome in patients with cerebral sparganosis after treatment. Front Immunol 2023; 14:1158635. [PMID: 37051247 PMCID: PMC10083495 DOI: 10.3389/fimmu.2023.1158635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionCerebral sparganosis is a rare parasitic infection of the brain tissue. The remission of MRI change and clinical symptom has been used to evaluate the therapeutic effect. However, there is no study to correlate the serum IgG antibody level of sparganum to the prognosis of disease after treatment. Methods87 patients with cerebral sparganosis were collected from three medical centers. Clinical symptoms and MRI changes were evaluated at 12 months after initial treatment, and serum IgG antibody level of sparganum was evaluated at 2, 6, and 12 months after treatment. The positive cut-off value was based on 2.1 times the optical density (OD) of negative control. The index value was defined as the sample OD divided by the cut-off value.ResultsAmong the 87 patients after treatment, 71 patients had good clinical outcomes, and 16 had poor clinical outcomes. The area under the curve (AUC) showed that the index value measured at 12 months after treatment had the best prediction effect, with a value of 2.014. In the good-outcome group, the index values were less than 2.014 in all 71 patients, and only 8 patients had mildly enhanced residual lesions on MRI. In the poor-outcome group, the index values were more than 2.014 in all 16 patients, and all patients still showed significantly enhanced lesions on MRI. Compared with poor-outcome patients, only 2 patients with good outcomes had disease recurrence after treatment.DiscussionThis study provided evidence that the serum IgG antibody level of sparganum was a promising biomarker to evaluate the prognosis of patients with cerebral sparganosis after treatment.
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Affiliation(s)
- Haijie Xiang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dandan Tan
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying Xiong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pengcheng Huang
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Xu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Zhihong Gong
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Fei Hu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Chunhua Xu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Wei Liu
- Department of Outpatient, The Nanchang City First Hospital, Nanchang, China
| | - Junpu Liu
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
| | - Hui Wan
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Daojun Hong, ; Huiqun Xie,
| | - Huiqun Xie
- Clinical Department, Jiangxi Provincial Institute of Parasitic Disease, Nanchang, China
- *Correspondence: Daojun Hong, ; Huiqun Xie,
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