ABSTRACT
OBJECTIVES: To compare the risk of relapse of vertebral osteomyelitis (VO), according to the duration of antibiotic therapy (< or =6 weeks versus >6 weeks). METHODS: We performed a 10-year retrospective study to assess the risk of VO relapse and to verify that this risk was not enhanced in patients who received 6 weeks of antibiotic therapy (Group 1) as compared with those who received a longer treatment (Group 2). VO was diagnosed based on clinical manifestations, magnetic resonance imaging and/or computed tomography findings, and isolation of a pyogenic organism in blood cultures and/or a discovertebral biopsy. Relapse was diagnosed based on isolation of the same organism in blood cultures and/or a discovertebral biopsy. Outcome was evaluated 6 months post-treatment and in December 2004. RESULTS: Group 1 included 36 patients (mean age, 58 +/- 15 years) and Group 2 included 84 patients (mean age, 67 +/- 15 years) (P = 0.003). Clinical data and microorganisms were comparable in the 2 groups. In the first 6 months, 6 (5%) patients died (Group 1, n = 2; Group 2, n = 4), and 5 (4%) in Group 2 relapsed, 2 with recurrent VO and 3 with recurrent bacteremia. In 2004, 91 patients were evaluated (mean follow-up, 40.6 +/- 31 months): 77 (85%) were cured, 13 (14%) died (Group 1, n = 3; Group 2, n = 10), 1 had VO due to a different microorganism (Group 2), and no long-term relapses occurred. CONCLUSION: Our results suggest that antibiotic therapy of VO could be safely shortened to 6 weeks without enhancing the risk of relapse.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Osteomyelitis/drug therapy , Spinal Diseases/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Osteomyelitis/pathology , Osteomyelitis/prevention & control , Recurrence , Retrospective Studies , Spinal Diseases/microbiology , Spinal Diseases/pathology , Time Factors , Treatment OutcomeABSTRACT
We describe three cases of Fusobacterium spp. diskitis and review with attention to risk factors, clinical features, diagnosis, treatment and outcome. In most of the reported cases, a ear-nose-throat infection was found. Clinical manifestations were similar to those of classic bacterial vertebral osteomyelitis. Clindamycin is the most appropriate antibiotic. The outcome seems to be very good without relapse with appropriate treatment compared to pyogenic vertebral osteomyelitis.
Subject(s)
Fusobacterium Infections/diagnosis , Fusobacterium necrophorum , Fusobacterium nucleatum , Osteomyelitis/diagnosis , Spinal Diseases/diagnosis , Aged , Anti-Bacterial Agents/administration & dosage , Clindamycin/administration & dosage , Discitis/diagnosis , Discitis/drug therapy , Discitis/microbiology , Drug Therapy, Combination , Female , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Fusobacterium necrophorum/isolation & purification , Fusobacterium nucleatum/isolation & purification , Humans , Lumbar Vertebrae , Male , Middle Aged , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Penicillins/administration & dosage , Spinal Diseases/drug therapy , Spinal Diseases/microbiology , Thoracic Vertebrae , Treatment OutcomeSubject(s)
Hemorrhage/diagnosis , Pulmonary Alveoli , Adult , Female , Humans , Lung Diseases/diagnosisABSTRACT
CONTEXT: The association of a systemic disease (SD) and a myelodysplastic syndrome (MDS) may not be a coincidence. We report 14 cases. METHODS: A retrospective study was conducted in patients presenting with an MDS, hospitalised between 1989 and 1999, in the search for a concomitant systemic disease. RESULTS: Ninety-seven patients, 61 men and 36 women, with a mean age of 74 +/- 11 years suffered from an MDS and 14 of them a concomitant SD: one nodular periateritis, 2 systemic vascularitis, 2 cutaneous vascularitis, 2 atrophic polychondritis, 4 Gougerot-Sjogrën syndrome, 2 systemic lupus and one cutaneous lupus. The systemic disease did not appear to influence survival. CONCLUSION: It is possible that the association is not a coincidence and therefore an MDS should be searched for when confronted with an SD, so that treatment may be adapted appropriately.
