Clostridium perfringens: a rare cause of spondylodiscitis case report and review of the literature

Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases

OBJECTIVES

To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis.

MATERIALS AND METHODS

We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection."

RESULTS

There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa =  - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection.

CONCLUSION

CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.

Clostridium perfringens in the spine: A rare cause of post-surgical infection

Background:

Post-surgical infections of the spine occur in from 0% to 18% of cases. Postoperative spine infections due to Clostridium Perfringens (CP) resulting in necrotizing fasciitis are extremely rare. However, since they may be fatal, early and definitive treatment is critical.

Case Description: A

62-year-old male with a T8-T9 Type C fracture, in ASIA Grade “E” (neurologically intact) underwent a posterior T6-T10 arthrodesis. However, 2 weeks postoperatively, he developed a postoperative thoracic wound infection; the cultures were positive for CP. As the patient developed necrotizing fasciitis, emergent debridement, negative pressure continued drainage, and initiation of appropriate antibiotic therapy were critical.

Conclusion:

Postoperative spinal infections due to CP with accompanying necrotizing fasciitis are extremely rare. As these infections may be fatal, they must be rapidly diagnosed and treated.

A 64-Year-Old Man with Low Back Pain Due to Clostridium perfringens Lumbar Discitis

Patient: Male, 64-year-old

Final Diagnosis: Clostridium perfringens infection

Symptoms: Lower back pain

Medication:—

Clinical Procedure: —

Specialty: Infectious Diseases • General and Internal Medicine

Gas forming infection of the spine: a systematic and narrative review

PURPOSE

Gas forming infection (GFI) of the spine is a rapidly progressive and potentially life-threatening infection. It can be a consequence of aetiologies such as Emphysematous Osteomyelitis (EOM), Necrotizing Fasciitis (NF), and Gas-containing Spinal Epidural Abscess (Gas-containing SEA). This review aims to summarize the characteristics of these subtypes of GFI, describing their aetiology, diagnosis, management, and prognosis.

METHODS

PubMed, Embase, Web of Science and the Cochrane Database were systematically searched for studies reporting on gas forming infections of the spine or a known subtype. Cases of post-operative and iatrogenic spinal infection were excluded.

RESULTS

The literature review revealed 35 studies reporting on 28 cases of EOM, three cases of NF involving the spine and seven cases of Gas-containing SEA. Thirty studies reporting on 32 cases of GFI were available for data analysis. The mean age of the patients was 60.9 years and a concomitant diagnosis of diabetes mellitus was reported in 57.5% of patients infected. Fever and back pain were the most common presenting symptoms. The lumbar spine was the most commonly affected spinal segment. Mortality from EOM, NF and Gas-containing SEA were 34.8, 100 and 28.5%, respectively.

DISCUSSION

Gas forming infection of the spine is a rare condition with an extremely poor prognosis, requiring early and aggressive surgical treatment. A multi-disciplinary approach is necessary for management. Nonetheless, even in cases of early recognition and optimal management, multisystem failure may still occur, and mortality rates remain high due to the aggressive nature of this infection.

LEVEL OF EVIDENCE

Systematic review of level IV studies.