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Marroquin-Herrera O, Rosales-Camargo SA, Morales-Sáenz LC, Alvarado-Gomez F. Clostridium perfringens in the spine: A rare cause of post-surgical infection. Surg Neurol Int 2021; 12:544. [PMID: 34877030 PMCID: PMC8645503 DOI: 10.25259/sni_1039_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Omar Marroquin-Herrera
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
| | | | - Luis Carlos Morales-Sáenz
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
| | - Fernando Alvarado-Gomez
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
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Abstract
Patient: Male, 64-year-old Final Diagnosis: Clostridium perfringens infection Symptoms: Lower back pain Medication:— Clinical Procedure: — Specialty: Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Harshil Bhatt
- Hospitalist Program, Department of Medicine, Goshen Hospital, Goshen, IN, USA
| | - Sandeep Singh
- Department of Medicine, Indiana University School of Medicine, South Bend, IN, USA
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Beit Ner E, Chechik Y, Lambert LA, Anekstein Y, Mirovsky Y, Smorgick Y. Gas forming infection of the spine: a systematic and narrative review. Eur Spine J 2021; 30:1708-20. [PMID: 33108532 DOI: 10.1007/s00586-020-06646-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/02/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022]
Abstract
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.
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Abstract
CASE Few cases have reported Clostridium species of bacteria as a source for vertebral osteomyelitis and epidural abscesses. The subspecies of Clostridium septicum has not been described as a cause. This case describes a 69-year-old man who hematogenously spread C. septicum without associated malignancy, subsequently failed conservative management in the form of intravenous antibiotics, and was definitively treated with surgical intervention through a minimally invasive approach. CONCLUSIONS An epidural abscess occurring in a surgically naive patient is a rare phenomenon. An epidural abscess caused by C. septicum is even rarer. Appropriate imaging, early recognition, and surgical debridement can lead to a favorable outcome.
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Affiliation(s)
- Adam J Money
- Prisma Health Spine Center. University of South Carolina School of Medicine, Columbia, South Carolina
| | - Seth Molloy
- Prisma Health Spine Center. University of South Carolina School of Medicine, Columbia, South Carolina
| | - Gregory Grabowski
- Prisma Health Spine Center. University of South Carolina School of Medicine, Columbia, South Carolina
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Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, Wilson DM. Imaging-Based Approach to Extradural Infections of the Spine. Semin Ultrasound CT MR 2018; 39:570-586. [PMID: 30527522 DOI: 10.1053/j.sult.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jason F Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco.
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Alina Uzelac
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Rebecca A Dumont
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Abstract
The authors present a case involving an 80-year-old man with infectious T10/T11 discitis on the background of a recent Clostridium perfringens bacteraemia. This case report describes a case of probable C. perfringens discitis as further investigations failed to identify any causative agents. He was treated with intravenous piperacillin/tazobactam to good effect, achieving favourable clinical outcome. Diagnosis of discitis/osteomyelitis can often be delayed and mismanaged due to its non-specific presentations. Timing of empirical antimicrobial therapy requires careful consideration based on haemodynamic stability and neurological function to maximise microbiological yield.
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Affiliation(s)
- Chen Han Yong
- Division of Medical Sub-Specialties, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Miranda Lam
- Division of Medical Sub-Specialties, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
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Yen CP, Beckman JM, Vivas AC, Bach K, Uribe JS. Effects of intradiscal vacuum phenomenon on surgical outcome of lateral interbody fusion for degenerative lumbar disease. J Neurosurg Spine 2017; 26:419-425. [DOI: 10.3171/2016.8.spine16421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The authors investigated whether the presence of intradiscal vacuum phenomenon (IVP) results in greater correction of disc height and restoration of segmental lordosis (SL).
METHODS
A retrospective chart review was performed on every patient at the University of South Florida's Department of Neurosurgery treated with lateral lumbar interbody fusion between 2011 and 2015. From these charts, preoperative plain radiographs and CT images were reviewed for the presence of IVP. Preoperative and postoperative posterior disc height (PDH), anterior disc height (ADH), and SL were measured at disc levels with IVP and compared with those at disc levels without IVP using the t-test. Linear regression was used to evaluate the factors that predict changes in PDH, ADH, and SL.
RESULTS
One hundred forty patients with 247 disc levels between L-1 and L-5 were treated with lateral lumbar interbody fusion. Among all disc levels treated, the mean PDH increased from 3.69 to 6.66 mm (p = 0.011), the mean ADH increased from 5.45 to 11.53 mm (p < 0.001), and the mean SL increased from 9.59° to 14.55° (p < 0.001). Significantly increased PDH was associated with the presence of IVP, addition of pedicle screws, and lack of cage subsidence; significantly increased ADH was associated with the presence of IVP, anterior longitudinal ligament (ALL) release, addition of pedicle screws, and lack of subsidence; and significantly increased SL was associated with the presence of IVP and ALL release.
CONCLUSIONS
IVP in patients with degenerative spinal disease remains grossly underreported. The data from the present study suggest that the presence of IVP results in increased restoration of disc height and SL.
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Affiliation(s)
- Chun-Po Yen
- 1Department of Neurological Surgery, University of South Florida, Tampa, Florida; and
- 2Department of Neurological Surgery, University of Virginia Heath System, Charlottesville, Virginia
| | - Joshua M. Beckman
- 1Department of Neurological Surgery, University of South Florida, Tampa, Florida; and
| | - Andrew C. Vivas
- 1Department of Neurological Surgery, University of South Florida, Tampa, Florida; and
| | - Konrad Bach
- 1Department of Neurological Surgery, University of South Florida, Tampa, Florida; and
| | - Juan S. Uribe
- 1Department of Neurological Surgery, University of South Florida, Tampa, Florida; and
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Seller M, Burghardt RD, Rolling T, Hansen-Algenstaedt N, Schaefer C. Clostridium perfringens: a rare cause of spondylodiscitis case report and review of the literature. Br J Neurosurg 2016; 32:574-576. [PMID: 27967243 DOI: 10.1080/02688697.2016.1267332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Presented is a case of a 64-year old male with a unique and yet unreported case of a spondylodiscitis caused by Clostridium perfringens. Becoming symptomatic with massive neurological deficits. Computed tomography (CT) revealed typical signs of spondylodiscitis involving the vertebral body L5 with extensive vacuum phenomenon.
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Affiliation(s)
- M Seller
- a Department of Orthopaedic , Study Conducted at the University Hamburg Eppendorf , Hamburg , Germany
| | - R D Burghardt
- a Department of Orthopaedic , Study Conducted at the University Hamburg Eppendorf , Hamburg , Germany
| | - T Rolling
- a Department of Orthopaedic , Study Conducted at the University Hamburg Eppendorf , Hamburg , Germany
| | - N Hansen-Algenstaedt
- a Department of Orthopaedic , Study Conducted at the University Hamburg Eppendorf , Hamburg , Germany
| | - C Schaefer
- a Department of Orthopaedic , Study Conducted at the University Hamburg Eppendorf , Hamburg , Germany
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Akagawa M, Kobayashi T, Miyakoshi N, Abe E, Abe T, Kikuchi K, Shimada Y. Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report. J Med Case Rep 2015; 9:81. [PMID: 25888739 PMCID: PMC4403783 DOI: 10.1186/s13256-015-0567-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/04/2015] [Indexed: 02/04/2023] Open
Abstract
Introduction Gas gangrene is most often caused by Clostridium perfringens infection. Gas gangrene is a medical emergency that develops suddenly. The mortality rate is higher with trunk involvement than with involvement of the extremities, which carries a better prognosis. With respect to vertebral involvement, there are few reports in the literature. The purpose of this paper is to report a very rare case of vertebral osteomyelitis caused by gas gangrene. Case presentation A 78-year-old Japanese woman with diabetes mellitus was admitted to our hospital with the chief complaints of back pain, dysuria, and complete paralysis of both legs. A computed tomography scan showed soft tissue swelling anterolaterally at intervertebral disc level T11/12 and a gas-containing epidural abscess that compressed her spinal cord. Cultures later grew Clostridium perfringens and Escherichia coli. Hemilaminectomy was done from T10 to T12, and an epidural abscess was removed. She went on to have fusion surgery 6 weeks after the initial operation and subsequently experienced complete pain relief. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane. Conclusions Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.
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Affiliation(s)
- Manabu Akagawa
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan.
| | - Takashi Kobayashi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Eiji Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan.
| | - Toshiki Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan.
| | - Kazuma Kikuchi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima-Nishifukuro, Akita, 011-0948, Japan.
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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Lotte R, Popoff MR, Degand N, Lotte L, Bouvet P, Baudin G, Cua E, Roger PM, Ruimy R. Lumbar discitis caused by Clostridium perfringens. J Clin Microbiol 2014; 52:3813-5. [PMID: 25056327 DOI: 10.1128/JCM.00983-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report here a rare case of chronic lumbar discitis caused by Clostridium perfringens in an elderly patient that was treated with a combination of β-lactams and clindamycin. Molecular analysis performed on the strain revealed an unusual toxin gene pattern.
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Santamaría Marín A, Monroy Gómez C, Clemente Tomé I, Pinardo Zabala A. Espondilodiscitis por Clostridium perfringens. Rev Clin Esp 2014; 214:286-7. [DOI: 10.1016/j.rce.2014.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022]
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Atia A, Raiyani T, Patel P, Patton R, Young M. Clostridium perfringens bacteremia caused by choledocholithiasis in the absence of gallbladder stones. World J Gastroenterol 2012; 18:5632-4. [PMID: 23112558 PMCID: PMC3482652 DOI: 10.3748/wjg.v18.i39.5632] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 04/20/2012] [Accepted: 04/22/2012] [Indexed: 02/06/2023] Open
Abstract
A 67-years-old male presented with periumbilical abdominal pain, fever and jaundice. His anaerobic blood culture was positive for clostridium perfringens. Computed tomogram scan of the abdomen and abdominal ultrasound showed normal gallbladder and common bile duct (CBD). Subsequently magnetic resonance cholangiopancreaticogram showed choledocholithiasis. Endoscopic retrograde cholangiopancreaticogramwith sphincterotomy and CBD stone extraction was performed. The patient progressively improved with antibiotic therapy Choledocholithiasis should be considered as a source of clostridium perfringens bacteremia especially in the setting of elevated liver enzymes with cholestatic pattern.
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