ABSTRACT
Nosocomial infections after spinal surgery are relatively uncommon but potentially serious. The goal of diagnostic evaluation is to determine the extent of infection and identify the microorganism involved. Neuroimaging provides accurate information on correct topography, localization and propagation of the infection. Microbiological data are able to give aetiological causes. In this patient with severe, chronic polymicrobial spine infection with epidural abscess and CSF fistula due to multidrug-resistant organisms, the cure was achieved with long-term antimicrobial specific therapy with quinupristin-dalfopristin (50 days) and linezolid (100 days) with mild side effects. This positive result was due to combined medical and surgical treatment.
Subject(s)
Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Discitis/drug therapy , Epidural Abscess/drug therapy , Lumbar Vertebrae/microbiology , Oxazolidinones/therapeutic use , Prosthesis-Related Infections/drug therapy , Virginiamycin/therapeutic use , Bacteria/isolation & purification , Cerebrospinal Fluid/microbiology , Combined Modality Therapy , Cross Infection/etiology , Cross Infection/surgery , Curettage , Device Removal , Discitis/etiology , Discitis/surgery , Epidural Abscess/etiology , Epidural Abscess/surgery , Female , Fistula/cerebrospinal fluid , Fistula/etiology , Fistula/microbiology , Fluconazole/therapeutic use , Fungi/isolation & purification , Humans , Internal Fixators/adverse effects , Laminectomy , Linezolid , Meropenem , Methicillin Resistance , Middle Aged , Osteomyelitis/etiology , Osteomyelitis/microbiology , Parkinson Disease/complications , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/surgery , Reoperation , Skin Diseases/cerebrospinal fluid , Skin Diseases/etiology , Skin Diseases/microbiology , Spinal Diseases/cerebrospinal fluid , Spinal Diseases/etiology , Spinal Diseases/microbiology , Spinal Stenosis/complications , Spinal Stenosis/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Staphylococcal Infections/surgery , Thienamycins/therapeutic useABSTRACT
Aicardi-Goutieres syndrome is a familial progressive early onset encephalopathy with basal ganglia calcifications, chronic CSF lymphocytosis and high level of interferon-alpha in CSF. Cutaneous necrotic lesions and the neuropathological aspect of microangiopathy and microinfarctions suggest a vascular process in relation to elevated interferon-alpha. A genetic defect in the regulation of its synthesis may be the causal factor of the disorder.
