ABSTRACT
Las infecciones espinales son cuadros clínicos poco frecuentes, que exigen un alto índice de sospecha. La prevalencia de infecciones piógenas de la columna ha ido en aumento, en parte debido al envejecimiento de la población y a un mayor número de pacientes inmunocomprometidos. El estudio imagenológico se puede iniciar con radiografías simples, pero la resonancia magnética es el examen imagenológico de elección, ya que puede dar resultados positivos de forma precoz, entregando información más detallada del compromiso vertebral y tejidos blandos adyacentes. Aunque la clínica y los hallazgos imagenológicos nos pueden orientar, es importante intentar un diagnóstico microbiológico tomando cultivos y muestras para identificar al agente causal antes de iniciar los antibióticos; aunque es óptimo un tratamiento agente-específico, hasta un 25% de los casos queda sin diagnóstico del agente. El tratamiento es inicialmente médico, con antibióticos e inmovilización, pero se debe considerar la cirugía en casos de compromiso neurológico, deformidad progresiva, inestabilidad, sepsis no controlada o dolor intratable. El manejo quirúrgico actual consiste en el aseo y estabilización precoz de los segmentos vertebrales comprometidos. Descartar una endocarditis concomitante y el examen neurológico seriado son parte del manejo de estos pacientes.
Spinal infections are unusual conditions requiring a high index of suspicion for clinical diagnosis. There has been a global increase in the number of pyogenic spinal infections due to an aging population and a higher proportion of immunocompromised patients. The imaging study should start with plain radiographs, but magnetic resonance imaging (mri) is the gold standard for diagnosis. Mri can detect bone and disc changes earlier than other methods, and it provides detailed information on bone and adjacent soft tissues. Blood cultures and local samples for culture and pathology should be obtained, trying to identify the pathogen. According to the result, the most appropriate drug must be selected depending on susceptibility and penetration into spinal tissues. Treatment should start with antibiotics and immobilization; surgery should be considered in cases with neurological impairment, progressive deformity, spine instability, sepsis, or non-controlled pain. Current surgical treatment includes debridement and early stabilization. Practitioners should rule out endocarditis and perform a serial neurological examination managing these patients.
Subject(s)
Humans , Spinal Diseases/diagnosis , Spinal Diseases/microbiology , Spinal Diseases/therapy , Prognosis , Spinal Diseases/physiopathology , Spine/microbiology , Spondylitis/diagnosis , Spondylitis/therapy , Discitis/diagnosis , Discitis/therapy , Epidural Abscess/diagnosis , Epidural Abscess/therapyABSTRACT
Describimos las características clínicas y demográficas en pacientes adultos con espondilitis tuberculosa así como un análisis exploratorio que buscó establecer características que contribuyeron al desarrollo de esta enfermedad, en un hospital de tercer nivel de Lima. Realizamos un estudio tipo serie de casos y describimos 33 casos recolectados entre 1999-2009. 18 pacientes (55 por ciento) fueron varones, la media de edad fue 31 años (IQ 23 a 51 años) y un tiempo de enfermedad de 3 meses (IQ 1 a 8 meses). El principal síntoma fue lumbalgia en 28 (85 por ciento). Los segmentos más comprometidos fueron el torácico en 28 (60 por ciento) casos y lumbar en 13 (28 por ciento). Tuberculosis pulmonar se encontró en 14 (42 por ciento) casos. Veinticuatro (73 por ciento) recibieron esquema I. La duración de tratamiento fue 10,5 ± 4,2 meses . Las características clínicas, diagnósticas fueron similares a series nacionales previas e internacionales.
We describe the demographic and clinical characteristics of adult patients with tuberculous spondylitis as well as an exploratory analysis that seeked to establish patient characteristics that contributed to the development of this disorder at a reference hospital in Lima. This is a case-series descriptive study where data collection from 33 medical records of patients from 1999 to 2009 was done. Eighteen (55 percent) were male. Median age was 31 years (IQR 23 to 51 years). Median time of symptoms was 3 months (IQR 1 to 8 months). The most frequent symptom was back pain in 28 (85 percent). The most frequently affected areas were the thoracic spine involved in 28 (60 percent) cases and lumbar spine in 13 (28 percent). Pulmonary tuberculosis was present in fourteen (42 percent) cases. Twenty four (73 percent) patients received first line treatment. Treatment duration was 10.5 ± 4.2 months. Clinical and diagnostic characteristics were similar to previous Peruvian case reports and current literature.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Spondylitis/microbiology , Tuberculosis, Spinal , Hospitals , Peru , Referral and Consultation , Retrospective Studies , Spondylitis/diagnosis , Spondylitis/therapy , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/therapy , Urban HealthABSTRACT
Em um paciente com alteração medular e história de investigação de próstata, nem metástases prostáticas para a coluna nem tuberculose devem ser excluídas. Após anamnese completa e detalhada, alguns exames são essenciais para o diagnóstico diferencial entre metástase prostática para a coluna e mal de Pott: o PSA, o PPD e exames de imagem (principalmente RNM), e, para fechar o diagnóstico, citologia da lesão. O diagnóstico rápido por meio desta metodologia e o tratamento tríplice para tuberculose permitem ao paciente uma estada menor no hospital, uma recuperação rápida e uma lesão tão mínima quanto possível ao sistema nervoso central.
Subject(s)
Middle Aged , Spondylitis/diagnosis , Spondylitis/therapy , Tuberculosis/diagnosis , Tuberculosis/therapyABSTRACT
Posterior uveitis is not a documented feature of Reiter's disease. We describe here a patient of Reiter's disease, who after a bout of dysentery in January 2002 developed macular edema of the right eye with visual acuity of 6/36. In December 2002, she was found to have phlyctenular conjunctivitis. In June 2004, when she reported with scaly plaques over both palms, repeat ophthalmological examination revealed macular degeneration of the right eye. The simultaneous occurrence of Reiter's disease and macular degeneration in this patient may be fortuitous but the immunological basis of both diseases suggests a possible association.