RESUMO
We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7% were males. The identifiable causes were infectious endocarditis 13 (43.3%); tuberculosis 7 (23.3%); urinary tract infection 4 (13.3%); bacteremia with focus 2 (6.7%) and without focus 2 (6.7%). The cause was not identified in other 2 cases (6.7%). Infections were due to pyogenic bacteriae in 19 (63.3%); tuberculosis 6 (20%) and unknown 5 (16.7%). All patients had localized pain, 70% fever, 36.7% irradiated pain and 23.3% paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4%. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3%; Mycobacterium tuberculosis 20%; Staphylococcus spp. 16.6%; Escherichia coli 6.6%; Pseudomonas aeruginosa 6.6%. There was no bacteriological recovery in 5 (16.7%). Localization was lumbar in 18 (60%), dorsal in 8 (26.6%) and cervical in 4 (13.3%). X-ray of the spine was positive in 63.3% of the cases. Technetium scan in 90.5%, CT in 85.7% and MRI in 100% of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10% surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.
Assuntos
Discite/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Discite/diagnóstico , Discite/etiologia , Discite/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Hypersensitivity pneumonitis (HP) is the clinical manifestation of an pulmonary immunological reaction to inhaled antigens. The list of provocative antigens and specific illnesses grows permanently. A woman of 56 years consulted for dyspnea and cough of two months of evolution. She worked in a factory of sausages removing the dust that recovers the salamis during their stationing. She presented hypoxemia and the pulmonary function test revealed a predominantly obstructive pattern. The x-ray of the thorax was normal and the high resolution computed tomography showed a mosaic pattern. A lung biopsy confirmed the diagnosis of HP. She improved with systemic corticosteroids and the avoidance of antigen exposure. In the cultures of the material that recovers the salamis, Penicillium spp. was recovered and was interpreted as the probable etiological agent of this HP, which we have denominated "the salami worker's lung".
Assuntos
Alveolite Alérgica Extrínseca/diagnóstico , Produtos da Carne , Doenças Profissionais/diagnóstico , Alveolite Alérgica Extrínseca/tratamento farmacológico , Alveolite Alérgica Extrínseca/microbiologia , Poeira , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Doenças Profissionais/tratamento farmacológico , Doenças Profissionais/microbiologia , Penicillium/isolamento & purificaçãoRESUMO
Hypersensitivity pneumonitis (HP) is the clinical manifestation of an pulmonary immunological reaction to inhaled antigens. The list of provocative antigens and specific illnesses grows permanently. A woman of 56 years consulted for dyspnea and cough of two months of evolution. She worked in a factory of sausages removing the dust that recovers the salamis during their stationing. She presented hypoxemia and the pulmonary function test revealed a predominantly obstructive pattern. The x-ray of the thorax was normal and the high resolution computed tomography showed a mosaic pattern. A lung biopsy confirmed the diagnosis of HP. She improved with systemic corticosteroids and the avoidance of antigen exposure. In the cultures of the material that recovers the salamis, Penicillium spp. was recovered and was interpreted as the probable etiological agent of this HP, which we have denominated [quot ]the salami workers lung[quot ].
RESUMO
We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7
were males. The identifiable causes were infectious endocarditis 13 (43.3
); tuberculosis 7 (23.3
); urinary tract infection 4 (13.3
); bacteremia with focus 2 (6.7
) and without focus 2 (6.7
). The cause was not identified in other 2 cases (6.7
). Infections were due to pyogenic bacteriae in 19 (63.3
); tuberculosis 6 (20
) and unknown 5 (16.7
). All patients had localized pain, 70
fever, 36.7
irradiated pain and 23.3
paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4
. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3
; Mycobacterium tuberculosis 20
; Staphylococcus spp. 16.6
; Escherichia coli 6.6
; Pseudomonas aeruginosa 6.6
. There was no bacteriological recovery in 5 (16.7
). Localization was lumbar in 18 (60
), dorsal in 8 (26.6
) and cervical in 4 (13.3
). X-ray of the spine was positive in 63.3
of the cases. Technetium scan in 90.5
, CT in 85.7
and MRI in 100
of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10
surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.
