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1.
Infectio ; 25(4): 300-302, oct.-dic. 2021.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286727

RESUMO

Resumen Caso reporte de una enfermedad infrecuente, aproximadamente 1% de las artritis sépticas son esternoclavicular, con poca respuesta a antibioterapia intravenosa, requiriendo manejo quirúrgico agresivo, el siguiente caso narra la excelente respuesta con el uso de perlas de sulfato de calcio impregnadas con antibióticos, existiendo en la literatura sólo casos reportes sobre su uso.


Abstract Case report of an infrequent disease, approximately 1% of septic arthritis are sternoclavicular, with little response to intravenous antibiotic therapy, requiring ag gressive surgical management, the following case narrates the excellent response with the use of calcium sulfate pearls impregnated with antibiotics, existing in the literature only cases reports on its use.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osteomielite , Sulfato de Cálcio , Artrite Infecciosa , Doença
2.
Georgian Med News ; (318): 93-98, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628386

RESUMO

The aim of the work was to study the effect of IL1Β (C3954T, rs1143634), PON1 (C108T, rs705379) gene variants on the risk of bacterial osteomyelitis development and its complicated course. The study involved 56 patients with osteomyelitis - 20 with not complicated (non-recurrent) course after treatment and 36 with complicated (recurrent) course. The data of population frequencies for the European population, obtained from the open database of "1000 Genomes project", were used as a control group. There was significantly increased distribution frequency of genotype 3954TT of IL1Β in patients with uncomplicated course compared to the control group (χ2=6.05, p=0.014, OR=4.99 (1.55-16.07)). And was found increased of minor genotype 108TT of PON1 frequency in patients with osteomyelitis compared to control group (χ2=4.38, p=0.036, OR=1.85(1.03-3.33)). There were found gender differences in the clinical effects of IL1Β gene variant: in men, the prevalence of genotype 3954CC was significantly to be increased in the patient with complicated osteomyelitis; genotype 3954CT was associated with a reduced risk of osteomyelitis and its complications developing, while in women was found the association of genotype 3954TT with an uncomplicated course of the disease. In conclusion, this study suggests that the variants of IL1В and PON1 genes associated with the risk of developing bacterial osteomyelitis and its complicated course and can be used as a prognostic marker for developing personalized prevention strategies.


Assuntos
Osteomielite , Polimorfismo Genético , Arildialquilfosfatase/genética , Feminino , Frequência do Gene , Humanos , Masculino , Osteomielite/epidemiologia , Osteomielite/genética , Prognóstico
3.
Intern Med ; 60(19): 3171-3176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34602523

RESUMO

Localized Listeria infection predominantly occurs in the prosthetic and hip joints. We herein report a case of Listeria monocytogenes ankle osteomyelitis in a 73-year-old man receiving adalimumab who was transferred to our hospital because of suspected rheumatoid arthritis (RA) flare. He reported a four-month history of left ankle swelling. A surgical biopsy revealed L. monocytogenes osteomyelitis in the left tibia and talus bones. The patient was successfully treated with antibiotics and surgical debridement. Thus, infection due to L. monocytogenes can present as ankle osteomyelitis in immunocompromised patients and may mimic an RA flare.


Assuntos
Artrite Reumatoide , Listeria monocytogenes , Listeriose , Osteomielite , Adalimumab/efeitos adversos , Idoso , Tornozelo , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Humanos , Listeriose/complicações , Listeriose/diagnóstico , Listeriose/tratamento farmacológico , Masculino , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico
4.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478533

RESUMO

BACKGROUND: The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis. METHODS: We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated. RESULTS: The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean ± SD total duration of hospitalization was 24.05 ± 15.43 and 20.67 ± 15.97 days, respectively (P = .43). The mean ± SD number of rehospitalizations after infection recurrence was 2.62 ± 1.63 and 1.67 ± 1.24, respectively (P = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (P = .69). CONCLUSIONS: Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.


Assuntos
Diabetes Mellitus , Pé Diabético , Osteomielite , Amputação , Pé Diabético/terapia , , Humanos , Osteomielite/cirurgia , Estudos Retrospectivos
5.
Khirurgiia (Mosk) ; (9): 34-39, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480453

RESUMO

OBJECTIVE: To analyze the incidence of cardiac surgeries and postoperative sternal osteomyelitis/sternomediastinitis, as well as treatment outcomes in these patients. MATERIAL AND METHODS: We summarized 171 patients with postoperative sternal osteomyelitis and sternomediastinitis. RESULTS: Organization of the Khabarovsk center for cardiovascular surgery in the Far Eastern Federal District was followed by 7.9- and 24.9-fold increase of the number of cardiac surgeries and CABG in 2005-2019, respectively. As a result, the number of patients with sternal osteomyelitis and sternomediastinitis after cardiac surgery increased from 0.50±0.10 to 1.59±0.17 cases per 100.000 (t=3.01; p<0.01). CPB and aortic clamping time (t=3.97; p<0.01), as well as surgery time (t=2.4; p<0.05) were significant risk factors of early postoperative complications. Two-stage surgical treatment of postoperative sternal osteomyelitis and sternomediastinitis (removal of ligatures and foreign bodies, sternal curettage with removal of sequesters at the first stage; resection of sternum with chest wall repair at the second stage) reduced hospital-stay from 31.9±13.4 to 29.2±10.8 days.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Osteomielite , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
6.
Pan Afr Med J ; 39: 84, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34466186

RESUMO

The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Osteomielite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Doença Aguda , Adolescente , Antibacterianos/administração & dosagem , Criança , Pré-Escolar , Terapia Combinada , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Desbridamento/métodos , Feminino , Humanos , Masculino , Osteomielite/microbiologia , Osteomielite/terapia , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia
7.
J Clin Pediatr Dent ; 45(4): 273-277, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34534306

RESUMO

Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon, aseptic, autoinflammatory condition characterized by multifocal bone lesions with pain, swelling, and frequent exacerbations and remissions. It is noteworthy that these lesions occur without any identifiable etiology or microbiologic finding. The clavicle and metaphyses of the long bones are often involved whereas involvement of the mandible is considered rare. It is usually diagnosed by exclusion of other diseases. As it shares most of its features with the more commonly occurring infective osteomyelitis, patients are often unnecessarily subjected to prolonged courses of antibiotics, serial radiation exposures, and repeated bone biopsies. We present a case of CRMO involving the mandible. Our primary objective is to demonstrate the clinical features of this uncommon disorder, highlighting the radiographic appearance. Familiarity with this condition among radiologists greatly increases the likelihood for early diagnosis and formulating an appropriate treatment plan.


Assuntos
Osteomielite , Antibacterianos/uso terapêutico , Doença Crônica , Humanos , Mandíbula/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Dor , Recidiva
8.
Hematology ; 26(1): 684-690, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34493173

RESUMO

BACKGROUND: Sickle cell anaemia affects about 4 million people across the globe, making it an inherited disorder of public health importance. Red cell lysis consequent upon haemoglobin crystallization and repeated sickling leads to anaemia and a baseline strain on haemopoiesis. Vaso-occlusion and haemolysis underlies majority of the chronic complications of sickle cell. We evaluated the clinical and laboratory features observed across the various clinical phenotypes in adult sickle cell disease patients. METHODS: Steady state data collected prospectively in a cohort of adult sickle cell disease patients as out-patients between July 2010 and July 2020. The information included epidemiological, clinical and laboratory data. RESULTS: About 270 patients were captured in this study (165 males and 105 females). Their ages ranged from 16 to 55 years, with a median age of 25 years. Sixty-eight had leg ulcers, 43 of the males had priapism (erectile dysfunction in 8), 42 had AVN, 31 had nephropathy, 23 had osteomyelitis, 15 had osteoarthritis, 12 had cholelithiasis, 10 had stroke or other neurological impairment, 5 had pulmonary hypertension, while 23 had other complications. Frequency of crisis ranged from 0 to >10/year median of 2. Of the 219 recorded, 148 of the patients had been transfused in the past, while 71 had not. CONCLUSION: The prevalence of SLU, AVN, priapism, nephropathy and the other complications of SCD show some variations from other studies. This variation in the clinical parameters across different clinical phenotypes indicates an interplay between age, genetic and environmental factors.


Assuntos
Anemia Falciforme , Adolescente , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/epidemiologia , Anemia Falciforme/metabolismo , Anemia Falciforme/patologia , Colelitíase/etiologia , Colelitíase/metabolismo , Colelitíase/patologia , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/metabolismo , Hipertensão Pulmonar/patologia , Nefropatias/epidemiologia , Nefropatias/etiologia , Nefropatias/metabolismo , Nefropatias/patologia , Úlcera da Perna/epidemiologia , Úlcera da Perna/etiologia , Úlcera da Perna/metabolismo , Úlcera da Perna/patologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Osteoartrite/epidemiologia , Osteoartrite/etiologia , Osteoartrite/metabolismo , Osteomielite/epidemiologia , Osteomielite/etiologia , Osteomielite/metabolismo , Osteomielite/patologia , Priapismo/epidemiologia , Priapismo/etiologia , Priapismo/metabolismo , Priapismo/patologia , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/patologia
9.
J Int Med Res ; 49(9): 3000605211042996, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34510962

RESUMO

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterized by chronic relapsing noninfectious bone inflammation of unknown etiology. Although CRMO is considered an extraintestinal manifestation in patients with inflammatory bowel disease, most cases of CRMO are associated with Crohn's disease; very few are associated with ulcerative colitis (UC). We herein describe a 21-year-old patient with UC who developed recurrent left thigh pain. The patient was diagnosed with CRMO associated with UC, which was well controlled with azathioprine treatment.


Assuntos
Colite Ulcerativa , Doença de Crohn , Osteomielite , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Fêmur/diagnóstico por imagem , Humanos , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Recidiva , Adulto Jovem
11.
BMC Infect Dis ; 21(1): 995, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556037

RESUMO

BACKGROUND: Mycetoma is the most common neglected disease in humans. It is a chronic, progressive, and destructive disease primarily caused by fungi or bacteria characterized by formation of dark pale grains commonly involve skin, soft tissue and rarely bone. CASE PRESENTATION: A 19 year old male patient with chronic right ankle pain, swelling and abscess formation for more than 1 year, patient was treated repeatedly with incision and drainage without any success. No X-ray, biopsy or swab for culture and sensitivity had been considered through the course of presentation. Patient was referred to Omdurman hospital where osteomyelitis secondary euomycetoma infection has been confirmed based on radiological and pathological assessment. Patient was treated surgically with aggressive debridement and bone curettage plus postoperative Itraconazole for 1 year. CONCLUSION: Clinicians must consider osteomyelitis as important differential diagnosis during initial assessment Eumycetoma infection in adults. Aggressive bone curettage followed by regular X-ray follow up can be limb saving procedure in such cases.


Assuntos
Calcâneo , Micetoma , Osteomielite , Adolescente , Adulto , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Drenagem , Humanos , Itraconazol , Masculino , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Osteomielite/diagnóstico , Adulto Jovem
12.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588202

RESUMO

A 16-year-old man was hospitalised with a painful space-occupying lesion in his posterior neck involving muscles, soft tissues, C1 cervical vertebra and vital cervical blood vessels. The true-cut biopsy showed inflammatory tissue. The microbiological analysis, which combined classical bacteriological and molecular methods, yielded at least four different anaerobic species. The patient was treated successfully with a prolonged course of ceftriaxone and metronidazole.


Assuntos
Abscesso , Osteomielite , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Adolescente , Ceftriaxona , Vértebras Cervicais/diagnóstico por imagem , Humanos , Masculino , Pescoço , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico
13.
Int J Infect Dis ; 111: 354-359, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34487853

RESUMO

OBJECTIVE: To analyze the clinical and laboratory characteristics of vertebral osteomyelitis in community-acquired bacterial meningitis patients. METHODS: All episodes of vertebral osteomyelitis in a cohort study of adult patients with community-acquired bacterial meningitis in the Netherlands were analyzed. Subsequently, a systematic review of published cases was performed. RESULTS: Between March 2006 and August 2018, 10 of 1974 (0.5%) meningitis patients were diagnosed with vertebral osteomyelitis. The median age was 70 years (interquartile range (IQR) 54-74 years); six (60%) were male and four (40%) were female. The median time between diagnosis of bacterial meningitis and vertebral osteomyelitis was 6 days (IQR 1-13 days). The most common presenting symptoms were back or neck pain, occurring in seven patients (70%); one patient presented with neurological deficits due to cauda equina compression. Streptococcus pneumoniae was the causative pathogen in five patients and Staphylococcus aureus in three. The literature review identified 32 additional cases, showing a similar distribution by age, sex, and pathogen. Seven (18%) of 40 patients from the series presented here and those reported in the literature died. CONCLUSIONS: Concomitant vertebral osteomyelitis is rare in community-acquired bacterial meningitis patients. Persisting back pain is a clue to the diagnosis and should prompt magnetic resonance imaging of the spine, because prolonged antibiotic treatment or surgical treatment may be indicated.


Assuntos
Meningites Bacterianas , Osteomielite , Infecções Estafilocócicas , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Coluna Vertebral
14.
BMJ Case Rep ; 14(9)2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544709

RESUMO

Pubic symphysis osteomyelitis is an infectious complication that rarely arises in men who have undergone treatment for prostate cancer. This process may more rarely arise from a fistulous tract between the pubic symphysis and the urinary tract. In this case report, we discuss the most common clinical presentations and laboratory findings that lead to the diagnosis of this disease process, as well as the role of MRI and other imaging modalities in confirmation of the diagnosis. This case serves as a reminder to clinicians to have earlier consideration of pubic symphysis osteomyelitis in their differential diagnosis to reduce the risk of long-term complications associated with undertreatment.


Assuntos
Fístula , Osteomielite , Sínfise Pubiana , Fístula da Bexiga Urinária , Fístula/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Sínfise Pubiana/diagnóstico por imagem
15.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531233

RESUMO

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.


Assuntos
Mucorales , Mucormicose , Osteomielite , Antifúngicos/uso terapêutico , Desbridamento , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Base do Crânio/diagnóstico por imagem
16.
BMC Pediatr ; 21(1): 342, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389010

RESUMO

BACKGROUND: In the management of pediatric osteomyelitis or septic arthritis, delay in treatment may affect outcome, while receipt of antibiotics prior to culture may affect culture results. We aimed to determine if pathogen identification decreased in cultures that were pretreated with antibiotics. METHODS: We conducted a retrospective cohort study of 584 hospitalized children between 30 days and 18 years of age admitted to two tertiary children's hospitals. Logistic regression assessed the effect of antibiotic duration on blood, bone, joint aspirate, and "other" culture positivity. RESULTS: Overall, 42% of blood cultures, 70% of bone cultures, 39% of joint cultures, and 70% of "other" cultures were positive. Compared with children who did not receive antibiotics prior to culture, there were no significant differences in odds of a positive culture in children whose cultures were pretreated with antibiotics for any of the culture types [OR (95% CI) 0.90 (0.56-1.44) for blood cultures, 0.77 (0.25-2.34) for bone cultures, 0.71 (0.39-1.28) for joint cultures, 1.18 (0.58-2.41) "for other" cultures; all p > 0.05]. Furthermore, the duration (hours) of antibiotics in the pretreated cultures was also not a significant predictor of culture positivity (OR ranged from 0.99-1.00 for all cultures, p > 0.05). CONCLUSIONS: Culture positivity was not associated with antibiotic pretreatment in any of the samples, even for longer duration of antibiotics prior to culture, though the small sample size of subgroups is an important limitation. In pediatric patients hospitalized with osteomyelitis and/or septic arthritis, early initiation of antibiotics may not affect culture positivity.


Assuntos
Artrite Infecciosa , Osteomielite , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Criança , Humanos , Lactente , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Fatores de Tempo
17.
BMC Infect Dis ; 21(1): 745, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344324

RESUMO

BACKGROUND: Empyema necessitans is a rare pulmonary condition described as the presence of pus in the pleural cavity with insidious extension into the surrounding soft tissue. The common microbial aetiology of empyema necessitans is tuberculosis. Nocardiosis a cause of empyema necessitans is rarely described in the literature. We herein present a case of an 80-year-old male with empyema necessitans with osteomyelitis of rib caused by Nocardia farcinica. CASE PRESENTATION: An 80-year-old male presented with complaints of soft swelling on the left lower posterior chest wall associated with dry cough and breathlessness on exertion. Computed Tomography (CT) thorax demonstrated empyema necessitans with features of left fifth rib osteomyelitis. Radiological guided aspiration of the chest wall collection revealed Nocardia species and surgical drainage of abscess was performed. Matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry (MALDI-TOF-MS) identified the isolate as Nocardia farcinica. He was treated with three-drug regimen: Trimethoprim-sulfamethoxazole, amikacin and ceftriaxone for 2 weeks. After showing improvement patient was discharged and advised to take oral Trimethoprim-sulfamethoxazole for the next 6 months with periodic follow-up. CONCLUSIONS: As our case demonstrates, the possibility of invasive Nocardiosis should not be overlooked even in immunocompetent patients. Clinicians should aware of this rare entity while treating patients with empyema necessitans.


Assuntos
Empiema , Nocardiose , Nocardia , Osteomielite , Idoso de 80 Anos ou mais , Humanos , Masculino , Nocardiose/complicações , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Osteomielite/tratamento farmacológico , Costelas
18.
BMC Musculoskelet Disord ; 22(1): 696, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399703

RESUMO

BACKGROUND: Gas forming infection of the spine is a consequence of vertebral osteomyelitis, necrotizing fasciitis, or a gas-forming epidural abscess, which is very rare and fatal conditions. This is the rare case of necrotizing fasciitis that rapidly progressed from the lumbar area to upper thoracic area. CASE PRESENTATION: A 58-year-old male complained of lower back pain with fever and chills. The patient had a history of uncontrolled diabetes mellitus without diabetic medication over the previous 3 months, and he had received several local injections around the lumbar area. Laboratory data revealed white blood cell count of 19,710 /mm3, erythrocyte sedimentation of 40 mm/h, and C-reactive protein of 30.7 mg/L. Radiological findings revealed a small amount of air bubbles in the paraspinal area and lumbar epidural spaces. The patient refused emergency surgery and was discharged from the hospital. The patient re-visited the emergency department two days after discharge complaining of more severe back pain with persistent fever, and his vital signs had deteriorated, with low blood pressure and tachycardia. K. pneumoniae was isolated in cultures from ultrasound-guided aspirates and peripheral blood. The follow-up radiographs revealed aggressive dissemination of innumerable air bubbles from the lumbar area to the T5 level. The patient underwent emergent decompressive laminectomy and debridement of infected paravertebral fascia and musculature. Despite intensive care for deteriorated vital signs and his back wound, the patient died on postoperative day 3 due to multi-organ failure. CONCLUSIONS: Necrotizing fasciitis involving the spine is a very rare disease with life-threatening conditions, rapid progression, and a high mortality rate. Therefore, prompt surgical treatment with a high index of suspicion is imperative to prevent potentially fatal conditions in similar extremely rare cases.


Assuntos
Abscesso Epidural , Fasciite Necrosante , Osteomielite , Dor nas Costas , Humanos , Masculino , Pessoa de Meia-Idade , Coluna Vertebral
19.
Spine (Phila Pa 1976) ; 46(18): 1207-1217, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34435983

RESUMO

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of this study was to develop recurrence-prediction models of pyogenic vertebral osteomyelitis (PVO). SUMMARY OF BACKGROUND DATA: Prediction of recurrence in PVO is crucial to avoid additional prolonged antibiotic therapy and aggressive spinal surgery and to reduce mortality. However, prediction of PVO recurrence by previously identified, initial risk factors is limited in PVO patients who exceptionally require prolonged antibiotic therapy and experience various clinical events during the treatment. We hypothesized that time-series analysis of sequential C-reactive protein (CRP) routinely measured to estimate the response to the antibiotics in PVO patients could reflect such long treatment process and increase the power of the recurrence-prediction model. METHODS: A retrospective study was performed to develop a PVO recurrence-prediction model, including initial risk factors and time-series data of CRP. Of 704 PVO patients, 493 and 211 were divided into training and test cohorts, respectively. Conventional stepwise logistic regression and artificial neural network (ANN) models were created from the training cohort, and the predictions of recurrence in the test cohort were compared. RESULTS: Prediction models using initial risk factors showed poor sensitivity (4.7%) in both conventional logistic model and ANN models. However, baseline ANN models using time-series CRP data showed remarkably increased sensitivity (55.8%-60.5%). Ensemble ANN model using both initial risk factors and time-series CRP data showed additional benefit in prediction power. CONCLUSION: The recurrence-prediction models for PVO created only using the initial risk factors showed low sensitivity, regardless of statistical method. However, ANN models using time-series data of CRP values and their ensemble model showed considerably increased prediction power. Therefore, clinicians treating PVO patients should pay attention to the treatment response including changes of CRP levels to identify high-risk patients for recurrence, and further studies to develop recurrence-prediction model for PVO should focus on the treatment response rather than initial risk factors.Level of Evidence: 4.


Assuntos
Proteína C-Reativa , Osteomielite , Proteína C-Reativa/análise , Humanos , Redes Neurais de Computação , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
20.
Medicina (Kaunas) ; 57(8)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34441015

RESUMO

Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21-89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21-83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4-58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.


Assuntos
Fluordesoxiglucose F18 , Osteomielite , Proteína C-Reativa , Humanos , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Estudos Retrospectivos
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