Diskitis

BACKGROUND Native vertebral osteomyelitis (NVO) is a common form of hematogenous osteomyelitis, with Staphylococcus aureus (S. aureus) being the most commonly isolated organism. Dalbavancin is approved by the US Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of vertebral osteomyelitis. We describe here what is probably the first reported case of using multiple weekly dalbavancin to treat a complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vertebral osteomyelitis...

OBJECTIVE: To determine the diagnostic yield of CT-guided percutaneous biopsy of densely sclerotic bone lesions. MATERIALS AND METHODS: We retrospectively analyzed CT-guided percutaneous bone biopsies performed at our institution from September 2008 through August 2011 (329 cases) and from September 2012 through August 2015 (324 cases) after adoption of a battery-powered drill system (OnControl). Bone lesions were included in the analysis if they were >70% sclerotic by visual inspection, had a density > 2 times that of adjacent trabecular bone, and had an attenuation of ≥250 HU...

BACKGROUND: Streptococcus gordonii is an infrequent cause of infective endocarditis (IE); associated spondylodiskitis has not yet been described in the literature. PURPOSE: We describe 2 patients who presented with new-onset, severe back pain; blood cultures revealed S. gordonii bacteremia, which led to the diagnosis of spondylodiskitis and IE. We review our 2-decade experience with S. gordonii bacteremia to describe the clinical and epidemiological characteristics of these patients...

OBJECTIVE: Sacroiliac joint injections are frequently performed procedures in the management of acute and chronic low-back pain, including patients with various immunocompromised states. Infectious complications following these procedures along with other spinal injections are rarely reported, but the true incidence is unknown. The purpose of this report is to highlight the devastating neurologic sequela that can occur, and to discuss potential future management strategies. CASE REPORT: We present a patient who developed diskitis, osteomyelitis, spinal epidural abscess, meningitis, and endocarditis from Staphylococcus aureus, all of which developed shortly after a sacroiliac joint injection...

Whipple's disease is a chronic systemic infection that is due to the bacterial agent Tropheryma whipplei and can be cured by appropriate antibiotic therapy. The typical patient is a middle-aged man. Rheumatologists are in a prime position to handle Whipple's disease. The classical presentation combines weight loss and diarrhea, preceded in three-quarters of patients by a distinctive pattern of joint manifestations that run an intermittent course, at least initially. The mean time from joint symptom onset to the diagnosis of Whipple's disease is 6 years...

Infections of the spine may involve different anatomic compartments, including intervertebral disks, vertebral bone, paraspinal soft tissues, epidural space, meninges, and spinal cord. This article focuses on the role of imaging in diagnosis and follow-up of infections of the intervertebral disk and vertebral bone, named respectively diskitis and spondylitis or vertebral osteomyelitis. Often, at the time of diagnosis, the infection already involves both structures; therefore the process is referred as spondylodiskitis...

BACKGROUND: Early detection of surgical site infection (SSI) following spinal surgery would allow for prompt treatment and would improve overall outcome, yet early diagnosis is a challenge. Computed tomography (CT) guided aspiration of fluid collections may aid in diagnosis, as its diagnostic utility has previously been demonstrated in the setting of hip SSI, knee SSI, and spontaneous diskitis. There is no literature on its use in post-operative spinal SSIs. QUESTIONS/PURPOSES: The current study aims to (1) determine the diagnostic value of CT-guided aspiration in evaluating suspected SSI; (2) identify the characteristics of the clinical presentation that are predictive of SSI; and (3) identify characteristics of the hematologic workup that are predictive of SSI...

UNLABELLED: : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation...

In mid-September 2012, the largest healthcare-associated outbreak in U.S. history began. Before it was over, 751 patients were reported with fungal meningitis, stroke, spinal or paraspinal infection, or peripheral osteoarticular infection, and 64 (8.5%) died. Most patients had undergone epidural injection, and a few osteoarticular injection, of methylprednisolone acetate that had been manufactured at the New England Compounding Center (NECC). The offending pathogen in most cases was Exserohilum rostratum, a brown-black soil organism that previously was a rare cause of human infection...

OBJECTIVES: The primary objective was to assess the diagnostic contribution of a second percutaneous needle biopsy in patients with spontaneous diskitis and negative findings from blood cultures and the first biopsy. We also assessed the sensitivity of the first biopsy and the diagnostic contribution of post-biopsy blood cultures. METHODS: Multicenter retrospective study of patients managed between 2004 and 2014. We excluded patients with postoperative diskitis...

BACKGROUND: Pelvic fixation with S2-alar-iliac (S2AI) screws can increase the rigidity of a lumbosacral construct, which may promote bone healing, improve antibiotic delivery to infected tissues, and avoid L5-S1 pseudarthrosis. PURPOSE: To describe the use of single-stage posterior fixation without debridement for the treatment of pyogenic vertebral diskitis and osteomyelitis (PVDO) at the lumbosacral junction. STUDY DESIGN: Technical report...

We herein describe the first reported case of pyogenic spondylitis and diskitis caused by Helicobacter cinaedi. The results of magnetic resonance imaging and the histology of biopsied tissue were suggestive of acute infection at the lumbar spine. The pathogen was obtained by a blood culture examination and identified by 16S rRNA analysis. Eight weeks of antibiotics therapy resulted in a good clinical course. H. cinaedi infections have been increasingly reported in recent years, but the pathogen's epidemiological and pathological characteristics are still unclear...

OBJECTIVE: The purpose of this study was to determine whether there is a difference in biopsying bone (endplate), disk, or paravertebral soft tissue to culture the pathogenic organism causing diskitis-osteomyelitis. MATERIALS AND METHODS: A retrospective review was conducted of 111 spinal biopsies performed between 2002 and 2011. Pathologic examination was used as the reference standard for detecting diskitis-osteomyelitis. Microbiologic yield, sensitivity, and specificity were calculated...

Spinal infections are a spectrum of disease comprising spondylitis, diskitis, spondylodiskitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy, and myelitis. Inflammation can be caused by pyogenic, granulomatous, autoimmune, idiopathic, and iatrogenic conditions. In an era of immune suppression, tuberculosis, and HIV epidemic, together with worldwide socioeconomic fluctuations, spinal infections are increasing. Despite advanced diagnostic technology, diagnosis of this entity and differentiation from degenerative disease, noninfective inflammatory lesions, and spinal neoplasms are difficult...

There is still no clear definition of diskogenic low-back pain and no consensus on a generally agreed test, such as provocative diskography (PD), to diagnose painful disk degeneration, and probably more importantly, to predict the outcome of therapy intended to reduce pain that is presumed to be diskogenic in nature. Nevertheless, PD is the most specific procedure to diagnose diskogenic low-back pain. Its accuracy, however, is rather low or at best unknown. Although rare, the most prevalent complication, postdiskography diskitis, can be devastating for the individual patient, so all measures, like strict sterile conditions and antibiotic prophylaxis, should be taken to avoid this complication...

Acid-fast bacillus (AFB) spinal osteomyelitis in a patient with AIDS is often presumed to be caused by reactivated Mycobacterium tuberculosis. However, other AFB pathogens can mimic M. tuberculosis and, to ensure appropriate and adequate therapy, should be considered by clinicians. We present a case of aggressive spinal osteomyelitis caused by Mycobacterium heckeshornense in an AIDS patient; a review of the literature is also included.

BACKGROUND: Sleep deprivation may adversely affect host defenses against infection while infection may impact sleep. We studied sleep quality in hospitalized patients with infection-related diagnoses. METHODS: This was an observational study in a 900-bed tertiary care community teaching hospital involving consecutive patients seen by an infectious disease consultant from June 26, 2008 to December 31, 2011. During routine part of their care, patients were enquired about their sleep quality, categorized into either "sound" or "unsound" sleep and the reason(s) for experiencing unsound sleep...

We report two atypical cases of focal Whipple's disease with rheumatic presenting symptoms. In one of these cases, the patient presented with chronic intermittent polyarthritis, systemic inflammation, and leukocytosis. Tests were positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. There was no structural joint damage. Combined glucocorticoid and methotrexate therapy was only partially effective. Endocarditis requiring emergency valve replacement surgery occurred 4 years later. Evaluation of this event led to the diagnosis of Tropheryma whipplei infection responsible for both the endocarditis and the joint disease...

Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection...

OBJECTIVE: To investigate the feasibility and efficacy of sight-guided percutaneous unilateral translaminar facet screw fixation (TLFSF) with interbody fusion for treatment of lower lumbar vertebra diseases. METHODS: Twenty-nine adult patients with lower lumbar disease underwent sight-guided percutaneous unilateral TLFSF combined with microsurgical spinal decompression, discectomy, and interbody fusion from June 2007 to June 2008. All 29 patients had low back pain caused by lumbar disc degeneration (20 cases), in situ recurrent lumbar disc herniation (2), primary diskitis (1), lumbar disc herniation with spinal stenosis (3), and first-degree lumbar degenerative spondylolisthesis (3)...