Vertebral osteomyelitis; methods for diagnosis and means of treatment

Vertebral osteomyelitis is an uncommon illness; adults are mostly affected. Our objective is to evaluate the short term outcome of oral versus parenteral antimicrobials treatment for pyogenic [nontuberculous and non-brucellosis] vertebral osteomyelitis, and the best invasive diagnostic method yielding a microbiological diagnosis. The medical records were reviewed in a retrospective study for patients >/- 18 years old from five urban hospitals within Amman-Jordan; two teaching and three primary care hospitals, during the period between August 1999 to June 2007. Due to the small numbers in the arm of antimicrobials treatment, tstudents' test was used to assess inferences like 95% confidence interval and p-values for the difference among treatment arms. Seventy-four medical records were available, inpatients records 35 from two teaching hospitals, 39 records from three primary care hospitals. The orally treated patients showed lack of difference against the parenteral therapy group at the end of 6 weeks therapy [p > 0.05]. Diagnostic methods tested for microbiological diagnosis were as follows; True cut biopsy, fine needle aspiration and limited laminectomy did not differ significantly in their microbiological diagnostic ability. Our data suggested lack of difference between oral and parenteral therapy groups at the end of six weeks treatment, but a questionable tendency [95% CI; -0.11 to 0.64, p= 0.08]. The diagnostic ability of the three methods did not suggest significant differences [p >0.05], except for true cut biopsy versus fine needle aspiration where it showed tendency [95% CI; - 0.20 to 0.42, p= 0.07]. The key to successful management is the early diagnosis, and bone sampling for microbiological examination, allowing proper antimicrobial selection. A proper bone sampling method is important to evaluate, especially in the absence of surgical indication and the co-notation in some parts of the world that M. tuberculosis is the most -if not the sole- pathogen in vertebral osteomyelitis

Prevalence and antimicrobial susceptibility patterns of bloodstream isolates at Jordan hospital intensive care unit: three years experience

To identify the most common species isolated from blood in a nosocomial setting and to assess the patterns of antimicrobials susceptibility of these isolates. In addition, to add to the regional antibiogram data that is ever changing, and to monitor highly resistant pathogens that are spreading in the region. This study was conducted at Jordan Hospital Intensive Care Unit over three years period [January 2006-December 2008]. Bloodstream isolates were utilized as a model to study susceptibility patterns, for that BSPs are less liable for contamination. All isolated micro-organisms were cultured in an automated culture machine [VersaTek] and antimicrobials susceptibility testing was precessed through [Viteck 1]. Identified isolates and antimicrobial susceptibility data were uploaded into Microsoft Excel Sheet. The most common Bloodstream isolates were coagulase-negative Staphylococci [38.1%], E.coli [12.4%], S. aureus [9.8%], Acinetobacter spp. [8.7%], Serratia spp. [8.2%] and Klebsiella spp. [6.1%]. Gram-negative isolates showed high prevalence of Extended-spectrum p-lactamse-producers [19.3%] distributed; E. coli [47.0%] isolates, Klebsiella [29.4%] and Serratia spp. [23.5%]. Escherichia coli isolates was 96% susceptible to Imipenem, Amikacin and Pipracillin/Tazobactam [PIP/TAZ], 59% susceptible to Ceftazidime and 57% susceptible to Cefepime. Pseudomonas aeruginosa was 67% susceptible to antipseudomonal P-lactams but 33% to Ciprofloxacin. Klebsiella and Serratia marscecence isolates were all susceptible to Imipenem and Amikacin. Acinetobacter was 24% Imipenem-susceptible. Nineteen S. aureus were isolated with 12 Methicillin-Resistant S. aureus [63%]. Methicillin resistant contributed to [31%] among 74 CoNS blood stream isolates. Enterococci were all susceptible to Vancomycin, teicoplanin, but 50% susceptible to Amoxicillin/Clavulanate. Coagulase-negative Staphylococci bloodstream isolates were dominating at Jordan Hospital Incentive Care Unit for the years [2006-2008]. Methicillin Resistance Staphlococcus Aureus were high in prevalence among Staphylococcus aureus bloodstream isolates; in addition, Extended-Spectrum 6-Lactamse producers among gram-negative isolates were also high. These findings may help shedding some light on the region antibiogram, and initial empiric therapy for septic patients the in Intensive Care Unit settings

Buruli-like ulcer in a Palestinian woman: a case report with uncertain diagnosis

We report a case of Buruli-like ulcer in a Palestinian woman. The patient presented with a new ulcer on her left hand dorsum preceded by wet minor trauma. In view of the patient's medical history and current remnants of ulceration involving the other hand she was managed ad as a case of Buruli-like ulcer. To our knowledge, no similar cases with our patient's ulcer-features, whether Buruli ulcer, Buruli-like ulcer of Mycolactone Producing Mycobacterium marinum, were reported in the literature from Palestine and Jordan. We report this case to document an ulcer that looked like Buruli ulcer which was not proved by laboratory hard evidence

Acute disseminated encephalomyelitis associated with active mycoplasma pneumonia infection

Acute Demyelinating Encephalomyelitis is rarely reported as Mycoplasma post-infectious phenomena, it usually occurs after subsidence of the acute infection, and to our knowledge no cases were reported to occur with active infection. Here we report a young male patient with Acute Demyelinating Encephalomyelitis associated with active Mycoplasma pneumonia infection. He presented with right lobar community acquired pneumonia. It was associated with diplopia, unsteady gait, lower limbs weakness and urine retention. The patient was treated with Azithromycin for fourteen days and a five days course of steroids; he had swift initial recovery of his pneumonia. Five months later he showed full clinical and radiological recovery of his central nervous system illness, a year later he continued to show full clinical recovery without recurrence. This was a rare case of Acute Demyelinating Encephalomyelitis associated with active mycoplasma pneumonia. It is still unclear whether immunoglobulins and/or steroids therapy should be part of treatment regimen in pure Acute Demyelinating Encephalomyelitis