Brucellar spinal epidural abscesses. single center experience of nineteen patients and review of the literature

Brucellar spinal epidural abscesses [SEA] are rare and very few series of them have been reported. We aimed to evaluate the clinical characteristics, laboratory, radiological findings and outcome of this entity. Of 146 patients with brucellosis, 19[13%] patients were diagnosed to have SEA during a period of 21 years [1990-2010]. Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and the brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp. were isolated in the blood. The mean age of patients was 51 +/- 16 years [14 males, 5 females; age range, 22-74 years]. The median diagnostic delay was 2 months. Back or neck pain [100% of patients], fever [100%], and sweating [68.6%] were the most common symptoms. Cultures of blood specimens from 4 patients [21%] were positive for Brucella melitensis. Three patients [15.8%] had motor weakness or paralysis. Magnetic resonance imaging was performed in all cases. The lumbar vertebra was the most frequently involved region with the rate of 84.2%, followed by thoracal [15.8%], cervical [5.3%], lumbosacral [5.3%], and thoraco-lumbar [5.3%] segments. A combination of rifampin and doxycycline was the most widely used therapy regimen [9 cases, 47.3%]. The duration of antimicrobial therapy of brucellosis [median, 7 months; range, 4-13 months] varied according to the clinical response. There were no deaths or severe sequelae in this study Brucellar SEA should be considered in patients who have back pain and neurologic disorders as well as systemic symptoms and findings in or from endemic areas

[ rickettsiosis: bacteriological aspects and diagnostic features]

Rickettsiae are gram-negative intracellular rods belonging to the family Rickettsiaceae, which currently includes only two genera: Rickettsia and Orientia. The species within the genus Rickettsia are divided into two groups: the spotted fever group [SFG] and typhus group [TG]. Rickettsiae are usually transmitted by ticks, mites, fleas and lice. After the arthropod bites or penetration through skin excoriations, the epithelial cell is the main target of the bacterium. At the site of inoculation, an eschar will appear, and then the bacteria can reach lymphatic and blood circulation leading to a rickettsemia. The bacteria will then reach several organs including skin rash, lung, brain, heart.. Since Rickettsiae are strict intracellular bacteria, the diagnosis of rickettsial diseases is often confirmed by serology which remains the most accessible tools to the routine laboratory. The microimmunofluorescence is the reference method. For detection and identification of rickettsia, various types of samples can be used such as skin biopsies at the eschar or rash, samples of whole blood or even ticks or fleas. The isolation of these bacteria is restricted to laboratories that can perform cell culture. PCR targeting different genes is sensitive and specific

Salmonella enteritidis spondylodiscitis: case report and review of literature

Extraintestinal manifestions of Salmonellosis are rare. Most of cases reported presented gastrointestinal symptoms, and were immunologically compromised. We report a case of a young immunocompetent patient with Salmonella enteritidis spondylodiscitis. She did not present any digestive symptoms. The tomodensitometric exam revaled L2 L3 spondylodiscitis. The culture of the biopsy yielded S. enteritidis. In the litterature, 115 cases of non-typhoidal salmonellosis were reported. Most of cases occur in patients immunologically compromised by sickle cell disease. Salmonella enteritidis, Salmonella typhimurium and Salmonella choleraesuis were the most common serotypes described