Frequency and characteristics of bacterial and viral low-grade infections of the intervertebral discs: a prospective, observational study.

STUDY DESIGN: Monocentric, prospective, observational study. OBJECTIVE: The clinical relevance of bacterial colonization of intervertebral discs is controversial. This study aimed to determine a possible relationship between bacterial and viral colonization and low-grade infection of the discs. METHODS: We investigated 447 disc samples from 392 patients. Microbiological culture was used to examine the samples for bacterial growth, polymerase chain reaction (PCR) was used for detection of herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and Cytomegalovirus (CMV), and histopathological analysis was used to detect signs of inflammation. The results were compared between subgroups organized according to gender, age, location of the samples, surgical approach, preoperative C-reactive protein (CRP), preoperative and 6 months postoperative Oswestry Disability Index (ODI) and Neck Disability Index (NDI), and Modic changes (MC) of the corresponding endplates. Also, we assessed the occurrence of postoperative infections within 6 months. RESULTS: Microbiological culture was positive in 38.78% of the analyzed intervertebral discs. Altogether, 180 bacteria were isolated. Coagulase-negative staphylococci (CONS) (23.41%) and Cutibacterium acnes (18.05%) were the most frequently detected microorganisms. None of HSV-1, HSV-2, or CMV were detected. Male patients (p = 0.00036) and cervical segments (p = 0.00001) showed higher rates of positive culture results. Ventral surgical approaches ( p < 0.001) and Type 2 MC (p = 0.0127) were significantly associated with a positive microbiological result ( p< 0.001). Neither pre- nor postoperative ODI and NDI are associated with positive culture results. In 4 (1.02%) patients, postoperative spondylodiscitis occurred. CONCLUSIONS: With 447 segments from 392 patients, we present one of the largest studies to date. While disc degeneration caused by HSV-1, HSV-2, and CMV seems unlikely, we found positive microbiological culture results in 38.78% of all discs. The role of local skin flora and sample contamination should be the focus of further investigations. LEVEL OF EVIDENCE: III. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (ID: NCT04712487, https://www. CLINICALTRIALS: gov/ct2/show/study/NCT04712487 ).

Identification of a new methicillin-resistant Staphylococcus aureus strain that cannot be assigned to any known spa type.

spa typing is a method used in molecular typing of methicillin-resistant Staphylococcus aureus (MRSA). Due to the lack of an amplification product in one of 55 MRSA cases, a new PCR setup, which allows an indicative description of a previously unknown type, was performed.

Fatal Epstein-Barr virus encephalitis in a 12-year-old child: an underappreciated neurological complication?

BACKGROUND: A 12-year-old boy presented to a community hospital with fever, malaise and fatigue. A polymerase chain reaction test of the cerebrospinal fluid was positive for Epstein-Barr virus. Despite intensive care treatment and antiviral drugs, the patient died 1 month after his initial presentation. INVESTIGATIONS: Physical examination, polymerase chain reaction analysis of the cerebrospinal fluid, brain MRI, immunohistochemistry and molecular biological investigations of postmortem brain samples. DIAGNOSIS: Epstein-Barr Virus encephalitis. MANAGEMENT: Aciclovir, intensive care treatment with intubation, sedation, antiepileptic drugs.

Cervical biopsies and cytological smears - a comparison of sample materials in HPV diagnostics.

BACKGROUND: Cervical cancer is causally related to cervical infections by oncogenic human papillomavirus (HPV) genotypes. To improve the quality of diagnosis evaluation of screening methods and their HPV type detection rate is an important part for this item. OBJECTIVES: Two different cervical specimens of the same patients were analysed simultaneously with molecular HPV subtyping methods to find the most sensitive sample material for cervical cancer screening. STUDY DESIGN: Biopsy specimens and cytological smears of the cervix of 443 patients were analysed for human papilloma virus (HPV) subtyping by a macroarray from Chipron, Germany, which allows a differentiation of 16 high and 16 low risk types. Results were compared for reliability and differences were studied. RESULTS: Both sample material groups showed HPV conformity of 70%, 23% more subtypes could be detected in smears in contrary to biopsies but only 6% vice versa. 14 biopsies and 7 smears were HPV negative although the concerning second sample type of the patients was HPV positive. HPV 16 as one of the most relevant subtypes in cervical cancer pathogenesis was missed in the biopsies' group with 34.3% out of 35 HPV 16 positive smear cases, whereas only one smear failed to discover this subtype contrariwise. CONCLUSION: Comparison of the examination results shows that subtyping of smear samples is able to detect more subtypes than by biopsy specimens. The probability to underdiagnose HPV 16 and to get a false negative result in bioptic sample material favours smear as method of choice for HPV subtyping.