Brucellosis and sacroiliitis: A differential diagnosis to keep in mind / Sacroiliitis por brucelosis: Un diagnóstico diferencial para tener presente

ABSTRACT Brucellosis is a zoonosis that causes a multi-organ granulomatous infection. It has diverse and non-specific clinic features that can make diagnosis difficult. Medical personnel often do not recognize it early. Delayed treatment is associated with high morbidity and even mortality. Its timely diagnosis requires a high index of suspicion. The case is presented of a 35-year-old male zootechnologist, previously healthy, with a progressive picture of two months of evolution of irradiated low back pain to the left hip, nocturnal diaphoresis, and unintentional weight loss. Elevation of acute phase reactants was documented and magnetic resonance imaging found signs of iliopsoas tendonitis and inflammatory changes in the left sacroiliac joint. The IgG and IgM antibodies using an immunoassay forbrucella were positive. After establishing antibiotic treatment, a marked clinical improvement, with resolution of the inflammatory process was evident.

RESUMEN La brucelosis es una zoonosis que genera una infección granulomatosa multiorgánica. Tiene una clínica diversa e inespecífica que puede hacer difícil el diagnóstico. Con frecuencia, el personal médico no la reconoce de forma temprana. El retraso en el tratamiento se asocia con una gran morbilidad e incluso mortalidad. Su diagnóstico oportuno requiere un alto índice de sospecha. Se presenta el caso de un hombre de 35 arios, zootecnista, previamente sano, con un cuadro progresivo de dos meses de evolución de dolor lumbar irradiado a cadera izquierda, diaforesis nocturna y pérdida no intencional de peso. Se documentó elevación de reactantes de fase aguda y en la resonancia magnética se encontraron signos de tendinitis del psoas y cambios inflamatorios en la articulación sacroilíaca izquierda. Los anticuerpos IgG e IgM por inmunoensayo para Brucella fueron positivos, y luego de instaurar tratamiento antibiótico se evidenció marcada mejoría clínica con resolución del proceso inflamatorio.

Infecciones piógenas de la columna vertebral / Pyogenic spinal infections

Las infecciones espinales son cuadros clínicos poco frecuentes, que exigen un alto índice de sospecha. La prevalencia de infecciones piógenas de la columna ha ido en aumento, en parte debido al envejecimiento de la población y a un mayor número de pacientes inmunocomprometidos. El estudio imagenológico se puede iniciar con radiografías simples, pero la resonancia magnética es el examen imagenológico de elección, ya que puede dar resultados positivos de forma precoz, entregando información más detallada del compromiso vertebral y tejidos blandos adyacentes. Aunque la clínica y los hallazgos imagenológicos nos pueden orientar, es importante intentar un diagnóstico microbiológico tomando cultivos y muestras para identificar al agente causal antes de iniciar los antibióticos; aunque es óptimo un tratamiento agente-específico, hasta un 25% de los casos queda sin diagnóstico del agente. El tratamiento es inicialmente médico, con antibióticos e inmovilización, pero se debe considerar la cirugía en casos de compromiso neurológico, deformidad progresiva, inestabilidad, sepsis no controlada o dolor intratable. El manejo quirúrgico actual consiste en el aseo y estabilización precoz de los segmentos vertebrales comprometidos. Descartar una endocarditis concomitante y el examen neurológico seriado son parte del manejo de estos pacientes.

Spinal infections are unusual conditions requiring a high index of suspicion for clinical diagnosis. There has been a global increase in the number of pyogenic spinal infections due to an aging population and a higher proportion of immunocompromised patients. The imaging study should start with plain radiographs, but magnetic resonance imaging (mri) is the gold standard for diagnosis. Mri can detect bone and disc changes earlier than other methods, and it provides detailed information on bone and adjacent soft tissues. Blood cultures and local samples for culture and pathology should be obtained, trying to identify the pathogen. According to the result, the most appropriate drug must be selected depending on susceptibility and penetration into spinal tissues. Treatment should start with antibiotics and immobilization; surgery should be considered in cases with neurological impairment, progressive deformity, spine instability, sepsis, or non-controlled pain. Current surgical treatment includes debridement and early stabilization. Practitioners should rule out endocarditis and perform a serial neurological examination managing these patients.

Canine breeds predisposed to develop diskospondylitis: a retrospective study of 181 cases (2009-2018) / Predisposição racial canina para o desenvolvimento de discoespondilite: estudo retrospectivo de 181 casos (2009-2018)

A study to determine the prevalence and predisposition of dog breeds to develop diskospondylitis (DS) was carried out on a population of 5,497 animals submitted to computed tomography or digital radiography of the spine between 2009 and 2018. Variables such as breed, gender, age, vertebral segment and total number of vertebrae affected were collected and submitted to the prevalence tests, chi-square and odds ratio. A total of 181 dogs presented DS, a prevalence of 3.4%. Of these, 65% were males with a probability 1.6x greater than females (CI 1.17-2.17). Dogs more than 10 years old have a 1.5x higher probability (CI 1.10-2.05), while those between 2-5 years the probability decreases 51% (CI 0.34-0.77). Large dogs (>30 kg; 45%) showed a 3.8x greater chance to develop DS (CI 2.56-5.33) than small dogs (<15 kg; 28%), although the small dogs showed a 34% lower probability (CI 0.24-0.47). The Labrador Retriever breed was 3.7x more likely to develop DS than all the other breeds studied (CI 2.56-5.33) and the French Bulldog, among the small breeds, was 2.8x more susceptible (CI 1.51-5.06). In conclusion older dogs, large dogs, especially Labrador Retrievers, are more likely to develop DS. The French bulldog should be studied further.

Para determinar a prevalência e predisposição racial da discoespondilite (DS) em cães realizou-se uma pesquisa numa população de 5497 animais submetidos a exame de tomografia computadorizada ou radiografia digital da coluna entre 2009 e 2018. Variáveis como raça, sexo, idade, segmento vertebral e total de vértebras acometidas foram coletadas e submetidas aos testes de prevalência, Qui-quadrado e odds ratio. Foram identificados 181 cães com DS, prevalência de 3,4%. Destes, 65% eram machos, probabilidade 1,6x maior que fêmeas (CI 1.17-2.17). Cães maiores que 10 anos tem probabilidade 1,5x maior (CI 1.10-2.05), enquanto em cães entre 2-5 anos a probabilidade diminui 51% (CI 0.34-0.77). Observou-se o predomínio de cães de grande porte (>30 kg; 45%), com 3,8x mais chances de DS (CI 2.56-5.33); seguido de 28% de cães de pequeno porte, ainda que demonstrada uma probabilidade 34% menor (CI 0.24-0.47). O labrador apresenta 3,7x mais chances que todas as raças estudadas (CI 2.56-5.33) e o buldogue francês, entre as raças de pequeno porte, 2,8x mais susceptibilidade (CI 1.51-5.06). Conclui-se que fatores como idade avançada, grande porte e, especialmente labradores, apresentam maior probabilidade a serem portadores de DS. O buldogue francês deve ser mais estudado quanto a sua discrepância em comparação a raças de mesmo porte.

Canine breeds predisposed to develop diskospondylitis: a retrospective study of 181 cases (2009-2018) / Predisposição racial canina para o desenvolvimento de discoespondilite: estudo retrospectivo de 181 casos (2009-2018)

A study to determine the prevalence and predisposition of dog breeds to develop diskospondylitis (DS) was carried out on a population of 5,497 animals submitted to computed tomography or digital radiography of the spine between 2009 and 2018. Variables such as breed, gender, age, vertebral segment and total number of vertebrae affected were collected and submitted to the prevalence tests, chi-square and odds ratio. A total of 181 dogs presented DS, a prevalence of 3.4%. Of these, 65% were males with a probability 1.6x greater than females (CI 1.17-2.17). Dogs more than 10 years old have a 1.5x higher probability (CI 1.10-2.05), while those between 2-5 years the probability decreases 51% (CI 0.34-0.77). Large dogs (>30 kg; 45%) showed a 3.8x greater chance to develop DS (CI 2.56-5.33) than small dogs (<15 kg; 28%), although the small dogs showed a 34% lower probability (CI 0.24-0.47). The Labrador Retriever breed was 3.7x more likely to develop DS than all the other breeds studied (CI 2.56-5.33) and the French Bulldog, among the small breeds, was 2.8x more susceptible (CI 1.51-5.06). In conclusion older dogs, large dogs, especially Labrador Retrievers, are more likely to develop DS. The French bulldog should be studied further.(AU)

Para determinar a prevalência e predisposição racial da discoespondilite (DS) em cães realizou-se uma pesquisa numa população de 5497 animais submetidos a exame de tomografia computadorizada ou radiografia digital da coluna entre 2009 e 2018. Variáveis como raça, sexo, idade, segmento vertebral e total de vértebras acometidas foram coletadas e submetidas aos testes de prevalência, Qui-quadrado e odds ratio. Foram identificados 181 cães com DS, prevalência de 3,4%. Destes, 65% eram machos, probabilidade 1,6x maior que fêmeas (CI 1.17-2.17). Cães maiores que 10 anos tem probabilidade 1,5x maior (CI 1.10-2.05), enquanto em cães entre 2-5 anos a probabilidade diminui 51% (CI 0.34-0.77). Observou-se o predomínio de cães de grande porte (>30 kg; 45%), com 3,8x mais chances de DS (CI 2.56-5.33); seguido de 28% de cães de pequeno porte, ainda que demonstrada uma probabilidade 34% menor (CI 0.24-0.47). O labrador apresenta 3,7x mais chances que todas as raças estudadas (CI 2.56-5.33) e o buldogue francês, entre as raças de pequeno porte, 2,8x mais susceptibilidade (CI 1.51-5.06). Conclui-se que fatores como idade avançada, grande porte e, especialmente labradores, apresentam maior probabilidade a serem portadores de DS. O buldogue francês deve ser mais estudado quanto a sua discrepância em comparação a raças de mesmo porte.(AU)

Cervical brucellar spondylitis causing incomplete limb paralysis.

Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

Cervical brucellar spondylitis causing incomplete limb paralysis

Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

Percutaneous endoscopic debridement and irrigation for thoracic infections.

OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS.: Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS.: Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS.: Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.

Resonancia magnética: su papel actual en las espondiloartritis / Magnetic resonance: its current role in spondyloarthritis

La Resonancia Magnética (RM) se ha convertido en una herramienta diagnóstica fundamental en la EsP axial, ya que se considera la mejor técnica para la detección de lesiones agudas a nivel del esqueleto axial. Su utilización ha sido la mayor contribución, en los últimos años, en la comprensión del curso de esta enfermedad. Esto ha conducido a que, en los nuevos criterios de la Assessment of SpondyloArthritis International Society (ASAS) para la clasificación de EsP de predominio axial, constituya uno de los brazos de ingreso a los criterios (brazo de imágenes). Además, la cuantificación de inflamación en RM, se ha convertido en uno de los parámetros de desenlace en los ensayos clínicos

Magnetic Resonance Imaging (MRI) has become a fundamental diagnostic tool in the axial SpA, since it is considered the best technique for the detection of acute lesions at the axial skeletal level. Its use has been the major contribution, in the last years, in the understanding of the course of this disease. This has led, in the new criteria of the Assessment of SpondyloArthritis International Society (ASAS) for the classification of axial SpA, to constitute one of the entry arms to the criteria. In addition, the quantification of inflammation in MRI has become one of the outcome parameters in clinical trials

Percutaneous endoscopic debridement and irrigation for thoracic infections

SUMMARY OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.

RESUMO OBJETIVOS: Investigar a eficácia e segurança de desbridamento endoscópico percutâneo e irrigação torácica para infecções e fazer uma escolha adequada de acordo com a condição do paciente. MÉTODOS: Trinta pacientes com infecção torácica que receberam tratamento cirúrgico de agosto de 2014 a dezembro de 2016 foram analisadosretrospectivamente. Havia 16 homens e 14 mulheres, de 41 a 90 anos, com uma média de 64,4 anos. Nove casos foram tratados com desbridamento endoscópico percutâneo e irrigação (grupo mínimo) e 21 casos foram tratados com desbridamento aberto em combinação com fixação do parafuso pedicular(grupo convencional). Os pacientes foram submetidos a acompanhamento durante um mês. Estado geral, índice operacional, resultados de laboratório e imagem e funcionalidades foram gravados. RESULTADOS: Em comparação com o grupo convencional, há mais comorbidades em pacientes do grupo mínimo (8 casos no grupo mínimo, 10 casos no grupo convencional, P = 0,049), menos tempo no hospital (10,1 + 2,26 dias no grupo mínimo, 16,1 + 6,81 dias no grupo convencional, P = 0,016), menos volume de sangramento (383,3 + 229,86 ml no grupo mínimo, 90 + 11,18 ml no grupo convencional, P = 0,000), menor pontuação no VAS a quitação (2,9 + 0,93 no grupo mínimo, 3,9 + 0,91 no grupo convencional, P = 0,013). Não houve nenhum caso de instabilidade espinhal no grupo mínimo, e 10 casos no grupo convencional, P = 0,013. Houve diferenças significativas. O nível de proteína C-reativa antes da operação no grupo mínimo era de 28,4±7,50mg/L. Em comparação com 45,1 + 15,78 mg/L no grupo convencional, P = 0,005, era mais baixa. CONCLUSÃO: O método de desbridamento endoscópico percutâneo e irrigação é eficaz para o tratamento de infecções em cirurgia torácica, especialmente adequado para pacientes com comorbidades e mau estado geral. Mas, para a infecção grave e instabilidade vertebral, tendemos a escolher a cirurgia aberta em combinação com a fixação.

Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica / Compressive Myelopathy caused by Mycobacterium Tuberculosis in an indigenous background child: A clinical case located within the Amazonian endemic zone / Mielopatia compressiva por Mycobacterium tuberculosis em uma menina indígena: um caso clínico da área amazônica endêmica

Introducción. La mielopatía compresiva es ocasionada por diversidad de condiciones. Los abscesos espinales se cuentan como una de sus causas de menor incidencia, con 0.2 a 2 casos por cada 10,000 ingresos hospitalarios, según estadísticas reportadas por el Hospital General de Massachusetts. El Mycobacterium tuberculosis es el segundo patógeno más frecuentemente implicado, con 25% de los casos. Objetivo.Presentar un caso de tuberculosis espinal en edad pediátrica, que es infrecuente pero de relevancia epidemiológica. Presentación del caso. Paciente femenina de siete años de edad, procedente de área endémica amazónica, con sintomatología de compresión de médula espinal. Su historia clínica, nexos epidemiológicos y hallazgos paraclínicos y quirúrgicos llevaron al diagnóstico de tuberculosis espinal. Recibió manejo descompresivo y terapia farmacológica con tetraconjugado, con evolución favorable al momento de su egreso. Conclusiones.La tuberculosis espinal, entidad infecciosa de baja frecuencia, requiere un alto índice de sospecha y un tratamiento oportuno. Las imágenes de resonancia magnética espinal orientan el diagnóstico, confirmándose mediante el aislamiento microbiológico del bacilo. Países como Colombia, con alta endemicidad para el Mycobacterium tuberculosis y con gran proporción de su población en riesgo, deben vigilar de manera constante la tuberculosis y tener presente esta entidad dentro de los diagnósticos diferenciales a descartar. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Introduction. Compressive Myelophaty is caused by multiple factors. Spinal abscesses are one of the causes with lowest occurrence rates. According to statistics provided by Massachusetts' General Hospital, these abscesses represent from 0.2 to 2 cases in 10,000 hospital admissions. Mycobacterium tuberculosis is the second pathogen associated with this disease, as it was found in 25% of related cases. Objective. To present a spinal tuberculosis case at a pediatric age, which is an infrequent medical situation but that has epidemiologic relevance. Case Presentation. A 7 year old female patient coming from the Amazonian endemic zone with symptoms of spinal cord compression. Her medical history, epidemiological links and paraclinical and surgical findings lead to a spinal tuberculosis diagnosis. She received decompression procedures and first-line anti-tuberculous drug treatment (RIPE). At the moment of hospital discharging, the patient showed positive response and evolution to these treatments. Conclusions. Spinal tuberculosis is a low-frequency infectious entity, that requires high level of suspicion and prompt treatment. Magnetic resonance imaging (MRI) of the spine guides towards the final diagnosis, that it is confirmed by microbiological isolation of the bacillus. Countries like Colombia, that is a high-endemic zone for Mycobacterium tuberculosis and that has a high percentage of population at risk, must keep a detailed surveillance of tuberculosis and must keep in mind this disease when constructing and ruling out differential diagnoses. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Compressive Myelopathy caused by Mycobacterium Tuberculosis in an indigenous background child: A clinical case located within the Amazonian endemic zone. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Introdução. A mielopatia compressiva é causada por uma variedade de condições. Abcessos na medula espinhal são contados como uma das causas de menor incidência, com 0.2 a 2 casos em cada 10,000 admissões hospitalares, segundo estatísticas relatadas pelo Hospital Geral de Massachusetts. O Mycobacterium tuberculosis é o segundo patógeno mais frequentemente envolvido, em 25% dos casos. Objetivo. Apresentar um caso de tuberculose espinhal em idade pediátrica que é infrequente, mas de relevância epidemiológica. Apresentação de caso. Uma paciente de sete anos de idade, da área endêmica da Amazônia, com sintomatologia de compressão medular. Sua história clínica, ligações epidemiológicas e achados paraclínicos e cirúrgicos levaram ao diagnóstico de tuberculose espinhal. A paciente recebeu tratamento descompressivo e terapia medicamentosa com tetra conjugado e teve evolução favorável no momento da alta. Conclusões.A tuberculose espinhal, infecção de baixa frequência, requer um alto índice de suspeita e tratamento oportuno. As imagens da ressonância magnética espinhal orientam o diagnóstico, confirmado por meio do isolamento microbiológico do bacilo. Países como Colômbia, com alta endemicidade para o Mycobacterium tuberculosis e com uma grande proporção de população em risco, devem monitorar constantemente a tuberculose e manter essa entidade em mente nos diagnósticos diferenciais a serem descartados. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Mielopatia compressiva por Mycobacterium tuberculosis em uma menina indígena: um caso clínico da área amazônica endêmica. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Doença do corpúsculo de inclusão e espondilite por Salmonella sp. em uma Boa constrictor constrictor / Inclusion body disease and spondilitis by Salmonella sp. in a Boa constrictor constrictor

Doença do corpúsculo de inclusão (IBD) é uma enfermidade caracterizada por corpúsculos intracitoplasmáticos em diversos tecidos, principalmente no sistema nervoso central, responsável pelos principais sinais clínicos atribuídos à doença que acomete Boas e Phytons de cativeiro; essa enfermidade tem sido uma preocupação mundial devido à alta morbidade e mortalidade. O diagnóstico é feito pela visualização dos corpúsculos causados por um Arenavírus modificado. Salmonella sp. pertence à microflora de animais de sangue frio e quente, e é um patógeno oportunista que pode causar quadros gastrointestinais ou septicêmicos. Em répteis a Salmonella sp. é a bactéria com maior frequência de citações em espondilites e osteomielites. Relata-se um caso de uma jiboia (Boa constrictor constrictor) que apresentava restrição de movimento e múltiplos granulomas dorsais nas vértebras; à radiografia evidenciaram-se regiões fraturadas. Após meses de tratamentos sem melhora clínica e o aparecimento de novas lesões o animal ficou prostrado, anoréxico, caquético e desenvolveu opistótono; optou-se pela eutanásia. À necropsia verificaram-se, nas vértebras, múltiplos focos dorsais com aumento de volume que variava de 1,7cm à 3,8cm. Ao corte as vértebras eram deformadas e exibiam conteúdo caseoso focal próximo ao canal medular, este foi coletado para microbiologia onde se identificou Salmonella sp. À microscopia as vértebras tinham um infiltrado inflamatório multifocal moderado de macrófagos e heterofilos. Algumas áreas possuíam grande quantidade de granulomas com calcificação central e inúmeras células gigantes; outros mostravam áreas de osteomalácia e fibrose. Em raros focos havia fratura do corpo vertebral e compressão da medula espinhal com leve infiltrado inflamatório invadindo o canal medular. No pulmão, principalmente no epitélio brônquico, por vezes até dentro de linfócitos do tecido linfoide bronco-associado, no intestino, fígado, vesícula biliar, nos rins e no encéfalo foram encontradas diversas estruturas eosinofílicas intracitoplasmáticas arredondadas que variavam de 1 a 10 µm. Essas estruturas acompanhavam ou não inflamações mononucleares. Os achados são compatíveis com IBD e espondilite por salmonelose. A IBD é uma enfermidade frequente em serpentes de cativeiro, de importância mundial, que provavelmente é subdiagnosticada no Brasil. Essa doença causa imunossupressão que favorece ao desenvolvimento de outras enfermidades, e é tipicamente associada a outras doenças como a espondilite encontrada no caso.(AU)

Inclusion Body Disease (IBD) is a disorder characterized by intracytoplasmic corpuscles in different tissues, mainly in the CNS, wich is responsible for the major neurological signs attributable to this disease. It affects Boas and Phytons in captivity and have been a global concern due to the high morbidity and mortality. The diagnosis is made by visualization of corpuscles caused by a modified Arenaviruses. Salmonella sp. belongs to microflora of cold and warm-blooded animals; it is an opportunistic pathogen that can causes gastrointestinal or septic disorders. In reptiles, Salmonella sp. is the bacteria most frequently quotes in spondylitis and osteomyelitis. This article describes a boa constrictor (Boa constrictor constrictor) that had restriction of movement and multiple granulomas in the dorsal vertebrae, the shadowgraph showed up fractured regions. After months of treatment without clinical improvement and the emergence of new injuries, the animal started to get prostrate, anorexic, cachectic and developed opisthotonos. It was opted for euthanasia. At necropsy it was found in multiple spots swelling of the dorsal vertebrae that ranging from mild to moderate. At the cutting vertebrae it was visible deformed and showed focal caseous content near the spinal cord, this was collected for microbiology where it was identified Salmonella sp. At microscopic evaluation the vertebrae had one to multifocal moderate inflammatory infiltrate of macrophages and heterophils. Some areas had lots of granulomas with central calcification and numerous giant cells. Other vertebras showed areas of osteomalácea and fibrosis. Rare focus had vertebral body fracture and spinal cord compression with mild infiltration entering the spinal cord canal. In the lung, especially in the bronchial epithelium, sometimes even within lymphocytes in bronchial-associated lymphoid tissue, in the intestine, liver, gall bladder, kidney and brain were found various structures of eosinophilic intracytoplasmic rounded ranging between 1 and 10 micrometers. These structures accompanied or not mononuclear inflammation. These findings are consistent with IBD and spondylitis due to salmonellosis. The IBD is a common disease in captive snakes, of world importance, is probably underdiagnosed in Brazil. This disease causes immunosuppression favoring the development of other affections, and is typically associated with other diseases such as spondylitis found in the case.(AU)

Doença do corpúsculo de inclusão e espondilite por Salmonella sp. em uma Boa constrictor constrictor / Inclusion body disease and spondilitis by Salmonella sp. in a Boa constrictor constrictor

Doença do corpúsculo de inclusão (IBD) é uma enfermidade caracterizada por corpúsculos intracitoplasmáticos em diversos tecidos, principalmente no sistema nervoso central, responsável pelos principais sinais clínicos atribuídos à doença que acomete Boas e Phytons de cativeiro; essa enfermidade tem sido uma preocupação mundial devido à alta morbidade e mortalidade. O diagnóstico é feito pela visualização dos corpúsculos causados por um Arenavírus modificado. Salmonella sp. pertence à microflora de animais de sangue frio e quente, e é um patógeno oportunista que pode causar quadros gastrointestinais ou septicêmicos. Em répteis a Salmonella sp. é a bactéria com maior frequência de citações em espondilites e osteomielites. Relata-se um caso de uma jiboia (Boa constrictor constrictor) que apresentava restrição de movimento e múltiplos granulomas dorsais nas vértebras; à radiografia evidenciaram-se regiões fraturadas. Após meses de tratamentos sem melhora clínica e o aparecimento de novas lesões o animal ficou prostrado, anoréxico, caquético e desenvolveu opistótono; optou-se pela eutanásia. À necropsia verificaram-se, nas vértebras, múltiplos focos dorsais com aumento de volume que variava de 1,7cm à 3,8cm. Ao corte as vértebras eram deformadas e exibiam conteúdo caseoso focal próximo ao canal medular, este foi coletado para microbiologia onde se identificou Salmonella sp. À microscopia as vértebras tinham um infiltrado inflamatório multifocal moderado de macrófagos e heterofilos. Algumas áreas possuíam grande quantidade de granulomas com calcificação central e inúmeras células gigantes; outros mostravam áreas de osteomalácia e fibrose. Em raros focos havia fratura do corpo vertebral e compressão da medula espinhal com leve infiltrado inflamatório invadindo o canal medular. No pulmão, principalmente no epitélio brônquico, por vezes até dentro de linfócitos do tecido linfoide bronco-associado, no intestino, fígado, vesícula biliar, nos rins e no encéfalo foram encontradas diversas estruturas eosinofílicas intracitoplasmáticas arredondadas que variavam de 1 a 10 µm. Essas estruturas acompanhavam ou não inflamações mononucleares. Os achados são compatíveis com IBD e espondilite por salmonelose. A IBD é uma enfermidade frequente em serpentes de cativeiro, de importância mundial, que provavelmente é subdiagnosticada no Brasil. Essa doença causa imunossupressão que favorece ao desenvolvimento de outras enfermidades, e é tipicamente associada a outras doenças como a espondilite encontrada no caso.(AU)

Inclusion Body Disease (IBD) is a disorder characterized by intracytoplasmic corpuscles in different tissues, mainly in the CNS, wich is responsible for the major neurological signs attributable to this disease. It affects Boas and Phytons in captivity and have been a global concern due to the high morbidity and mortality. The diagnosis is made by visualization of corpuscles caused by a modified Arenaviruses. Salmonella sp. belongs to microflora of cold and warm-blooded animals; it is an opportunistic pathogen that can causes gastrointestinal or septic disorders. In reptiles, Salmonella sp. is the bacteria most frequently quotes in spondylitis and osteomyelitis. This article describes a boa constrictor (Boa constrictor constrictor) that had restriction of movement and multiple granulomas in the dorsal vertebrae, the shadowgraph showed up fractured regions. After months of treatment without clinical improvement and the emergence of new injuries, the animal started to get prostrate, anorexic, cachectic and developed opisthotonos. It was opted for euthanasia. At necropsy it was found in multiple spots swelling of the dorsal vertebrae that ranging from mild to moderate. At the cutting vertebrae it was visible deformed and showed focal caseous content near the spinal cord, this was collected for microbiology where it was identified Salmonella sp. At microscopic evaluation the vertebrae had one to multifocal moderate inflammatory infiltrate of macrophages and heterophils. Some areas had lots of granulomas with central calcification and numerous giant cells. Other vertebras showed areas of osteomalácea and fibrosis. Rare focus had vertebral body fracture and spinal cord compression with mild infiltration entering the spinal cord canal. In the lung, especially in the bronchial epithelium, sometimes even within lymphocytes in bronchial-associated lymphoid tissue, in the intestine, liver, gall bladder, kidney and brain were found various structures of eosinophilic intracytoplasmic rounded ranging between 1 and 10 micrometers. These structures accompanied or not mononuclear inflammation. These findings are consistent with IBD and spondylitis due to salmonellosis. The IBD is a common disease in captive snakes, of world importance, is probably underdiagnosed in Brazil. This disease causes immunosuppression favoring the development of other affections, and is typically associated with other diseases such as spondylitis found in the case.(AU)

High cervical spine spondylodiscitis management and literature review.

Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

High cervical spine spondylodiscitis management and literature review / Espondilodiscite da coluna cervical alta: manejo e revisão da literatura

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.

Actualidades en infecciones vertebrales / Actualités sur les infections vertébrales / News on Vertebral Infections

Introducción: las infecciones vertebrales constituyen una afección de baja incidencia, pero con incremento importante en años recientes, el cual está en relación con una población más susceptible por diversas razones. A pesar de nuevos métodos para el diagnóstico, la demora constituye un importante problema. Propósito: revisar y discutir algunos temas actuales acerca de las infecciones vertebrales, la epidemiologia, etiología, fisiopatología, diagnóstico y tipos de tratamientos. Método: se seleccionó la literatura apropiada usando las bases de datos Pubmed, Hinari y Clinical Key. Resultados: la literatura muestra la importancia del correcto y rápido diagnóstico; determinar el agente causal es de primordial importancia para aplicar una adecuada terapia antimicrobiana. El tratamiento conservador produce, generalmente, buenos resultados y el quirúrgico está indicado en déficit o sepsis neurológicos, inestabilidad espinal y/o deformidad y fallo del tratamiento conservador. Se muestra algoritmo para diagnóstico y tratamiento. Conclusiones: aplicar una metodología correcta para el diagnóstico y tratamiento de las infecciones vertebrales, logra resultados satisfactorios(AU)

Introduction: vertebral infections are a disease of low incidence, but with significant increase in recent years. This increase is related to a more susceptible population due to various reasons. Despite the new methods for diagnosis, its delay is a major problem. Objective: review and discuss some current issues about the spine infections, epidemiology, etiology, pathophysiology, diagnosis and types of treatment. Method: select the appropriate literature using PubMed database, Hinari and Clinical Key. Results: the literature shows the importance of correct and rapid diagnosis, which determine the causal agent, is primordial to implement appropriate antimicrobial therapy. Conservative treatment generally produces good results and surgery is indicated in neurological deficit or sepsis, spinal instability and / or deformity and failure of conservative treatment. Diagnostic and treatment algorithm is shown. Conclusions: applying correct methodology for the diagnosis and treatment of spinal infection, satisfactory results are achieved(AU)

Introduction: les infections vertébrales sont des affections à faible incidence, mais d'un récent accroissement important. Cette augmentation est associée à une population plus sensible pour des raisons diverses. Malgré les nouvelles méthodes diagnostiques, le retard constitue un problème important. Objectif: le but de cette étude est d'examiner et discuter des questions actuelles sur les infections vertébrales, leur épidémiologie, leur étiologie, leur physiopathologie, leur diagnostic, et les types de traitement. Méthode: on a sélectionné une littérature appropriée au moyen des bases de données de PubMed, Hinari et Clinical Key. Résultats: la littérature montre l'importance d'un diagnostic correct et précoce; la définition de l'agent causal est d'une importance essentielle pour appliquer une adéquate thérapie antimicrobienne. En général, le traitement conservateur a de bons résultats, mais le traitement chirurgical est indiqué en cas de déficit ou sepsis neurologiques, d'instabilité et/ou déformation rachidienne, et d'échec du traitement conservateur. Un algorithme est présenté pour le diagnostic et le traitement. Conclusions: l'application d'une correcte méthodologie pour le diagnostic et le traitement des infections vertébrales assure des résultats satisfaisants(AU)

Tuberculosis vertebral o mal de Pott en una paciente adulta / Spinal tuberculosis or Pott´s disease in an adult patient

Se describe el caso de una paciente de 47 años de edad, atendida en la Consulta de Medicina Interna del Policlínico "Esteban Caballero", perteneciente al área de salud Matías del municipio de Tercer Frente de Santiago de Cuba, quien presentó dolores de moderada intensidad en la región dorsolumbar, que no se aliviaban con analgésicos. Los estudios ecográfico y radiográfico de la columna vertebral confirmaron el diagnóstico de mal de Pott. Se indicó tratamiento específico y la afectada evolucionó satisfactoriamente.

The case of a 47 years patient assisted in the Internal Medicine Service of "Esteban Caballero" Polyclinic is described, belonging to Matías health area of Tercer Frente municipality in Santiago de Cuba who presented pains of moderate intensity in the dorsolumbar region that were not relieved with analgesics. The echographic and radiographic studies of the spine confirmed the diagnosis of Pott´s disease. Specific treatment was indicated and the patient had a satisfactory clinical course.

[Clinical problems in medical mycology: Problem number 48]. / Problemas clínicos en micología médica: problema número 48.

We present the case of a 42-year-old man, HIV-positive, with low CD4(+) T cell count (31 cells/µl), who was admitted to Hospital de Infecciosas F. J. Muñiz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200mg. With the latter the patient showed a rapid, complete clinical response.