Caracterización y asociación clínico bacteriológica en la espondilodiscitis piógena / Bacteriological-clinical association and characterization in Pyogenic Spondylodiscitis

Resumen: Objetivo: Determinar la asociación entre las características clínicas y estudios de laboratorio con el tipo de microorganismo aislado en hemocultivos de pacientes con espondilodiscitis piógena. Material y métodos: Es un estudio transversal analítico, se revisaron expedientes clínicos de pacientes con espondilodiscitis piógena desde Enero de 2013 hasta Enero de 2017. Se realizó análisis descriptivo univariado usando frecuencias y porcentajes para variables cualitativas, medidas de tendencia central y dispersión para las cuantitativas. Análisis bivariado mediante prueba de χ2 o test exacto de Fisher. Análisis de variables cuantitativas mediante t Student o U de Mann-Whitney. Se usó coeficiente de correlación de Spearman. Considerando significancia estadística p < 0.05. Resultados: Se obtuvo una muestra de 34 pacientes, 20 (58%) fueron mujeres, mediana (Me) de edad 60 años (52-66). Se aisló en hemocultivos, bacterias Gram positivas 11 (32.4%) y Gram negativas 23 (67.6%). El microorganismo aislado más frecuente fue Escherichia coli 12 (35.3%). Los pacientes con espondilodiscitis por Gram negativas presentaron dolor leve y velocidad de sedimentación globular (VSG) Me 26 mm/hra P (18-36), los pacientes con espondilodiscitis por Gram positivas presentaron dolor severo y VSG Me 38 mm/h P (34-40) (p = 0.000 y 0.028, respectivamente). La VSG y dolor en el grupo de pacientes con espondilodiscitis por bacterias Gram negativas tuvo un coeficiente de correlación de Spearman moderado 0.418, (p = 0.047); en el grupo de Gram positivas, un coeficiente de correlación de Spearman bajo 0.228, (p = 0.507). Conclusión: Existe una asociación clínica y estadística de manera significativa entre los tipos de microorganismo aislado en hemocultivo, la intensidad del dolor valorado en escala visual análoga (EVA) y los niveles de VSG.

Abstract: Objective: Determine the association between clinical characteristics and laboratory studies with the type of isolated microorganism in blood cultures of patients with Pyogenic Spondylodiscitis. Material and methods: It is a cross-analytical study, clinical records of patients with Pyogenic Spondylodiscitis were reviewed from January 2013 to January 2017. Univariate descriptive analysis was performed using frequencies and percentages for qualitative variables, central trend measures and dispersion for quantitative ones. Bivariate analysis by testing of χ2 or Fisher's exact test. Analysis of quantitative variables using T Student or Mann-Whitney U. Spearman's correlation coefficient was used. Considering statistical significance p < 0.05. Results: A sample of 34 patients was obtained, 20 (58%) were women, median (Me) of age 60 years (52-66). Was isolated into blood cultures, Gram-positive bacteria 11 (32.4%) gram negatives 23 (67.6%). The microorganism most common isolate was Escherichia coli 12 (35.3%). Patients with Gram-negative spondylodiscitis had mild pain and globular sedimentation rate (VSG) Me 26 mm/hra P (18-36), patients with Gram-positive spondylodyscitis had severe pain and VSG Me 38 mm/h P (34-40) (p= 0.000 and 0.028, respectively). VSG and pain in the group of patients with gram-negative bacteria spondylodiscitis had a moderate Spearman correlation coefficient of 0.418, (p = 0.047); in the Gram positives group, a low correlation coefficient of Spearman 0.228, (p = 0.507). Conclusion: There is a clinical and statistical association significant between types of isolated microorganism in blood culture, pain intensity valued on analog visual scale (EVA) and VSG levels.

Spondylodiscitis with Extensive Spine Involvement ­ Case Report

Spondylodiscitis consists of an inflammatory process of infectious origin that affects primarily the intervertebral disc and spreads to the adjacent vertebral bodies, often evolving into osteomyelitis, with consequent associated neurological damage. The diagnosis is often delayed, with an average of 2 to 6 months between the appearance of the first symptoms and the confirmation of the disease. Therefore, the laboratorial and imaging exams play an important role in the diagnosis of spondylodiscitis, as well as in the orientation for the treatment to be followed (conservative or surgical). We report a case of extensive involvement of the spine and discuss about the epidemiology of the disease, its diagnosis, and therapeutic principles.

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.

Espondilodiscitis Bacteriana Inespecífica: una afección con incidencia creciente. Revisión de seis casos clínicos en período 2009-2011, Hospital Pasteur / Non specific bacterial Spondylodiscitis: an increasingly frequent condition. Review of six clinical cases in the 2009-2011 period. Hospital Pasteur

La Espondilodiscitis bacteriana inespecífica es la infección bacteriana de dos vértebras adyacentes con compromiso del disco intervertebral a gérmenes inespecíficos. Es poco frecuente, pero su incidencia se ha incrementado en los últimos años, vinculada al aumento de la realización de procedimientos invasivos, mayor sobrevida de pacientes inmunocomprometidos, así como a su mayor sospecha diagnóstica. La presencia de signos de alarma (“redflags”) del dolor dorso-lumbar permite orientar a esta etiología. Analizamos retrospectivamente 6 casos clínicos de espondilodiscitis bacteriana inespecífica asistidos en el Hospital Pasteur en el período 2009-2011. En su mayoría fueron hombres, entre los 50 y 60 años y la localización más frecuente fue lumbar. En todos los casos el germen se obtuvo en los hemocultivos, correspondiendo en la mitad de ellos a Staphylococcus aureus. Hubo una buena respuesta terapéutica y la evolución fue favorable en lo infeccioso en todos los casos, aun con los distintos planes antibióticos utilizados. El retraso en el diagnóstico es un elemento de mal pronóstico y existe alta tasa de complicaciones...

Espondilodiscite como complicação infecciosa de cateterismo cardíaco / Spondylodiscitis ss Infectious complication of cardiac catheterization

A espondilodiscite é a principal manifestação da osteomielite vertebral hematogênica em pacientes >50 anos, sendo o Staphylococcus aureus o agente envolvido na maioria dos casos. O diagnóstico clínico é dificultado pela inespecificidade dos sintomas e pela baixa incidência. Suas consequências podem ser desastrosas principalmente quando se compromete a coluna espinhal. Este relato apresenta caso de espondilodiscite por S. aureus após angioplastia coronariana percutânea.

Spondylodiscitis is the main manifestation of hematogenous vertebral osteomyelitis in patients over 50 years old, with Staphylococcus aureus the agent involved in most cases. Clinical diagnosis is complicated by nonspecific symptoms and low incidence. The consequences can be disastrous, especially when affecting the spine. This report presents a case of spondylodiscitis caused by S. aureus after percutaneous coronary angioplasty.

Spondylodiscitis and infectious endocarditis: a round-trip to be considered

The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course. A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflamatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the need of a longer antibiotic therapy course, which can range from 6 weeks to 3 months.

Valor adicional del SPECT al cintigrama óseo de cuerpo entero en la evaluación de dolor lumbar: a propósito de un caso / SPECT in whole body bone scintigraphy in patient with low back pain: clinical case

Paciente, hombre de 20 años de edad, con dolor lumbar de 2 meses de evolución, refractario a tratamiento médico y que posteriormente se asocia a hipertermia. Exámenes de laboratorio reportaron hematíes normales, leucocitos normales, sedimentación globular normal al igual que la PCR. Se le realizó radiografía de columna dorso-lumbar concluyéndose como normal. Las imágenes planares de cuerpo entero del cintigrama óseo (Cx Oseo) con 99mTc-MDP, no mostraron alteraciones significativas en columna lumbar, sin embargo en los cortes tomográficos (SPECT) se evidenció importante actividad osteoblástica con compromiso de espacio intervertebral y plataformas vertebrales de L1-L2 adyacentes. En forma posterior se efectuó Resonancia Magnética (RM) donde se observó disminución del espacio intervertebral L1-L2 con edema de sus plataformas articulares adyacentes, coincidente a los hallazgos del SPECT óseo. El cuadro clínico del paciente fue interpretado como una discitis aséptica y evolucionó satisfactoriamente con analgesia local e inmovilización.

We report the case of a 20 years old patient, male, with a 2 month’s history of back pain with no response to medical treatment. Laboratory showed normal red and white count cells, globular sedimentation and inflammation indexes (RCP). Dorsolumbar spine Rx was reported as normal. The planar bone scintigraphy images done with 99mTc-MDP showed no significant abnormalities in lumbar spine, but the bone single-photon emission tomography (SPECT) showed intense focal uptake in the intervertebral disc and adyacent vertebral platforms of L1-L2. A Magnetic Resonance (MRI) done inmediatly after showed reduction of the intervertebral space of L1-L2 and focal edema in adyacent platforms in coincidence with the SPECT findings. The final diagnosis was an aseptic discitis of L1-L2.

Espondilodiscite tuberculosa: o problema diagnóstico diante da necessidade de uma conduta terapêutica precoce / Tuberculous spondylitis: a diagnosis problems in front of therapeutical approaches early needs

Os autores fazem uma análise retrospectiva de 10 casos de espondilodiscite tuberculosa (EDT), atendidos no Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba (HULW/UFPB), no período de 1987 a 1997, todos com diagnóstico presuntivo de EDT, confirmados por exames de imagem. Enfatizam os aspectos clínicos, epidemiológicos, laboratoriais de diagnóstico, inclusive por imagem, comentando cada caso per se. Ressaltam os aspectos radiográficos mais sugestivos dessa enfermidade, visando à instituição de um protocolo terapêutico para posterior seguimento e evolução. Chamam ainda a atenção para a instituição do tratamento específico precoce, no intuito de evitar seqüelas irreparáveis, sobretudo a forma mais temível: a neurotuberculosa

Abscess retroperitoneal d'origine brucellienne [a propos d'un cas]

We report one case of retroperitoneal abscess, who complicate a brucellosis spondylodiscitis. The diagnosis of brucellosis was confirmed by morbid anatomy eram and serodiagnostic, and the spinal origin by tomography. spinal lumbar made after surgery. The evolution was good after medical and surgical treatment