Unusual cause of infective discitis in an adolescent

Lumbar Spine Infection with Eikenella corrodens Presented as Abdominal Pain: A Case Report and Literature Review

Background

Eikenella corrodens is a part of the inherent flora on the surface of human mucosa. It usually does not cause disease unless the patient has been bitten, injured or surgically infected. Lumbar spine infection caused by Eikenella corrodens usually presents with conventional symptoms such as low back pain and fever. Herein, we report a case of lumbar intervertebral space infection with Eikenella corrodens presented as abdominal pain.

Case Presentation

A 38-year-old man with no medical history of note presented with abdominal pain. Initially, local doctors suspected that the patient had abdominal disease. However, abdominal diseases were ruled out and only lumbar spine infection was confirmed. Then, the patient was misdiagnosed as lumbar tuberculosis. Finally, anaerobic culture and metagenomic next-generation sequencing confirmed the Eikenella corrodens, which was rarely involved in lumbar intervertebral space infection. The patient recovered after operation and antibiotic therapy.

Conclusion

This case indicated a rare symptom of lumbar spine infection, abdominal cramping, which is caused by Eikenella corrodens. Blood culture had low sensitivity as a diagnostic method for Eikenella corrodens, but lesion sample culture or metagenomic next-generation sequencing had high sensitivity for early diagnosis.

Needle Licker’s Osteomyelitis Revisited: An Unusual Case of Vertebral Osteomyelitis withEikenella corrodensin a Diabetic Patient

Vertebral osteomyelitis due toEikenella corrodensis extremely rare. We report an unusual case of an infection caused byE. corrodensin a self-insulin-administering patient with diabetes. Similar to needle licker’s osteomyelitis, our case shows most likely the same pathomechanism and stresses the importance of correct insulin application.

Oral amoxicillin-clavulanate for treating diabetic foot infections

AIM

To assess amoxicillin-clavulanate (AMC) for the oral therapy of diabetic foot infections (DFIs), especially for diabetic foot osteomyelitis (DFO).

METHODS

We performed a retrospective cohort analysis among 794 DFI episodes, including 339 DFO cases.

RESULTS

The median duration of antibiotic therapy after surgical debridement (including partial amputation) was 30 days (DFO, 30 days). Oral AMC was prescribed for a median of 20 days (interquartile range, 12-30 days). The median ratio of oral AMC among the entire antibiotic treatment was 0.9 (interquartile range, 0.7-1.0). After a median follow-up of 3.3 years, 178 DFIs (22%) overall recurred (DFO, 75; 22%). Overall, oral AMC led to 74% remission compared with 79% with other regimens (χ² -test; P = 0.15). In multivariate analyses and stratified subgroup analyses, oral AMC resulted in similar clinical outcomes to other antimicrobial regimens, when used orally from the start, after an initial parenteral therapy, or when prescribed for DFO.

CONCLUSIONS

Oral AMC is a reasonable option when treating patients with DFIs and DFOs.

Spinal infections due to Eikenella corrodens: case report and literature review

Spinal infections with Eikenella corrodens are rare. We report a unique case of infection caused by E. corrodens diagnosed more than two years after cervical surgery. All other published cases of spinal infections caused by E. corrodens were searched. Characteristics of this bacterium, its challenging diagnosis and therapy are discussed.

Empyema caused by eikenella corrodens

Eikenella corrodens is a fastidious, facultative anerobic, non-motile, gram-negative bacilli that is part of the normal flora of the mouth and upper respiratory tract. It is being increasingly recognized as a human pathogen and has been implicated in a variety of human infections, including, periodontitis, brain abscess, endocarditis, osteomyelitis, intra-abdominal infections, and pleuropulmonary infections. We report, for the first time, from the Himalayan Kingdom of Nepal, a case of left-sided empyema due to Eikenella corrodens, in an 83-year-old man. Eikenella corrodens was isolated as a pure growth from the pleural aspirate, proving its pathogenic potential. Surgical drainage and an appropriate antimicrobial therapy resulted in a therapeutic response. We have discussed the difficulties that can be encountered in isolating Eikenella corrodens and in choosing appropriate antibiotics for its treatment.

Eikenella corrodens discitis in a habitual betel quid chewer: a case report

STUDY DESIGN

Case report.

OBJECTIVE

To describe the case of a patient who habitually chewed betel quid and presented with intractable lower back pain owing to L4-L5 discitis caused by Eikenella corrodens.

SUMMARY OF BACKGROUND DATA

E. corrodens is a normal inhabitant of mucosal surfaces in humans, particularly the oral cavity. Vertebral discitis due to E. corrodens is extremely rare. Discitis caused by E. corrodens in a habitual betel quid chewer has not been reported thus far.

METHODS

A 52-year-old man had suffered from lower back pain for many years, and it worsened 3 months before admission. He had had severe periodontitis because of habitual betel quid chewing for over 10 years.

RESULTS

The patient underwent staged spine surgeries because of the coexistence of L4-L5 discitis and isthmic spondylolisthesis. Tissue culture revealed the presence of E. corrodens. One and half years after the operation, the patient was fully ambulatory but demonstrated mild atrophy in the right thigh compared with the left thigh.

CONCLUSION

E. corrodens discitis is extremely rare. We hypothesize that E. corrodens is a potential causative organism of discitis in patients who habitually chew betel quid.

Spontaneous spondylodiscitis: presentation, risk factors, diagnosis, management, and outcome

BACKGROUND

Spontaneous spondylodiscitis is an uncommon disease, which may result in serious complications with potentially high morbidity and mortality. We conducted a prospective case study over a 2-year period in order to analyze the clinical features, approaches to management, and outcome of spondylodiscitis.

METHODS

Eight consecutive patients (four men, four women; age range 53-82 years) suffering from spondylodiscitis were identified during the study period. Parameters recorded included: demographics, past medical history, predisposing factors, presenting signs and symptoms, spinal level and extension of the infection, laboratory indices of inflammation, microbiological testing, radiological assessment, kind and duration of treatment, follow-up magnetic resonance imaging (MRI) studies, and outcome.

RESULTS

Duration of symptoms varied from 14 to 90 days. All patients had back pain; fever>or=38 degrees C was present in 5/8 (62.5%) and neurological findings in 6/8 (75%). Diabetes mellitus was identified in six (75%). Most of the patients had elevated laboratory markers of inflammation. At the initial MRI, 12 anatomical levels were found. The microorganism was identified in 7/8 by blood or bone marrow cultures (50% Staphylococcus aureus). None of the patients underwent surgical intervention. Seven patients (87.5%) recovered to full activity; follow-up MRI study results were not always in parallel with the clinical improvement of patients.

CONCLUSIONS

Spontaneous spondylodiscitis should be considered in every patient with back pain accompanied by fever and laboratory markers of inflammation. The major predisposing risk factor seems to be uncontrolled diabetes. MRI appears to be the method of choice for confirming diagnosis. Timely and accurate diagnosis along with prompt administration of antibiotics appears mandatory for a favorable outcome and avoidance of surgical intervention.

Eikenella corrodens, cause of a vulvar abscess in a diabetic adult

We report a case of Eikenella corrodens causing vulvar abscess in a diabetic patient. Eikenella corrodens is a slow growing, nonmotile, facultative anaerobic, Gram-negative bacillus which is commensal of the oral cavity, intestinal and genital tracts. The most common clinical sources of this organism are human bite wounds, head and neck infections and respiratory tract infections. In our knowledge, the presented case is the first report of Eikenella corrodens causing vulvar abscess in a diabetic patient.

Spondylodiscitis due to Bacteroides fragilis: two cases and review

Non-iatrogenic spondylodiscitis caused by anaerobic bacteria remains exceptional. We describe 2 cases of spondylodiscitis with epidural abscess due to Bacteroides fragilis, 1 after colonoscopy with biopsy and 1 in a cirrhotic patient. The clinical and imaging findings were not discriminant relative to other pyogenic spondylodiscitis. One should consider B. fragilis when treating a spondylodiscitis with epidural abscess, especially in patients with a possibly digestive portal of entry.

Eikinella corrodens wound infection in a diabetic foot: a brief report

Eikinella corrodens normally forms part of the flora of the oral cavity and mucous membranes of the respiratory tract. It is usually associated with dental, head and neck infections (Cohen, Powderly, 2004, Infectious Diseases) and is considered to be an unusual cause of orthopaedic infections. We recently treated a diabetic patient with E. corrodens osteomyelitis of the fifth metatarsophalangeal joint, a phenomenon which has been reported in only three cases previously (Konugres et al., 1987, E. corrodens as a cause of osteomyelitis in the feet of the diabetic patients. Report of three cases). We recommend including E. corrodens in the spectrum of causative pathogens in diabetic foot infections.

Spondylodiscitis: diagnosis and treatment

BACKGROUND

We present our experience in the diagnosis and treatment of spondylodiscitis.

METHODS

27 patients with spondylodiscitis were studied. There were 15 men and 12 women, with ages ranging from 26 to 85 years. Of the 27 cases, there were 21 patients with pyogenic spondylodiscitis, 6 patients with tuberculosis spondylodiscitis, and 8 patients with diabetes mellitus complication. Two patients presented with tetraparesis, 13 with paraparesis, and 1 with hemiparesis. Seventeen patients underwent surgical treatment, among whom surgical intervention with instrumentation was performed on 5 patients, and emergency operation was performed on 6 patients.

RESULTS

Fourteen patients were judged as "excellent," 8 patients as "good," and 4 patients as "no change." One patient died because of infection by penicillin-resistant Staphylococcus pneumoniae.

CONCLUSION

It is very difficult to diagnose spondylodiscitis at the first medical examination. Most spondylodiscitis patients often first visit a department of internal medicine. We strongly recommend that all doctors, especially doctors examining diabetes mellitus patients daily, should be well informed of spondylodiscitis in order to improve its diagnosis.