Infecciones piógenas de la columna vertebral / Pyogenic spinal infections

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.

Cervical brucellar spondylitis causing incomplete limb paralysis

Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

The First Case of Concurrent Infective Endocarditis and Spondylitis Caused by Streptococcus tigurinus

No abstract available.

A Case of Delayed-onset Multiple Metastatic Infection following Liver Abscess / 대한소화기학회지

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.

Cervical spondylitis and spinal abscess due to Actinomyces meyeri

Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption–Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification.

Espondilodiscite: um diagnóstico diferencial raro de dor abdominal / Spondylodiscitis: a rare differential diagnosis of abdominal pain

Espondilodiscite é um processo inflamatório, geralmente infeccioso, que acomete os discos intervertebrais e as vértebras associadas. O diagnóstico pode ser bastante difícil, devido à raridade da doença, à sintomatologia insidiosa e à alta prevalência de dor lombar na populaçãogeral. Este relato descreve o caso de paciente admitido em serviço de Gastroenterologia com dor abdominal e lombar, acompanhada de emagrecimento progressivo. A propedêutica realizada foi fundamental para o diagnóstico e a exclusão de outras causas. O tratamento conservador foi suficiente para a completa recuperação do paciente.

Spondylodiscitis is an inflammatory process, often of infectious origin, that attacks the intervertebral disks and related vertebra. Diagnosis may be very difficult because it is a rare disease of insidious symptoms and also because of the high incidence of backache in the general. This report describes the case of a patient admitted to the Gastroenterology service with a complaint of abdominal and lumbar pain followed by progressive weight loss. Propaedeutics used had fundamental importance in the diagnosis and elimination of other causes. Conservative treatment was enough to achieve patient recovery.

Espondilitis tuberculosa en adultos: revisión de una serie de casos en un hospital de tercer nivel, Lima-Perú / Tuberculous spondylitis in adults: a case series from a reference hospital in Lima, Peru

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.

Metástase de câncer de próstata ou mal de Pott? Desafio no diagnóstico diferencial e relato de caso

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.

Non contiguous multilevel spondylitis: an exceptional presentation of spinal brucellosis

The aim of this study was to describe the imaging features of multilevel brucellar spondylitis and discuss the diagnostic challenges The authors report describes one case of noncontiguous synchronous multifocal involvement of thoracic and lumbar spine. Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, but multilevel involvement is uncommon and only ten cases were reported in literature. Although it is an exceptional form, multifocal brucellar spondylitis is worth to be known to avoid diagnostic mistakes

Uso del fibroscopio en el manejo de la vía aérea de la espondiloartritis anquilopoyética: reporte de un caso / Use of the fiberscope in the management of the airway of the ankylopoietic spondylarthritis: a case report

La espodilitis anquilopoyética se caracteriza por brotes leves o moderados de espondilitis activa que alternan con períodos de inactivación total o casi total de la enfermedad con incapacidad. Se presenta el caso de una paciente sometida a artroplastia total de cadera derecha, ya que su enfermedad provocó una artrosis degenerativa de dicha cadera con incapacidad para la marcha. Por los test predictivos realizados por el personal experimentado durante el manejo de la vía aérea en el momento de la intubación a través del fibroscopio fue catalogada como vía aérea difícil.

The ankylopoietic spondylitis is characterized for mild or moderate outbreaks of active spondylitis that alternate with total or almost total periods of inactivación of the disease with incapacity. A case of a patient submitted to a total arthroplasty of the right hip is presented, since this disease caused to her a degenerative arthrosis of the said hip with incapacity for the march. Due to the predictable tests carried out by the experienced personnel during the management of the airway at the intubation moment through the fiberscope was catalogued as a difficult one.

Diagnostic accuracy of MR imaging in tuberculous spondylitis.

OBJECTIVE: To systemically evaluate MR imaging features of tuberculous spondylitis and to find features that may help differentiating tuberculosis from other spinal diseases. MATERIAL AND METHOD: Retrospective review of 65 MR imaging of two groups of patients between January 2002 and December 2005. Thirty-one patients were diagnosed as tuberculosis spondylitis and the rest were a randomly selected group of 34 patients with other spinal diseases. All images were reviewed by two neuroradiologists blinded to clinical data. Sensitivity and specificity of each MR imaging features were calculated. RESULTS: Three most useful MR imaging features with high sensitivity and specificity (> 80%) were endplate disruption (100%, 81.4%), paravertebral soft tissue (96.8%, 85.3%), and high signal intensity of intervertebral disc on T2W (80.6%, 82.4%). High sensitivity but low specificity signs in MRI included bone marrow edema (90.3%, 76.5%), bone marrow enhancement (100%, 42.5%), posterior element involvement (93.5%, 76.5%), canal stenosis (87.1%, 26.5%), and spinal cord or nerve root compression (80.6%, 38.2%). Low sensitivity but high specificity features in MRI were intervertebral disc enhancement (63.3%, 84.2%), vertebral collapse (58.1%, 85.3%), and kyphosis deformity (67.7%, 82.4%). Overall, the sensitivity and specificity of MRI for spinal tuberculosis were 100% and 88.2% respectively. CONCLUSION: The authors presented three good to excellent sensitivity and specificity MR imaging features for spinal tuberculosis, end plate disruption, paravertebral soft tissue formation, and high signal of intervertebral disc on T2W. In contrast to a previous study, most of the presented cases still presented with classic radiological pictures of "two vertebral disease with the destruction of the intervertebral disc". Only a small portion of the patients revealed sparing intervening disc or isolated single vertebral body involvement, which possibly reflected the early stages of the disease process.

Arthritis in inflamatory bowel disease

Inflammatory bowel disease is a systemic disorder with intestinal and extra-intestinal features. Arthritis is a well recognized extra intestinal manifestation. Spondylitis, sacroiliiatis are the common involvement with IBD. NSAIDs are generally recommended in the treatment with caution due to its potential of flaring up the gastrointestinal symptoms. Sulphasalazine, methotraxate, aziothioprine and anti TNF alpha agents are licensed for treatment of arthritis in IBD

Clinical manifestation of tuberculous and pyogenic spine infection.

The authors compared clinical and baseline parameters between patients with tuberculous spondylitis (67 patients) and pyogenic vertebral osteomyelitis (34 patients). The average age was 50.8 (range, 1 to 82 years). Males were slightly more predominant in both pyogenic and tuberculous infections. Seventy per cent of patients with pyogenic infection had had symptoms for less than 3 months, while this was the case for only 44 per cent of the tuberculous patients. Lumbar spine was the most common site of involvement. Associated infections were more commonly found in tuberculous infection. Thirty per cent of tuberculous spondylitic patients were initially misdiagnosed, while 44 per cent of patients with pyogenic vertebral osteomyelitis had delayed diagnosis. Only 20 per cent and 30 per cent of tuberculous and pyogenic patients had fever, respectively. Neurological deficit occurred more frequently in pyogenic than in tuberculous infection (79% vs 59%), while bowel bladder involvement was more commonly found in tuberculous spondylitis. Kyphosis was significantly more common in tuberculosis than in pyogenic infection (50.8% vs 26.5%, respectively). Sinus tract formation, subcutaneous abscess formation and positive for SLRT (straight-leg-raising test) were found in only a small percentage of the patients. Duration of symptoms, site, associated infection, kyphosis and neurological deficit could be used for differentiation of spinal infection.

Espondilitis tuberculosa de ubicación no habitual: a propósito de un caso / Atypical form of spinal tuberculosis

Se presenta una paciente de 41 años con dolor lumbar de 20 meses de evolución, al que se agregó impotencia funcional y parestesia de miembros inferiores. La Tomografía Axial Computada de columna lumbosacra sin y con contraste evidenció compromiso óseo y de partes blandas. El examen directo del material obtenido por punción aspirativa bajo guía Tomografía Computada fue positivo para BAAR. Se reporta un caso de espondilodiscitis tuberculosa de ubicación no habitual, revisión bibliográfica y diagnósticos diferenciales

Variación entre dos observadores en la evaluación radiográfica de las articulaciones sacroiliacas: I Estudio en poblaciones con riesgo y sin riesgo de sacroiliítis / Interobserver variations in the radiographic evaluation of the sacroiliac joints. I. Comparative study with high and low of the sacroiliitis risk

Antecedentes. La interpretación radiográfica de las articulaciones sacroilíacas está sujeta a variaciones entre observadores. Objetivo. Determinar el grado de concordancia de las interpretaciones dos observadores con experiencia diferente. Material y métodos. Dos reumatólogos certificados en un intervalo de 10 años, evaluaron en forma independiente un total de 1320 variables en 55 radiografías de la pelvis (cegados y codificados) de familiares de pacientes con espondilitis anquilosante juvenil después de un consenso para definir cada una de las variables. La concordancia de los datos obtenidos (presentes o ausentes) fue analizada con una prueba de Kappa ponderada al total de observaciones realizadas. Resultados. El grado de concordancia fue menor al evaluar el tercio superior de las articulaciones sacroiliacas y la variable "anquilosis". Ambos observadores registraron una proporción de "ausencia" mayor que la de "presencia" para cada variable; sin embargo, el observador con menor experiencia registró "presencia" con mayor frecuencia. La calificación final (graduación de sacroiliítis) tuvo una concordancia moderada (kappa: 0.546 y 0.500). Conclusiones. La concordancia de los observadores en este estudio fue, en general, moderada. Las discrepancias más importantes se encuentran en la evaluación de "disminución del espacio articular" y "esclerosis subcondral". La concordancia en la interpretación de todas las variables en el tercio superior y de algunas de ellas en el tercio medio es razonable y mayor en el tercio inferior

Frecuencia de las enfermedades reumáticas en el Hospital Regional Docente de Trujillo (1982-1987) / Frecuency of rheumatic diseases in the Regional Hospital Docente de Trujillo (1982-1987)

Se presenta un estudio longitudinal de 2178 pacientes, quienes desarrollaron 2344 enfermedades reumáticas, realizado en el Hospital Regional Docente de Trujillo, en 5 años (1982-1987), con la finalidad de determinar la frecuencia y las características en relación al lugar, tiempo y persona. Los tres grupos de enfermedades reumáticas predominantes fueron los reumatismos no articulares, las artropatías degenerativas y las enfermedades difusas del tejido conjuntivo. El sexo femenino predominó en la proporción de 2 a 1. Las enfermedades reumáticas se presentaron en todos los grupos etáreos, pero la mitad ocurrió entre los 40 a 49 años. Las cuatro quintas partes procedieron de la provincia de Trujillo y fueron atendidos en los Servicios de Medicina, Reumatología y Traumatología. El 50 por ciento de las enfermedades fueron diagnosticadas utilizando solamente criterios clínicos. La proporción de estos procesos reumáticos representó el 1,7 por ciento del total de casos atendidos durante los 5 años del estudio