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1.
Rev Med Suisse ; 15(666): 1818-1822, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599523

RESUMO

Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an infection that usually affects an intervertebral disc and the two adjacent vertebrae. Microbiology varies with the host's risk factors and local epidemiology. MRI is the preferred radiologic modality. Nevertheless, the definitive diagnosis is based on microbiological and histopathological elements. Antibiotic therapy alone may in some cases lead to cure, while in other cases the use of surgery is necessary. If it isn't diagnosed in time, vertebral osteomyelitis can have serious consequences. Thus, the physician must be familiar with the anamnestic, clinical and paraclinical elements that will bring him to actively look for this disease.


Assuntos
Osteomielite , Adulto , Antibacterianos/uso terapêutico , Dor nas Costas/etiologia , Humanos , Disco Intervertebral/microbiologia , Disco Intervertebral/cirurgia , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/microbiologia , Osteomielite/terapia
2.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502778

RESUMO

BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis. INTERPRETATION: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Osteomielite/microbiologia , Febre Q , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Anamnese , Noruega , Osteomielite/diagnóstico por imagem , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Tomografia Computadorizada por Raios X , Doença Relacionada a Viagens , Perda de Peso
3.
J Orthop Surg Res ; 14(1): 24, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670055

RESUMO

BACKGROUND: There was a controversy about surgery approach of thoracic and lumbar tuberculosis (TB) treatment. The aim of this study was to compare the microbiology outcomes of the drainage liquid and the clinical outcomes of a posterior and anterior approach in the treatment of thoracic and lumbar TB. MATERIALS AND METHODS: A total of 105 patients were enrolled in this prospective study from February 2011 to September 2015. Patients were divided into two groups: group A (51 patients, posterior approach surgery) and group B (54 patients, anterior approach surgery). Intraoperative TB samples were sent for Mycobacterium tuberculosis culture (MTBC). Drainage fluid was postoperatively collected for polymerase chain reaction (PCR), acid-fast strains (AFS), MTBC, and DNA molecular detection (DNAMD) analyses. Compare the drainage liquid positive rate of the two groups and estimate relationship between the positive results of drainage fluid and the lesion region. In addition, the clinical outcomes including the bony fusion, relapse rate, complications, and neurological status were collected. RESULTS: There was no significant difference in the positive rate of AFS, PCR, DNAMD, MTBC, or any positive rate (APR) of drainage liquid between the two groups (P > 0.05). In both groups, the MTBC-positive rate of postoperative drainage fluid was significantly lower than that of the intraoperative sample (P < 0.01). There was no significant relationship between APR and the lesion region (P > 0.05). All the patients had at least 2 years of follow-up, with an average of 34.4 ± 15.8 months. There were four patients in group A and two patients in group B who had recurrent spine TB, and the rest of the patients had fusion in the surgical area. There was no significant difference in the incidence of TB recurrence or other complications between the two groups (P > 0.05). All the patients with neurological dysfunction had improved after surgery. CONCLUSION: Compared with anterior approach surgery, posterior approach surgery had equal effectiveness of debridement. The two kinds of surgery can effectively clear the lesions surrounding the spine and heal thoracic and lumbar TB.


Assuntos
Desbridamento/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Adulto , Drenagem/métodos , Feminino , Humanos , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Fusão Vertebral/métodos , Ferida Cirúrgica/diagnóstico por imagem , Ferida Cirúrgica/microbiologia , Vértebras Torácicas/microbiologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Tuberculose da Coluna Vertebral/microbiologia , Tuberculose da Coluna Vertebral/cirurgia , Adulto Jovem
4.
Transpl Infect Dis ; 21(1): e13025, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30414295

RESUMO

Nocardia species represent a well-recognized yet uncommon cause of opportunistic infections in humans. It most frequently presents as a pulmonary infection with or without central nervous system involvement. It is a very rare cause of spinal abscesses, with only 26 cases reported in the literature. Here we report a 49-year-old man with a history of renal transplantation who presented with low back pain and was diagnosed with epidural and paraspinal abscesses due to Nocardia cyriacigeorgica that was successfully treated with antimicrobial therapy alone. In addition to the case reported here, we also conducted a systematic review of the existing literature regarding spinal abscesses due to Nocardia species and examined the success of the various treatments utilized.


Assuntos
Abscesso Epidural/diagnóstico , Transplante de Rim/efeitos adversos , Vértebras Lombares/microbiologia , Nocardiose/diagnóstico , Infecções Oportunistas/diagnóstico , Administração Intravenosa , Antibacterianos/uso terapêutico , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Abscesso Epidural/patologia , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nocardia/isolamento & purificação , Nocardiose/microbiologia , Nocardiose/patologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Resultado do Tratamento
5.
Med Mal Infect ; 49(1): 54-58, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30385069

RESUMO

OBJECTIVES: Veillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections. PATIENTS AND METHOD: We report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor. RESULTS: The 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery. CONCLUSIONS: Veillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain.


Assuntos
Discite/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Vértebras Lombares/microbiologia , Veillonella , Adulto , Discite/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Imunocompetência , Osteomielite/diagnóstico , Osteomielite/microbiologia , Veillonella/isolamento & purificação , Veillonella/fisiologia
7.
BMC Musculoskelet Disord ; 19(1): 445, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572849

RESUMO

BACKGROUND: The existence of latent low-virulence anaerobic bacteria in degenerated intervertebral discs (IVDs) remains controversial. In this study, the prevalence of low-virulence anaerobic bacteria in degenerated IVDs was examined, and the correlation between bacterial infection and clinical symptoms was analysed. METHODS: Eighty patients with disc herniation who underwent discectomy were included in this study. Under a stringent protocol to ensure sterile conditions, 80 disc samples were intraoperatively retrieved and subjected to microbiological culture. Meanwhile, tissue samples from the surrounding muscle and ligaments were harvested and cultured as contamination markers. The severity of IVD degeneration and the prevalence of Modic changes (MCs) were assessed according to preoperative MRI analysis. RESULTS: Of the 80 cultured discs, 54 were sterile, and 26 showed the presence of bacteria: Propionibacterium acnes (21 cases) and coagulase-negative staphylococci (5 cases). MRI revealed that the presence of bacteria was significantly associated with MCs (P<0.001). However, there was no significant association between bacterial infection and the severity of IVD degeneration (P = 0.162). CONCLUSIONS: Our findings further validated the presence of low-virulence anaerobic bacteria in degenerated IVDs, and P. acnes was the most frequent bacterium. In addition, the latent infection of bacteria in IVDs was associated with Modic changes. Therefore, low-virulence anaerobic bacteria may play a crucial role in the pathophysiology of MCs and lumbar disc herniation.


Assuntos
Infecções por Bactérias Gram-Positivas/microbiologia , Degeneração do Disco Intervertebral/microbiologia , Deslocamento do Disco Intervertebral/microbiologia , Disco Intervertebral/microbiologia , Vértebras Lombares/microbiologia , Propionibacterium acnes/patogenicidade , Infecções Estafilocócicas/microbiologia , Staphylococcus/patogenicidade , Adulto , Idoso , Discotomia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Propionibacterium acnes/isolamento & purificação , Índice de Gravidade de Doença , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação , Técnicas de Cultura de Tecidos , Virulência
8.
J Orthop Surg Res ; 13(1): 306, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509282

RESUMO

BACKGROUND: The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis. METHODS: We retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction. RESULTS: Of the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain. CONCLUSIONS: Unilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.


Assuntos
Desbridamento/métodos , Drenagem/métodos , Endoscopia/métodos , Infecções por Bactérias Gram-Positivas/cirurgia , Vértebras Lombares/cirurgia , Espondilite/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilite/diagnóstico por imagem
9.
Medicine (Baltimore) ; 97(48): e13484, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508977

RESUMO

The benefits of navigation-assisted technologies are not entirely understood. Therefore, this study aimed to examine the outcomes of patients with lumbar tuberculosis who received computer navigation-assisted minimally invasive direct lateral interbody fusion (DLIF).This was a retrospective study of 33 patients with lumbar tuberculosis who underwent minimally invasive DLIF at the Department of Spine and Orthopedics of Guigang People's Hospital (Guangxi, China) between January 2015 and December 2016. The patients were pathologically diagnosed as lumbar tuberculosis and grouped into the navigation-assisted fluoroscopy (NAV; n = 18) and non-navigation-assisted fluoroscopy (non-NAV; n = 15) groups. X-ray exposure and operation times were assessed in all patients.All surgical procedures were successfully completed. No case was converted into open surgery. The NAV group had longer surgical preparation time but shorter operation time compared with the non-NAV group (both P <.01). Total operation time showed no significant difference between the 2 groups (P = .1). The time of radiation exposure in the non-NAV group was longer compared with that of the NAV group (53.2 ±â€Š9.9 vs 13.5 ±â€Š2.6 s; P <.01). There were no significant differences regarding intraoperative blood loss, postoperative drainage volume, length of hospital stay, bone fusion and complications between the 2 groups (all P >.05).Computer navigation-assisted minimally invasive DLIF could significantly reduce intraoperative radiation exposure, with no increase in total operation time.


Assuntos
Fluoroscopia/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Cirurgia Assistida por Computador/métodos , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
BMC Musculoskelet Disord ; 19(1): 283, 2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30086740

RESUMO

BACKGROUND: To investigate the clinical efficacy of minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosis. METHODS: From January 2013 to January 2016, 35 cases with thoracic and lumbar spinal tuberculosis received direct lateral approach debridement, interbody bone grafting, and interbody fusion. Of the 35 cases, 16 patients were male and 19 were female and the median age was 55.2 (range 25-83). The affected segments were single interspace, and the involved vertebral bodies included: 15 cases of thoracic vertebrae (1 cases of T5/6, 2 cases of T6/7, 4 cases of T7/8, 3 cases of T8/9, 5 cases of T9/10) and 20 cases of lumbar spine (2 cases of L1/2, 6 cases of L2/3, 6 cases of L3/4, 6 cases of L4/5). After MIDLIF operation, all the patients received medication of four anti-tubercular drugs for 12 to18 months. RESULTS: The patients were followed up for 7 to 40 months with an average of 18.5 months. The visual analogue scale (VAS) at the last follow-up was 2.8 ± 0.5, which was significantly different from the preoperative VAS (8.2 ± 0.7). After MIDLIF, there was 5 cases occurred with transient numbness in one side of the thigh or inguinal region, and 10 cases suffered from flexion hip weakness. All the bone grafts were fused within 6~ 18 months (average of 11.5 months) after the operation. CONCLUSION: Minimally invasive lateral approach interbody fusion technology have the advantage of less injury and quick recovery after surgery, which is the effective and safe treatment for thoracic and lumbar spinal tuberculosis.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Antituberculosos/uso terapêutico , Transplante Ósseo , Desbridamento , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Vértebras Lombares/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Recuperação de Função Fisiológica , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Vértebras Torácicas/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/microbiologia , Tuberculose da Coluna Vertebral/fisiopatologia
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 32(1): 112-117, 2018 01 15.
Artigo em Chinês | MEDLINE | ID: mdl-29806375

RESUMO

Objective: To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis. Methods: The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress. Results: Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone. Conclusion: The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.


Assuntos
Transplante Ósseo/métodos , Vértebras Lombares/microbiologia , Vértebras Torácicas/microbiologia , Tuberculose da Coluna Vertebral/cirurgia , Humanos , Ílio/transplante , Vértebras Lombares/cirurgia , Região Lombossacral , Procedimentos Cirúrgicos Reconstrutivos , Pesquisa , Costelas/transplante , Fusão Vertebral , Vértebras Torácicas/cirurgia , Transplantes , Resultado do Tratamento , Tuberculose da Coluna Vertebral/microbiologia
12.
Rev Esp Cir Ortop Traumatol ; 62(6): 471-473, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29636227

RESUMO

There are increasingly more patients with prosthetic implants (orthopaedic prostheses, lumbar instruments, osteosynthesis material). In the last decade, infections caused by carbapenem resistant Enterobacteriaceae have increased (bacteriaemia, abscesses, urinary tract infections...) with great difficulty in treatment and important associated comorbidity. We present the first case of infection of a lumbar instrumentation by Klebsiella pneumoniae producing carbapenemase D, OXA-48 type, and successfully treated.


Assuntos
Antibacterianos/uso terapêutico , Artrodese , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/uso terapêutico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Vértebras Lombares/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto , Antibacterianos/farmacologia , Combinação de Medicamentos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/etiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Vértebras Lombares/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico
13.
BMC Surg ; 18(1): 16, 2018 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-29534714

RESUMO

BACKGROUND: Here we report a rare case of lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae, which had spread to the iliopsoas muscles, leading to urine retention. CASE PRESENTATION: A 68-year-old woman with low back pain experienced a sudden onset of bilateral lower limb weakness, it was followed 14 days later by urine retention. At consultation, magnetic resonance imaging and identification of serum ß-hemolytic streptococci provided a diagnosis of Streptococcus agalactiae infection. She was started on antibiotics. Despite diminishing signs of inflammation, preoperative MRI showed an epidural mass at T12-L4 compressing the cord and involving the paravertebral muscles as well. Group B beta-hemolytic streptococci were detected in both urine and blood. Because of bilateral lower limb weakness and urine retention, T12-L4 hemilaminectomy was performed. The L3/L4 intertransverse ligament resected and abscess drained. Histopathology revealed that inflammatory cells had invaded the facet joint. Group B beta-hemolytic streptococci were identified, confirming the diagnosis. The patient continued with the antibiotics postoperatively, and her health rapidly improved. CONCLUSION: Lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae is a clinical emergency, with significant morbidity and mortality especially with delayed diagnosis. A delay in both diagnosis and aggressive treatment can lead to not only severe neurological deficit but also to septicaemia, multiorgan failure, and even death.


Assuntos
Artrite Infecciosa/microbiologia , Abscesso Epidural/microbiologia , Vértebras Lombares/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Articulação Zigapofisária/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/terapia , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/terapia , Feminino , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/microbiologia , Abscesso do Psoas/terapia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/terapia , Infecções Estreptocócicas/terapia , Retenção Urinária/etiologia , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
14.
BMC Pediatr ; 18(1): 24, 2018 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-29397048

RESUMO

BACKGROUND: Salmonella spondylitis is an uncommon complication of Salmonella infection in immunocompetent children. To prevent treatment failure and neurological deficits, it needs prompt diagnosis and sufficient effort to identify the causative organism. There are some options to identify the causative organism such as Computed Tomography (CT) guided biopsy or surgical debridement, however when to perform these invasive interventions remains controversial. CASE PRESENTATION: A 13-year-old boy presented with occasional high fever and lower back pain. He was diagnosed with spondylitis of the L4-5 vertebral bodies and paravertebral abscess. Initial blood cultures were negative, therefore empirical antibiotic treatment was started. He responded well to conservative management, and was discharged after clinical improvement. However, he was re-hospitalized 2 weeks after discharge, and surgical debridement was performed which led to the detection of Salmonella Saintpaul as the causative pathogen. It was revealed that the possible source of infection was consumption of raw poultry eggs, or contact with poultry. Definitive antibiotic therapy was started. He was discharged with good recovery after a 6-week hospitalization. CONCLUSIONS: This is the very first case report of pyogenic spondylitis caused by Salmonella Saintpaul. Salmonella should be considered as a causative pathogen of pyogenic spondylitis in immunocompetent children. Identifying the causative organism is essential to prevent treatment failure, and a high index of suspicion is needed for prompt diagnosis especially when blood cultures are negative. Invasive interventions such as CT-guided biopsy should be considered even if the clinical course seems to be uncomplicated.


Assuntos
Abscesso/diagnóstico , Vértebras Lombares/microbiologia , Infecções por Salmonella/diagnóstico , Espondilite/diagnóstico , Abscesso/imunologia , Adolescente , Humanos , Imunocompetência , Masculino , Infecções por Salmonella/imunologia , Espondilite/imunologia
15.
Int J Infect Dis ; 68: 31-35, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29339229

RESUMO

BACKGROUND: Spondylodiscitis is an infection of the vertebral column, the incidence of which is increasing due to an increase in the susceptible population and improved ascertainment. This disease has been associated with a wide range of microorganisms. Fungal spondylodiscitis is uncommon (0.5-1.6%) and strongly associated with immunosuppression and diabetes (Gouliouris et al., 2010). A rare case of Candida glabrata spondylodiscitis in a non-neutropenic diabetic patient is reported herein, along with a review of the literature. CASE REPORT: A case of C. glabrata spondylodiscitis of L3-L4 metameres was diagnosed. The diagnosis was obtained through open biopsy of an abscess and culture examination. The patient was treated with anidulafungin and surgical debridement of the lesion. CONCLUSIONS: The diagnosis of spondylodiscitis is often delayed or missed. Physicians should consider this entity in the differential diagnosis of lumbar pain in order to initiate an appropriate therapy to prevent spinal cord lesions and disability. This is particularly relevant in the case of a fungal aetiology, as there is a recognized global shift towards invasive candidiasis due to non-albicans Candida species, in particular C. glabrata, which has variable susceptibility to antifungal drugs.


Assuntos
Candida glabrata/isolamento & purificação , Candidíase/diagnóstico , Discite/diagnóstico , Abscesso/diagnóstico , Abscesso/microbiologia , Idoso , Anidulafungina , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Desbridamento , Discite/tratamento farmacológico , Discite/microbiologia , Farmacorresistência Fúngica , Equinocandinas/uso terapêutico , Humanos , Imunossupressão , Vértebras Lombares/microbiologia , Masculino
17.
Mycoses ; 61(1): 48-52, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28872711

RESUMO

Invasive Candida infection is the fourth most common bloodstream infection. Blood cultures are the current gold standard diagnostic method, however, false negatives remain a clinical challenge. We developed a new technique measuring Candida-reactive T cells as diagnostic read-out for invasive Candida infection. In a pilot study, we followed the treatment course of a patient with an invasive Candida infection of the lumbar vertebral spine. We present the case of a 56-year-old patient with HIV-associated Burkitt lymphoma who developed septic shock during chemotherapy-induced neutropenia. For the first time, we provide flow cytometry-based diagnostics with Candida-reactive T cells for invasive candidiasis with comprehensive MRI imaging. The Candida-reactive T cell assay has potential to complement current diagnostic assays for invasive Candida infection and thus to support targeted treatment.


Assuntos
Candida/imunologia , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/imunologia , Vértebras Lombares/microbiologia , Linfócitos T/imunologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/virologia , Proteína C-Reativa/análise , Ligante de CD40/análise , Ligante de CD40/imunologia , Candidíase Invasiva/sangue , Discite/microbiologia , Citometria de Fluxo/métodos , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/microbiologia , Osteomielite/diagnóstico , Osteomielite/microbiologia , Projetos Piloto
18.
BMC Musculoskelet Disord ; 18(1): 504, 2017 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-29187182

RESUMO

BACKGROUND: Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. Few studies in the literature have been presented on SJT, reports of surgical treatment for SJT are even fewer. In this study, we retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment. METHODS: We reviewed 17 patients with severe SJT of 3 different types who underwent posterior open-window focal debridement and bone graft for joint fusion. Among them,five patients with anterior sacral abscess had anterior abscess curettage before debridement. Two patients with lumbar vertebral tuberculosis received one-stage posterior tuberculous debridement, interbody fusion and instrumentation. Follow-up was performed 36 months (26 to 45 months) using the following parameters: erythrocyte sedimentation rate(ESR), status of joint bony fusion on CT scan, visual analogue scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: Buttock pain and low back pain were progressively relieved with time. 6 months later, pain was not obvious, and ESR resumed to normal levels within 3 months. Solid fusion of the sacroiliac joint occurred within 12 months in all cases. No complications or recurrence occurred. At final follow-up, all patients had no pain or only minimal discomfort over the affected joint and almost complete functional recovery. CONCLUSIONS: Posterior open-window focal debridement and joint fusion is an efficient and secure surgical method to treat severe SJT. If there is an abscess in the front of the sacroiliac joint, anterior abscess curettage should be performed as a supplement.


Assuntos
Abscesso/cirurgia , Desbridamento/métodos , Dor/cirurgia , Articulação Sacroilíaca/cirurgia , Fusão Vertebral , Tuberculose da Coluna Vertebral/cirurgia , Abscesso/complicações , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Adulto , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Dor/etiologia , Medição da Dor , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/microbiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/microbiologia , Adulto Jovem
19.
Am J Case Rep ; 18: 1315-1319, 2017 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-29222405

RESUMO

BACKGROUND Native vertebral osteomyelitis (NVO) is a common form of hematogenous osteomyelitis, with Staphylococcus aureus (S. aureus) being the most commonly isolated organism. Dalbavancin is approved by the US Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of vertebral osteomyelitis. We describe here what is probably the first reported case of using multiple weekly dalbavancin to treat a complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vertebral osteomyelitis. CASE REPORT A 58-year-old man with a long history of recurrent MRSA bacteremia, who failed multiple courses of vancomycin and daptomycin, presented with recurrent MRSA bacteremia complicated by diskitis and osteomyelitis of the lumbar vertebrae. The patient was treated with dalbavancin 1000 mg intravenously weekly for two weeks followed by 500 mg weekly for six additional weeks. He improved clinically, his back pain resolved, and C-reactive protein (CRP) decreased to normal. Three months after the last dose of dalbavancin therapy, he underwent angiography for peripheral artery diseases, after which he developed a fever, mild leukocytosis, an elevated CRP, and the repeat blood cultures were positive for MRSA. No apparent adverse events were observed during dalbavancin therapy. CONCLUSIONS In this case, multiple weekly dalbavancin infusions appeared to be safe in the treatment of vertebral osteomyelitis caused by MRSA, but did not seem to prevent infection recurrence. However, reinfection with a new strain from the angiography catheter insertion is highly likely. Clinical studies are needed to further assess the safety and effectiveness of multiple weekly dalbavancin dosing in the management of vertebral osteomyelitis.


Assuntos
Antibacterianos/administração & dosagem , Staphylococcus aureus Resistente à Meticilina , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Teicoplanina/análogos & derivados , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Vértebras Lombares/microbiologia , Masculino , Pessoa de Meia-Idade , Teicoplanina/administração & dosagem
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