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1.
Rev. Méd. Clín. Condes ; 31(5/6): 448-455, sept.-dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1224138

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/therapy
2.
Acta ortop. mex ; 33(3): 141-145, may.-jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1248651

ABSTRACT

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.


Subject(s)
Humans , Female , Pain , Discitis/complications , Discitis/etiology , Discitis/therapy , Retrospective Studies , Treatment Outcome
3.
Rev. chil. infectol ; 33(3): 322-330, jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-791027

ABSTRACT

Introducción: La espondilodiscitis (ED) implica prolongados períodos de hospitalización, de latencia diagnóstica y riesgo de complicaciones a largo plazo. No existen publicaciones recientes en Chile al respecto. Objetivos: Caracterizar un grupo de pacientes con ED. Pacientes y Métodos: Serie clínica, que incluyó pacientes en un período de ocho años. Resultados: 37 pacientes, 37,8% mujeres y 62,2% hombres, con promedio etario 66,8 años; 64,9% adultos mayores, 35,1% diabéticos y 21,6% con co-morbilidad urológica. Los principales síntomas fueron dolor y fiebre. 89,2% tuvo elevación de VHS. 86,5% contó con resonancia magnética, que siempre fue confirmatoria, siendo la columna lumbar la localización más frecuente (43,2%). Se identificó etiología en 28/37 pacientes: en 71,4% cocáceas grampositivas (Staphylococcus aureus predominantemente), sólo en 10,7% M. tuberculosis. Staphylococcus aureus estuvo asociado a co-morbilidades médicas en forma significativa (p < 0,05) y el grupo de bacilos gramnegativos a historia hepatobiliar y/o intestinal (p < 0,05). El método de mayor rendimiento fue el cultivo obtenido por punción quirúrgica. El tratamiento antimicrobiano fue indicado en promedio por 63,8 días (IQR 53-72), con reacciones adversas en 18,9%. La estadía hospitalaria fue 38,9 días promedio, no existiendo fallecidos durante este período. 18,9% presentó secuelas motoras. Discusión: La mayoría de pacientes con ED correspondió a adultos mayores, siendo S. aureus la principal etiología. Hubo una baja frecuencia de M. tuberculosis. Resultó considerable la magnitud de efectos adversos asociados a la terapia antimicrobiana y las complicaciones neurológicas.


Background: Spondylodiscitis (SD) involves long periods of hospitalization, diagnostic latency and risk of long-term complications. No updated series are available in Chile and a change in demographic features and etiology is suspected. Aim: To characterize a group of patients with SD. Patients and Methods: Clinical series including patients over an 8 year period. Results: We identified 37 patients; 37.8% women and 62.2% men (mean age 66.8 years); 64.9% were elderly; 35.1% had diabetes and 21.6% urological comorbidity. Main symptoms were pain and fever. Erythrocyte sedimentation rate was elevated in 89.2%, and 86.5% patients had MRI, which was always confirmatory. Lumbar spine was the most common site of infection (43.2%). Etiology was identified in 28/37 patients: 71.4% yielded grampositive cocci (Staphylococcus aureus predominantly), Mycobacterium tuberculosis was identified in only 10.7%. Staphylococcus aureus was associated to medical comorbidities (p < 0,05) and gramnegative bacilli to hepatobiliar or intestinal symptoms (p < 0,05). Culture obtained by a surgical procedure had the highest yield. The average duration of antibiotic therapy was 63.8 days (IQR 53-72). Treatment-related side effects were detected in 18.9% of patients. The average hospital stay was 38.9 days. No deaths occurred during hospitalization. Motor sequelae were present in 18.9% of this series. Discussion: Most patients with SD were older adults. Staphylococcus aureus was predominant and M. tuberculosis was uncommon. Antibiotic side effects were relevant as well as the neurological complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Discitis/microbiology , Discitis/epidemiology , Osteomyelitis/microbiology , Osteomyelitis/epidemiology , Spinal Diseases/microbiology , Spinal Diseases/epidemiology , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Staphylococcus aureus/isolation & purification , Discitis/therapy , Comorbidity , Chile/epidemiology , Retrospective Studies , Risk Factors , Treatment Outcome , Sex Distribution , Gram-Negative Aerobic Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Hospitals, General/statistics & numerical data
4.
Rev. med. Rosario ; 81(3): 107-115, sept-dic. 2015. graf
Article in Spanish | LILACS | ID: lil-775947

ABSTRACT

Introducción: la espondilitis representa un desafío diagnóstico, ya que el dolor lumbar, su principal manifestación clínica, constituyeun motivo de consulta muy frecuente en la práctica cotidiana y carece de especificidad. Por lo tanto, resulta indispensablemantener una elevada sospecha clínica. Objetivo: Analizar las características clínicas, analíticas, microbiológicas e imagenológicas,el tratamiento, la evolución y los factores pronósticos de pacientes internados por espondilodiscitis en el Hospital Provincial delCentenario, desde enero de 2011 a marzo de 2015, excluyéndose los casos postquirúrquicos. Resultados: Se analizaron 19 pacientescon una edad media 48±11 años, 63% varones. Se identificaron como comorbilidades: diabetes (37%), obesidad (16%), etilismo(21%), insuficiencia renal crónica en hemodiálisis (16%), HIV (11%), adicción EV (11%). Los gérmenes más frecuentes fueron losestafilococos (52%). Al ingreso el 94% presentó dolor, 73% fiebre y 36% foco neurológico. La media de tiempo de evolución desíntomas hasta ingreso fue 62±80 días (rango 4-360 días). La velocidad de eritrosedimentación fue elevada en todos los pacientes,y sólo 37% presentaban leucocitosis. La vancomicina fue el antibiótico más utilizado. El 37% de los pacientes presentaba infeccióndiseminada. La mortalidad fue del 26%. Los pacientes que tuvieron un tiempo de evolución al ingreso mayor a 25 días presentaronpeor evolución (colecciones, foco neurológico o muerte) (p<0,05). Conclusiones: en esta serie, la asociación de la consulta tardíacon la mala evolución destaca la importancia de considerar las pautas de alarma en centros de atención primaria para posibilitar undiagnóstico más temprano.


Introduction: Spondylodiscitis represents a diagnostic challenge since the main clinical manifestation, low back pain, is very frequent andnonspecific, and often impedes a timely diagnosis. Clinical suspicion is essential. Objective: to analyze the clinical, analytical, microbiological,and radiological features, as well as outcome and prognostics factors, in patients with spondylodiscitis admitted to the Hospital Provincialdel Centenario (Rosario, Argentina), from January 2011 to March 2015. Postsurgical cases were excluded. Results: Nineteen patients wereincluded. Mean age was 48±11 years, 63% were males. We identified the following comorbid diseases: diabetes (37%), obesity (16%),alcoholism (21%), hemodialysis-dependent chronic kidney disease (16%), HIV (11%), intravenous drug abuse (11%). The most frequentcausative organism was Staphylococcus sp. (52%). Upon admission 94% of patients presented pain, 73% fever, and 36% neurologicalinvolvement. The average time from the onset of symptoms to diagnosis was 62±80 days (range 4-360). The erythrocyte sedimentation ratewas raised in all the patients, and only 37% had leukocytosis. Vancomycin was the most frequently prescribed antibiotic. Disseminatedinfection was present in 37% of patients. The mortality rate was 26%. Patients with a time lag to diagnosis higher than 25 days had worseoutcome (suppurative collections, neurological involvement, or death) compared to those with earlier diagnosis (p <0.05). Conclusions:The association of late consultation with poor outcome in this study emphasizes the importance of educating the general population toencourage attendance to medical centers. Physicians in primary care settings must be trained to identify pain pattern, and incorporateclinical perspectives capable of recognizing a defined syndrome at first contact, in other to achieve a better outcome.Key words: Spondylodiscitis, comorbid conditions, diagnostic delay, outcome.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Discitis/diagnosis , Discitis/microbiology , Discitis/mortality , Discitis/pathology , Discitis/prevention & control , Discitis/therapy , Comorbidity , Diagnosis , Low Back Pain , Clinical Evolution , Prognosis , Vancomycin
5.
Coluna/Columna ; 13(4): 294-297, 12/2014. graf
Article in English | LILACS | ID: lil-732418

ABSTRACT

Objective: To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Methods: Imaging exams used in this study were plain radiographs and magnetic resonance imaging of the spine. Results: Data from 33 patients, 10 (30.3%) females and 23 (69.7%) males were evaluated. The average time to diagnosis was four months and 28 days (SD ± 1 month and 28 days) and 19 patients (57.5%) presented neurological deficit. Surgical treatment was performed in 22 patients (66.6%) and three patients (9.1%) had complications from the surgery. Conclusions: Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge. However, drug treatment associated with surgery shows good results. .


Objetivo: Avaliar os resultados clínicos e radiológicos do tratamento de pacientes portadores de espondilodiscite. Métodos: Os exames de imagem utilizados neste estudo foram radiografias simples e ressonância magnética da coluna vertebral. Resultados: Foram avaliados os dados de 33 pacientes, sendo 10 (30,3%) do sexo feminino e 23 (69,7%) do sexo masculino. O tempo médio gasto para o diagnóstico foi de 4 meses e 28 dias (DP ± 1 mês e 28 dias) e 19 pacientes (57,5%) apresentavam déficit neurológico. O tratamento cirúrgico foi realizado em 22 pacientes (66,6%) e três pacientes (9,1%) apresentaram complicações decorrentes do tratamento cirúrgico. Conclusões: Apesar do avanço tecnológico nos exames complementares, o diagnóstico precoce da espondilodiscite continua sendo um desafio. No entanto, o tratamento medicamentoso associado ao procedimento cirúrgico apresenta bons resultados. .


Objetivo: Evaluar los resultados clínicos y radiológicos de tratamiento de pacientes con espondilodiscitis. Métodos: Las pruebas de imagen utilizadas en este estudio fueron las radiografías simples y resonancia magnética de la columna vertebral. Resultados: Los datos de 33 pacientes, 10 (30,3 %) del sexo femenino y 23 (69,7%) del sexo masculino fueron evaluados. El tiempo medio hasta el diagnóstico fue de 4 meses y 28 días (DE ± 1 mes y 28 días) y 19 pacientes (57,5%) tuvieron déficit neurológico. El tratamiento quirúrgico se realizó en 22 (66,6%) pacientes y 3 (9,1%) tuvieron complicaciones de la cirugía. Conclusiones: A pesar de los avances tecnológicos en los exámenes complementares, el diagnóstico precoz de espondilodiscitis sigue siendo un desafío. Sin embargo, el tratamiento farmacológico asociado con la cirugía presenta buenos resultados. .


Subject(s)
Humans , Discitis/diagnostic imaging , Discitis/surgery , Discitis/therapy , Treatment Outcome
6.
Arch. med. interna (Montevideo) ; 36(2): 55-59, jul. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-754149

ABSTRACT

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...


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Discitis/diagnosis , Discitis/etiology , Discitis/therapy , Low Back Pain/diagnosis , Low Back Pain/etiology , Low Back Pain/therapy , Staphylococcus aureus , Discitis/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy
7.
Rev. chil. pediatr ; 85(1): 68-73, feb. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-708817

ABSTRACT

Introduction: Spondylodiscitis (discitis plus osteomyelitis) is an infection of the spine that involves the intervertebral disc and the vertebral body. Patients present common symptoms although little specific, and suspicion for diagnosis is required. Most cases are resolved with pharmacological management; antibiotics remain as the main treatment. Objective: To describe a patient with a spondylodiscitis, the diagnostic and therapeutic approach. Case report: A 2-year-old preschooler, with three months of refusal to walk, pain associated with standing and sitting, and absence of fever throughout evolution is presented. Physical examination reported tenderness in the lumbar region, muscle contracture and decreased lumbar lordosis. No neurological involvement and negative Gowers' sign were described. Lumbosacral spine X-ray and pelvic MRI showed abnormality of the L5-S1 disc, with bone erosions compatible with spondylodiscitis. Antibiotic treatment, physical rehabilitation and analgesia were administered, the patient completely evolved from condition. Conclusion: Spondylodiscitis must be considered in children with acute ambulation changes. The importance of prompt diagnosis and treatment involving the entire multidisciplinary team in order to improve the prognosis of patients is emphasized.


Introducción: La Espondilodiscitis (discitis más osteomielitis) es la infección de la columna que compromete el disco intervertebral y el cuerpo vertebral. Esta entidad cursa con sintomatología típica, aunque poco específica y requiere un alto índice de sospecha para su diagnóstico. La mayoría de los casos se resuelven con manejo farmacológico, siendo los antibióticos el pilar en el tratamiento. Objetivos: Caracterizar una paciente con Espondilodiscitis, su abordaje diagnóstico y terapéutico. Caso clínico: Preescolar de 2 años, con historia de 3 meses con rechazo de la marcha, dolor con la bipedestación y sedestación, sin fiebre durante toda su evolución. Al examen físico destacaba dolor a la palpación de la región lumbar, contractura de los músculos para espinosos y disminución de la lordosis lumbar. Sin compromiso neurológico, signo de Gowers negativo. Radiografía de columna lumbosacra normal y resonancia magnética con contraste de pelvis, evidenció alteración del disco L5-S1, con erosiones óseas compatibles con Espondilodiscitis. Se administró tratamiento antibiótico, analgesia y rehabilitación física, evolucionando con resolución completa del cuadro. Conclusión: En niños con alteraciones agudas en la deambulación debe pensarse en la Espondilodiscitis. Se destaca la importancia de un diagnóstico y tratamiento oportuno, que involucra a todo un equipo médico multidisciplinario, para mejorar el pronóstico de los pacientes.


Subject(s)
Humans , Female , Child, Preschool , Discitis/diagnosis , Discitis/therapy
8.
Clin. biomed. res ; 34(1): 80-83, 2014. ilus
Article in English | LILACS | ID: biblio-834445

ABSTRACT

Transrectal ultrasound-guided prostate needle biopsy is the ideal method of obtaining prostate specimens for histological analysis and is therefore often used in clinical practice. In most studies, prostate biopsy is considered a safe procedure with few major complications. In the present report, we describe a case of endocarditis with spondylodiscitis, two very rare complications associated with prostate biopsy. In the present report, we describe a case of infective endocarditis (IE) with spondylodiscitis (SD), two very rare complications of prostate biopsy. Only a few cases have been described in the literature reporting IE or SD as complications of prostate biopsy.


Subject(s)
Humans , Male , Aged , Discitis/diagnosis , Discitis/therapy , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/etiology , Biopsy/adverse effects , Prostate
9.
Arq. bras. neurocir ; 32(4)dez. 2013. ilus
Article in Portuguese | LILACS | ID: lil-721637

ABSTRACT

A espondilodiscite é a junção de osteomielite vertebral, espondilite e discite, sendo causada por vários agentes. O Staphylococcus aureus, Brucella abortus e Mycobacterium tuberculosis são os mais comuns no Brasil, e o reconhecimento dos patógenos é de extrema importância para a definição do tratamento antimicrobiano específico. Os exames de imagem são os exames de escolha para o diagnóstico da espondilodiscite, sendo a ressonância nuclear magnética (RNM) o padrão-ouro para fechar o diagnóstico, além de poder ser utilizado como método avaliativo da eficácia terapêutica. O tratamento conservador é feito com base no uso de antibióticos, uso de órteses e repouso. Já o tratamento cirúrgico consiste na descompressão da coluna, desbridamento da área infectada e fusão vertebral. O seguinte trabalho é uma análise das publicações ligadas ao assunto com o objetivo de esclarecer e elucidar dúvidas sobre um tema ainda pouco estudado no nosso meio neurocirúrgico, evidenciada pela escassez de trabalhos brasileiros nessa área.


The spondylodiscitis is the junction of vertebral osteomyelitis, spondylitis and discitis, being caused by various agents. The Staphylococcus aureus, Brucella abortus and Mycobacterium tuberculosis are the most common in Brazil, and the recognition of pathogens is extremely important to define the specific antimicrobial treatment. Imaging tests are the tests of choice for the diagnosis of spondylodiscitis, and the magnetic resonance imaging (MRI) is the gold standard to make the diagnosis, and can be used as a method evaluation of therapeutic efficacy. The conservative treatment is based on the use of antibiotics, use of orthoses and repose. The surgical treatment consists in decompression of the column, debridement of infected area and spinal fusion. This article is an analysis of the publications related to the subject in order to clarify and elucidate questions about a subject still little studied in our midst neurosurgical, evidenced by the paucity of Brazilians studies in this area.


Subject(s)
Humans , Discitis/surgery , Discitis/diagnosis , Discitis/etiology , Discitis/therapy , Neurosurgery
10.
Journal of Infection and Public Health. 2010; 3 (1): 5-16
in English | IMEMR | ID: emr-98249

ABSTRACT

Although uncommon, spontaneous and postoperative pyogenic spondylodiscitis entail major morbidity and may be associated with serious long-term sequelae. A review of the literature was done to advance our understanding of the diagnosis, treatment, and outcome of these infections. The principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilize the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple intraoperative cultures of bone and soft tissue, perform a thorough debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Appropriate management requires aggressive medical treatment and, at times, surgical interventions. If recognized early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome


Subject(s)
Humans , Discitis/therapy , Discitis/surgery , Discitis/drug therapy , Treatment Outcome , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Diagnosis, Differential
12.
Rev. Asoc. Argent. Ortop. Traumatol ; 73(3): 268-276, 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-506215

ABSTRACT

Introducción: La espondilodiscitis cervical hematógena se manifiesta con diversos signos y síntomas. La íntimarelación de la médula espinal con este sector móvilconcede a las infecciones cervicales un trato especial.Por su baja incidencia no existen pautas precisas de tratamiento. El objetivo de este trabajo fue evaluar retrospectivamente el tratamiento de una serie consecutiva de pacientes adultos con espondilodiscitis cervical hematógena. Materiales y métodos: Se evaluaron 11 pacientes con un seguimiento promedio de 60 meses. Los 7 pacientes con diagnóstico de inestabilidad mecánica, compromiso neurológico o presencia de abscesos fueron tratados quirúrgicamente con desbridamiento y artrodesis por vía anterior; los 4 restantes fueron tratados en forma conservadora. Todos recibieron inmovilización externa y antibioticoterapiaintravenosa. Resultados: Todos los pacientes presentaron remisión de los signos clínicos, radiológicos y de laboratorio de infección. En los 3 pacientes con compromiso medular la recuperación fue completa, mientras que, de los 3 pacientes con compromiso radicular, uno permanece con parestesias. Conclusiones: De acuerdo con nuestras pautas de selección, la combinación de la antibioticoterapia y la inmovilizaciónexterna o la cirugía resultó ser un tratamientoadecuado en esta pequeña serie de pacientes con espondilodiscitis cervical.


Subject(s)
Adult , Middle Aged , Discitis/surgery , Discitis/therapy , Spinal Diseases/surgery , Spinal Diseases/therapy , Cervical Vertebrae/pathology , Anti-Bacterial Agents , Retrospective Studies , Follow-Up Studies , Treatment Outcome
16.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 51(2): 113-116, mar.-abr. 2005. ilus, tab
Article in Portuguese | LILACS | ID: lil-411149

ABSTRACT

OBJETIVO: Foram avaliados retrospectivamente nove casos de discite na infância, confirmando suas formas variadas de apresentação, que levam ao atraso e dificuldades no diagnóstico. MÉTODOS: Os autores demonstraram que as radiografias iniciais podem se apresentar sem alterações, sendo importantes os exames de cintilografia ou ressonância magnética, nesses casos. RESULTADOS E CONSLUSÕES: Um paciente necessitou de tratamento cirúrgico para descompressão do canal lombar, devido à presença de abscesso discal. Os demais pacientes foram tratados conservadoramente, através de repouso, antibioticoterapia adequada e imobilização. Todos os pacientes evoluíram satisfatoriamente, e não apresentavam queixas nas suas avaliações finais.


Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Discitis/diagnosis , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Discitis/microbiology , Discitis/therapy , Follow-Up Studies , Magnetic Resonance Imaging , Retrospective Studies , Tomography, X-Ray Computed
18.
Rev. méd. Chile ; 131(5): 473-482, mayo 2003.
Article in Spanish | LILACS | ID: lil-356114

ABSTRACT

BACKGROUND: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between. AIM: To report the clinical features of a series of patients with spondylodiscitis. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002. RESULTS: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72 per cent of patients, but magnetic resonance imaging was done only in 4 (16 per cent). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36 per cent), followed by Staphylococcus aureus infection in five (20 per cent). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36 per cent of cases. Most patients evolved satisfactorily and recovered from neurological complications (88 per cent). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8 per cent). CONCLUSIONS: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Discitis/microbiology , Lumbar Vertebrae/microbiology , Discitis/diagnosis , Discitis/therapy , Retrospective Studies , Magnetic Resonance Imaging , Staphylococcal Infections/complications , Blood Sedimentation , Follow-Up Studies , Tomography, X-Ray Computed , Tuberculosis, Spinal/complications
19.
Jordan Medical Journal. 2002; 36 (1): 60-61
in English | IMEMR | ID: emr-59599
20.
Rev. mex. radiol ; 53(3): 121-4, jul.-sept. 1999. ilus
Article in Spanish | LILACS | ID: lil-266318

ABSTRACT

Presentamos el caso clínico de un recién nacido masculino de 30 días de edad, con antecedentes de bronconeumonía, que desarrolló espondilodiscitis piógena, luego de punción para obtención de líquido cefalorraquídeo. La resonancia magnética (RM) mostró la destrucción de cuerpos vertebrales de T10 y T11, su disco intervertebral y delimitó el absceso de partes blandas; drenando percutáneamente bajo control fluoroscópico, el cultivo reveló Staphyloccocus aureus


Subject(s)
Humans , Male , Infant, Newborn , Discitis/diagnosis , Magnetic Resonance Spectroscopy , Staphylococcus aureus/isolation & purification , Discitis/therapy
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