Espondilodiscitis Infecciosa en el Hospital de Clínicas: Análisis de una serie de 10 casos - Período 1997-2007

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Abstract

Introducción: La espondilodiscitis es una enfermedad poco frecuente. Su presentación clínica suele ser inespecífica y el diagnóstico dificultoso. Objetivo: Describir las características clínicas y evolutivas de una serie de pacientes hospitalizados con espondilodiscitis de etiología inespecífica en el Hospital de Clínicas (HC). Metodología: Se analizaron las historias clínicas de todos los pacientes hospitalizados con espondilodiscitis en el HC (1/01/1997 - 31/07/2007). El diagnóstico de sospecha se estableció en base a: clínica, laboratorio e imagenología. Caso confirmado: aislamiento de germen de material habitualmente estéril: sangre y/o hueso. Se excluyeron los producidos por Mycobacterium tuberculosis. Se analizaron: manifestaciones clínicas, etiología y evolución. Resultados: Identificamos 10 casos de espondilodiscitis, 7 correspondieron a pacientes de de sexo masculino, edad media 53,8 años (18-70 años). El síntoma más frecuente fue lumbalgia (7/10). El diagnóstico fue confirmado en 9 casos. La etiología predominante fue Staphylococcus spp. Discusión: Los datos son coincidentes con otras series: enfermedad poco frecuente y de difícil diagnóstico; fiebre y leucocitosis elevada inconstantes; VES elevada se presenta como un marcador frecuente, aunque inespecífico.

Translated abstract

Introduction: Spondylodicitis is an unfrequent disease. Its clinical presentation and recognition may be unclear and could take long periods of time before diagnosis is achieved. Objective: To know the clinical features of a series of patients with infectious spondylodiscitis in the Hospital de Clinicas, “Dr Manuel Quintela” (HC). Methodology: We analyzed clinical records of hospitalized patients with spondylodiscitis in the HC (1/01/97 and 31/07/07). Presumption diagnosis was established based on clinical, laboratory and imagenology. Confirmed case: bacterial isolation obtained from blood or spinal puncture cultures. Exclusion criteria: Mycobacterium tuberculosis isolation. We analyzed clinical manifestations, etiology and outcomes. Results: 10 cases were identified in this period, 7 male, mean age 53,8 years. Low back pain was the most frequent (7/10) symptom. The agent was isolated in 9 cases. The most frequent etiology was Staphylococcus spp. Discussion: As described in other series, spondylodiscitis is not a frequent disease and its diagnosis is difficult. Fever was uncommon and leukocyte count was mildly elevated. The erythrocyte sedimentation rate elevation appears to be an important indicator but not specific.

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Most cited references 23

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Pyogenic vertebral osteomyelitis.

E Carragee (1997)

I retrospectively reviewed the records of 111 patients who had pyogenic vertebral osteomyelitis unrelated to an open procedure on the spine. The mean age at the time of the diagnosis was sixty years (range, eighteen to eighty-four years); sixty-one patients (55 per cent) were sixty years old or more. Forty-four patients (40 per cent) had an impaired immune system secondary to diabetes mellitus, the use of corticosteroids, chemotherapy for cancer, rheumatic or immunological disease, renal or hepatic failure, malnutrition, or myelodysplasia. Magnetic resonance imaging, critical for the determination of an early diagnosis, was performed for 103 patients (93 per cent). The infection in sixty-eight patients (61 per cent) was diagnosed within one month after the onset of symptoms. The most frequent infecting organism was Staphylococcus aureus (forty patients; 36 per cent). The infection in forty-one patients (37 per cent) was caused by organisms, such as Staphylococcus epidermidis, Propionibacterium acnes, and diphtheroid species, that are traditionally considered to be of low virulence. The urinary tract was the most frequent source of infection (confirmed in thirteen patients and suspected in twenty-one). The success of non-operative treatment was predicted by four independent variables: an age of less than sixty years, the immune status, infection with Staphylococcus aureus, and a decreasing erythrocyte sedimentation rate. Forty-two patients were managed with debridement and arthrodesis. Fourteen of these patients also had instrumentation of the spine, in the presence of infection, without compromise of the outcome. Eighteen patients died by the time of the latest follow-up evaluation at a mean of four years (range, two years and two months to six years and six months): seven who had been managed non-operatively died in the first month after the diagnosis was made, three died in the acute postoperative period, three died of late complications of paraplegia, and five died of unrelated causes. None of the eighty-nine patients who were seen at a minimum of two years postoperatively had had late recurrence of infection. Chronic, severe back pain was noted in only seven patients.

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Adult spinal epidural abscess: clinical features and prognostic factors.

Cheng-Hsien Lu, Wen-Neng Chang, Chen-Chung Lui … (2002)

Twenty-nine adult patients with spinal epidural abscess (SEA), aged 31-73 years, have been identified over a period of 8 years. The 29 SEA patients included 21 men and eight women with a mean age of 54 years. Initial diagnosis of SEA was made in only 17% of our patients and another 48% of patients were initially suggested of having infection or mass of the spine. Spinal pain and fever were the two most common clinical features shared among our patients. The two most common pathogens were Staphylococcus aureus and Mycobacterium tuberculosis, which were found in 62% of patients. Twenty-seven patients received surgical intervention and antibiotic treatment for SEAs, one of which succumbed to meningitis. Two patients without neurological abnormalities received conservative treatment alone and survived. The number of patients, which showed improvement of symptoms, included all seven patients with neck/back pain without neurologic deficits, all 15 patients with paraparesis, 10 of 13 patients with bladder/bowel dysfunction with or without motor deficits, and none of the five with plegia. Preoperative plegia was identified as a poor prognostic factor, and patients with SEA continue to show high rates of morbidity and mortality. Thus, in order to improve the therapeutic outcome of patients with SEA, early diagnosis and management are mandatory to treat the patients before the deterioration of neurologic deficit occurs.

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Infective endocarditis: diagnosis and management.

Patrick O'Gara, M Haldar (2006)

Despite advances in antimicrobial therapy, diagnostic imaging and cardiac surgery, infective endocarditis (IE) remains challenging clinically and is associated with high morbidity and mortality. Diagnosis relies on several factors: initial clinical suspicion, microbiological data and echocardiographic findings. The use of an integrated diagnostic schema, such as the modified Duke criteria, is useful. Transthoracic or transesophageal echocardiography should be performed promptly for all suspected IE cases. Although the choice of investigation might be influenced by availability, the approach to imaging should be tailored to the individual's clinical situation. Promptly administered intravenous antimicrobial therapy is essential, while the use of antiplatelet or antithrombin therapy to prevent embolic complications is not supported by clinical data. Deciding whether to undertake cardiac surgery for the treatment of IE can be extremely difficult. The principal indications are the development of heart failure from acute, severe aortic or mitral regurgitation, or perivalvular extension of infection. The timing of surgery following central nervous system embolization is problematic because of the risk of hemorrhagic transformation. Prophylactic surgery to prevent embolization is currently advocated only for the management of large, mobile vegetations, when undertaken at centers performing high volumes of heart valve surgery. In this review, we describe diagnostic approaches for IE, particularly echocardiography, and provide recommendations for treatment, paying particular attention to surgery in the acute setting.

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Author and article information

Contributors

Álvaro Danza Galdo: Role: ND

Federico Roca Errandonea: Role: ND

Ignacio Batista Rago: Role: ND

Journal

Journal ID (publisher-id): ami

Title: Archivos de Medicina Interna

Abbreviated Title: Arch Med Int

Publisher: Prensa Medica Latinoamericana (Montevideo, , Uruguay )

ISSN (Electronic): 1688-423X

Publication date (Print and electronic): March 2010

Volume: 32

Issue: 1

Pages: 9-12

Affiliations

[02] Montevideo orgnameUdelaR orgdiv1Cátedra de Cardiología

[01] Montevideo orgnameUdelaR orgdiv1Facultad de Medicina orgdiv2Hospital de Clínicas Uruguay

Article

Publisher ID: S1688-423X2010000100004

SO-VID: 8d597d41-ac6d-49dd-a1ab-98d8356fa664

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 23 June 2009

Date accepted : 09 December 2009

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Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 4

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SciELO Uruguay

Keywords: Osteomielitis vertebral,Espondilodiscitis,Staphylococcus aureus,Spondylodiscitis,Vertebral osteomyelitis

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Keywords: Osteomielitis vertebral, Espondilodiscitis, Staphylococcus aureus, Spondylodiscitis, Vertebral osteomyelitis

Espondilodiscitis Infecciosa en el Hospital de Clínicas: Análisis de una serie de 10 casos - Período 1997-2007 Translated title: Infectious Spondylodiscitis In the Hospital de Clínicas: Analysis of 10 cases - 1997-2007 period

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Most cited references 23

Pyogenic vertebral osteomyelitis.

Adult spinal epidural abscess: clinical features and prognostic factors.

Infective endocarditis: diagnosis and management.

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