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Panigrahi S, Acharya A, Otta S, Puppala S. Spinal fungal abscess mimicking as potts spine. Int J Mycobacteriol 2023; 12:364-366. [PMID: 37721246 DOI: 10.4103/ijmy.ijmy_115_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Spinal epidural abscess (SEA) is a rarest form of spinal infections and is characterized by the presence of pus in the space between the dura mater, and the osseoligamentous confines of the vertebral canal. This can cause spinal injury due to direct compression or local ischemia. The major etiology of SEA is bacterial and tuberculous in endemic regions. The incidence of fungal spinal abscess is relatively low and <5% of SEA is attributable to fungi. We, here, report a case of 77-year-old known patient of chronic renal disease on hemodialysis that presented with low-back pain for 15 days and was subsequently diagnosed with SEA by magnetic resonance imaging, and causative organism was identified as Candida by culture. The abscess was surgically drained after laminectomy. The patient improved with surgery and antifungal treatment.
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Affiliation(s)
- Souvagya Panigrahi
- Department of Neurosurgery, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Abhijit Acharya
- Department of Neurosurgery, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Department of Microbiology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sumirini Puppala
- Department of Neurology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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2
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Bai AD, Findlater A, Irfan N, Singhal N, Loeb M. Cefazolin versus cloxacillin as definitive antibiotic therapy for methicillin-susceptible Staphylococcus aureus spinal epidural abscess: a retrospective cohort study. Int J Antimicrob Agents 2021; 58:106429. [PMID: 34469802 DOI: 10.1016/j.ijantimicag.2021.106429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We compared the effectiveness of cefazolin and cloxacillin as definitive antibiotic therapy for methicillin-susceptible Staphylococcus aureus (MSSA) spinal epidural abscess (SEA). METHODS This retrospective cohort study included patients with MSSA SEA from two academic hospitals in Hamilton, Ontario, Canada, between 2014 and 2020. Patients treated with cefazolin were compared to those treated with cloxacillin. Co-primary outcomes included 90-day mortality, antibiotic failure, adverse reactions and recurrence. Inverse probability of treatment weighting using propensity scores was used to balance important prognostic factors and to estimate an adjusted risk difference. RESULTS Of 98 patients with MSSA SEA, 50 and 48 patients were treated with cefazolin and cloxacillin, respectively. Mortality at 90 days was 8% and 13% in the cefazolin and cloxacillin groups, respectively (P = 0.52). The antibiotic failure rate was 12% and 19% in the cefazolin and cloxacillin groups, respectively (P = 0.41). The serious adverse reactions rate was 0% and 4% in the cefazolin and cloxacillin groups, respectively (P = 0.24). The recurrence rate was 2% and 8% in the cefazolin and cloxacillin groups, respectively (P = 0.20). The adjusted risk difference for mortality at 90 days was -1% [95% confidence interval (CI) -10% to 8%] favouring cefazolin. The adjusted risk differences for antibiotic failure, adverse reactions and recurrence were 1% (95% CI -12% to 14%), -5% (95% CI -11% to 2%) and -18% (-36% to -1%) respectively. CONCLUSION Cefazolin is likely as effective as an antistaphylococcal penicillin and may be considered as a first-line treatment for MSSA SEA.
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Affiliation(s)
- Anthony D Bai
- Health Research Methodology Program, McMaster University, Hamilton, Ontario, Canada.
| | - Aidan Findlater
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Neal Irfan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nishma Singhal
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
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Horiya M, Anno T, Kawada M, Yamada H, Takahashi K, Takenouchi H, Iwamoto H, Kawasaki F, Kurokawa K, Kaneto H, Kaku K, Tomoda K. Pyogenic psoas abscess on the dorsal side, and bacterial meningitis and spinal epidural abscess on the ventral side, both of which were induced by spontaneous discitis in a patient with diabetes mellitus: A case report. J Diabetes Investig 2021; 12:1301-1305. [PMID: 33179391 PMCID: PMC8264412 DOI: 10.1111/jdi.13461] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022] Open
Abstract
Type 2 diabetes mellitus patients are immunocompromised, particularly under poorly controlled conditions, and thereby they could develop rare inflammatory diseases, such as spontaneous discitis, pyogenic psoas abscess, spinal epidural abscess and bacterial meningitis. Herein we report a pyogenic psoas abscess on the dorsal side, and bacterial meningitis and spinal epidural abscess on the ventral side, both of which were induced by spontaneous discitis in a patient with poorly controlled type 2 diabetes mellitus. This case was very rare and interesting, because we successfully treated various infections with antibiotics over a long period of time, complicated by hyperglycemic crises, although the patient suffered severe bone destruction and required rehabilitation for a long time.
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Affiliation(s)
- Megumi Horiya
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Takatoshi Anno
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Mayuko Kawada
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Haruki Yamada
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Kaiou Takahashi
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Haruka Takenouchi
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Hideyuki Iwamoto
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Fumiko Kawasaki
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | | | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and MetabolismKawasaki Medical SchoolKurashikiJapan
| | - Kohei Kaku
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
| | - Koichi Tomoda
- Department of General Internal Medicine 1Kawasaki Medical SchoolOkayamaJapan
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4
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Tambunan D, Rana M. Increasing ear pain and headache. J Fam Pract 2020; 69:464-470. [PMID: 33176347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Visits to the family physician, a specialist, and the ED prompted us to look beyond the initial diagnosis of acute otitis media.
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Affiliation(s)
| | - Mandeep Rana
- Department of Pediatrics, Division of Pediatric Neurology and Sleep Medicine, Boston University School of Medicine, Boston Medical Center, MA, USA.
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5
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Sheoran L, Goel N, Acharya S, Adsul N, Wattal C. A rare aetiology of spinal epidural abscess. Indian J Med Microbiol 2019; 37:590-592. [PMID: 32436886 DOI: 10.4103/ijmm.ijmm_19_493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Spinal epidural abscess (SEA) due to Streptococcus pneumoniae is a rare entity, but it is associated with high mortality. Here, we describe a rare case of pneumococcal SEA in an immunocompetent adult who presented with fever, lower back pain and paresis. Central nervous system examination revealed a decreased power in bilateral lower limbs. Magnetic resonance imaging of the lumbosacral spine showed loculated pus collection in the epidural space at the level of L4-L5 vertebrae. Pus obtained following L4-L5 decompression along with blood cultures grew S. pneumoniae. The patient was treated with clindamycin and cefoperazone-sulbactam for 6 weeks, and no relapse was noted on 11 months follow-up.
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Affiliation(s)
- Lata Sheoran
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
| | - Neeraj Goel
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
| | - Shankar Acharya
- Department of Spinal Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Nitin Adsul
- Department of Spinal Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
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Ahuja K, Das L, Jain A, Meena PK, Arora SS, Kandwal P. Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy: a rare case report with literature review. Spinal Cord Ser Cases 2019; 5:62. [PMID: 31632720 PMCID: PMC6786417 DOI: 10.1038/s41394-019-0206-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Holocord spinal cord epidural abscess is an uncommon condition that may result in serious neurological complications. Prompt diagnosis and early treatment is of paramount importance for an optimum clinical outcome. This case report describes a novel technique of interval laminectomy at two sites in the thoracic spine and surgical decompression with the help of infant feeding tubes in a case of holocord spinal epidural abscess (HSEA). Case presentation An 18-year-old male presented to the emergency department with high-grade fever and low back ache of 2 weeks duration and loss of bowel and bladder control for 4 days. Neurological examination revealed intact motor power and sensation in all four limbs at presentation; however, there was a rapid deterioration to complete quadriplegia within 24 h. A diagnosis of holocord epidural abscess was made. Emergent decompression via interval thoracic laminectomy was done and appropriate antimicrobial therapy was instituted. At 10 months of follow-up, the individual showed complete neurological recovery. Discussion The technique used in this case is unique with respect to the level of laminectomy and the manoeuvre employed for pus evacuation. Complete neurological and functional recovery was achieved despite complete paralysis pre-operatively. The outcome indicates that there may be good prognosis for individuals with HSEA accompanied with neurological deficit and emergent surgical decompression.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Lakshmana Das
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Aakriti Jain
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Pradeep Kumar Meena
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Shobha S. Arora
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
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7
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Ross AB, Tang JY, Rosas HG, Bice MJ. Fluoroscopy-guided percutaneous needle aspiration of posterior epidural abscesses: a report of two cases. Spinal Cord Ser Cases 2019; 5:43. [PMID: 31632702 PMCID: PMC6786395 DOI: 10.1038/s41394-019-0190-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Spinal epidural abscesses are most commonly treated with surgical decompression and antibiotics or in specific instances managed medically with antibiotic therapy alone. Image-guided percutaneous aspiration as an alternative to surgery has only rarely been reported in the literature. Case presentation We report two cases of successful fluoroscopy-guided needle aspiration of posterior epidural abscesses. Case 1 is a 48-year-old man who presented with several days of escalating back pain and constitutional symptoms with MRI showing a posterior epidural abscess at L2-L3 causing spinal stenosis. The patient remained neurologically intact. Percutaneous needle aspiration of the collection provided dramatic pain relief with the aspirate growing methicillin sensitive Staphylococcus aureus. The patient made a full recovery on antibiotic therapy. Case 2 is an 81-year-old man who presented with worsening upper back pain and was found to have osteomyelitis/discitis with a large posterior epidural abscess in the thoracic spine. Needle drainage was performed with the sample growing Bacteroides fragilis. This patient also responded successfully to nonsurgical management with full recovery after appropriate antibiotic therapy. Discussion In carefully selected patients, image-guided needle aspiration of posterior epidural abscesses may be a viable and less invasive alternative to surgery.
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Affiliation(s)
- Andrew B. Ross
- Department of Radiology – Musculoskeletal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave. D4/330, Madison, WI 53792 USA
| | - Joseph Y. Tang
- Department of Radiology – Musculoskeletal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave. D4/330, Madison, WI 53792 USA
| | - Humberto G. Rosas
- Department of Radiology – Musculoskeletal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave. D4/330, Madison, WI 53792 USA
| | - Miranda J. Bice
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, USA
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8
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Shew W, Bell S. Unusual presentation of spinal epidural abscess and a cautionary tale of acupuncture. N Z Med J 2019; 132:69-72. [PMID: 30973862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- William Shew
- House Officer, Department of General Medicine, Auckland District Health Board, Auckland
| | - Sarah Bell
- General Medicine Consultant, Department of General Medicine, Auckland District Health Board, Auckland
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9
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Abstract
Edwardsiella tarda is commonly isolated from aquatic environments and a variety of animals. We present the first case of E. tarda bacteremia with psoas and epidural abscess. The patient was a 65-year-old woman with recurrent gastric cancer who had frequently consumed raw fish and grilled eel. She was successfully treated with antimicrobials and surgery. We also review reports published in English regarding E. tarda bacteremia in Japan and the experience at our hospital. On the basis of this review, we conclude that the major underlying disease leading to E. tarda bacteremia is malignancy and that the gastrointestinal tract is the most commonly affected organ. The overall mortality rate due to E. tarda bacteremia in our review was 38.1% (8/21). Although E. tarda bacteremia is rare, clinicians should be aware of this fatal food-borne infection.
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Affiliation(s)
- Kiyozumi Suzuki
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
| | - Mitsuru Yanai
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
| | - Yuta Hayashi
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
| | - Hiromasa Otsuka
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
| | - Kimitoshi Kato
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
| | - Masayoshi Soma
- Division of General Medicine, Department of Internal Medicine, Nihon University School of Medicine, Japan
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10
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Sunkara A, Buergler JM. A 66-Year-Old Woman with Severe Back Pain. Methodist Debakey Cardiovasc J 2018; 14:e2. [PMID: 30847016 PMCID: PMC6358170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 06/09/2023] Open
Affiliation(s)
- Anusha Sunkara
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - John M Buergler
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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11
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Chen GL, Feng TT, Xu ST, Wang JQ, Tan L, Wang JY, Ma Y, Huang GC. [A case report of Brucellosis spondylitis with epidural abscess]. Zhongguo Gu Shang 2017; 30:1151-1154. [PMID: 29457440 DOI: 10.3969/j.issn.1003-0034.2017.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Indexed: 06/08/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Gui-Cheng Huang
- Nanjing University of Chinese Medcine, Nanjing 210000, Jiangsu, China;
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12
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Goolamali SI, Carulli MT, Davies UM. Spinal Abscess and Mitral Valve Endocarditis Secondary to Asymptomatic Fusobacterium-Induced Dental Abscess. J R Soc Med 2017; 99:368-9. [PMID: 16816268 PMCID: PMC1484547 DOI: 10.1177/014107680609900721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- S I Goolamali
- Department of Rheumatology, East Surrey Hospital, Redhill, Surrey RH1 5RH, UK.
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13
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Schmitt J, Prunet B, Veyrieres JB, Gaillard T, Delarbre D, Meaudre E. [Staphylococcus aureus epidural abscess following epidural catheter placement in a patient suffering from psoriasis]. Presse Med 2017. [PMID: 28623076 DOI: 10.1016/j.lpm.2017.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J Schmitt
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France.
| | - B Prunet
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-B Veyrieres
- Hôpital d'instruction des armées Sainte-Anne, service d'imagerie médicale, boulevard Sainte-Anne, 83000 Toulon, France
| | - T Gaillard
- Hôpital d'instruction des armées Sainte-Anne, laboratoire de bactériologie, boulevard Sainte-Anne, 83000 Toulon, France
| | - D Delarbre
- Hôpital d'instruction des armées Sainte-Anne, service de médecine interne, boulevard Sainte-Anne, 83000 Toulon, France
| | - E Meaudre
- Hôpital d'instruction des armées Sainte-Anne, département d'anesthésie-réanimation, boulevard Sainte-Anne, 83000 Toulon, France
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Henriksen P, Yazdanyar N, Schmidt LS, Frederiksen MS. [Epidural abscess secondary to sinusitis]. Ugeskr Laeger 2016; 178:V10160754. [PMID: 28041546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Approximately 0.5-2% of upper viral infections are com-licated by secondary acute bacterial sinusitis and may in rare cases evolve into more serious complications such as meningitis and intracranial abscess. Symptoms are often subtle and nonspecific as fever, headache, scalp tenderness, nausea and altered mental status. In this case report of a 12-year-old boy with an epidural abscess secondary to sinusitis we intend to increase the knowledge to these rare, but potentially life-threatening complications to ensure the optimal and timely treatment.
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Meade CM, Cantos VD, Nasri H, Serbanescu M, Anderson EJ. Epidural Abscess in Lemierre׳s Syndrome. Am J Med Sci 2016; 354:325-326. [PMID: 28918841 DOI: 10.1016/j.amjms.2016.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/04/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Christina M Meade
- Department of Medicine and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Valeria D Cantos
- Department of Medicine and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Hachem Nasri
- Department of Medicine and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mara Serbanescu
- Department of Medicine and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Evan J Anderson
- Department of Medicine and Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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16
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Oki M, Ueda A, Tsuda A, Yanagi H, Ozawa H, Takagi A. Salmonella Enterica Serotype Enteritidis Vertebral Osteomyelitis and Epidural Abscess Complicated with Meningitis. Tokai J Exp Clin Med 2016; 41:169-171. [PMID: 27628612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Infection with non-typhoidal Salmonella often results in a self-limited acute gastroenteritis. Extra-intestinal Salmonella infection is relatively rare and occurs predominantly in infants and adults with significant underlying conditions. We describe a 54-year-old Japanese man with a history of heavy alcohol consumption and daily contact with a dog, who developed bacteremia complicated by vertebral osteomyelitis, spinal epidural abscess, and meningitis, due to Salmonella enterica serotype Enteritidis. This case suggests that Salmonella should be considered as an etiologic pathogen in adult patients with perivertebral infection or meningitis.
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Affiliation(s)
- Masayuki Oki
- Division of General Internal Medicine, Department of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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17
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Kaye ID, Protopsaltis TS. Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review. Bull Hosp Jt Dis (2013) 2016; 74:237-243. [PMID: 27620549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.
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18
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Gazeau P, Jaffuel S, Garo B, Ansart S, Allano V. A cervical empyema due to Panton-Valentine leukocidin Staphylococcus aureus. Med Mal Infect 2016; 46:326-7. [PMID: 27112520 DOI: 10.1016/j.medmal.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- P Gazeau
- Service de maladies infectieuses, hôpital de la Cavale-Blanche, BP 824, 29609 Brest cedex, France.
| | - S Jaffuel
- Service de maladies infectieuses, hôpital de la Cavale-Blanche, BP 824, 29609 Brest cedex, France
| | - B Garo
- Service de maladies infectieuses, hôpital de la Cavale-Blanche, BP 824, 29609 Brest cedex, France
| | - S Ansart
- Service de maladies infectieuses, hôpital de la Cavale-Blanche, BP 824, 29609 Brest cedex, France
| | - V Allano
- Service de neurochirurgie, hôpital de la Cavale-Blanche, BP 824, 29609 Brest cedex, France
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19
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Burton KR, Wang X, Dhanoa D. Holocord spinal epidural abscess in a pregnant patient presenting as premature labour: a rare presentation of an unusual diagnosis. CAN J EMERG MED 2016; 16:334-8. [PMID: 25060090 DOI: 10.2310/8000.2013.131134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despite extensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.
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Zhang Q, Koga H. Tubercular Spinal Epidural Abscess of the Lumbosacral Region without Osseous Involvement: Comparison of Spinal MRI and Pathological Findings of the Resected Tissue. Intern Med 2016; 55:695-8. [PMID: 26984093 DOI: 10.2169/internalmedicine.55.5707] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present a case of tubercular spinal epidural abscess (SEA) without osseous involvement that mimicked an acute bacterial abscess. This case manifested quite unusual findings not only radiographically, but also clinically compared with previously reported cases of tubercular SEA.
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Affiliation(s)
- QingLong Zhang
- Department of Minimally Invasive Spinal Surgery, Zhangzhou Zhengxing Hospital, China
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21
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Abstract
A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment.
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Affiliation(s)
- Jr-Han Liou
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing, and Management.
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22
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital, Landshut 84034, Germany
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Skaaby T, Fink J, Dragsted UB. [Spinal epidural abscesses are rare and warrant fast intervention]. Ugeskr Laeger 2014; 176:V08120483. [PMID: 25497638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A spinal epidural abscess is a rare infectious disease that warrants urgent treatment. Symptoms involve a classic triad of fever, backache and neurological deficits but all the symptoms are rarely seen at the first contact. The low incidence and the non-specific symptoms can delay the diagnosis, resulting in grave neurological sequelae and death. Common risk factors are diabetes mellitus and intravenous drug abuse. Successful treatment relies on a multidisciplinary approach. We describe a case of spinal epidural abscesses in a previously healthy young man without known risk factors.
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Affiliation(s)
- Tea Skaaby
- Forskningscenter for Forebyggelse og Sundhed, Glostrup Hospital, Ndr. Ringvej 57, 2600 Glostrup.
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24
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Awater SPJ, Gisolf EH, Richter C. A small abscess with severe complications. Neth J Med 2014; 72:373-377. [PMID: 25178772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- S P J Awater
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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Miyamoto T, Nakatani T, Narai Y, Sakakibara M, Hashimoto T, Saito Y. [Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster]. Masui 2014; 63:353-357. [PMID: 24724451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.
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Bucheit J, Collins R, Joshi P. Methicillin-resistant Staphylococcus aureus epidural abscess treated with ceftaroline fosamil salvage therapy. Am J Health Syst Pharm 2014; 71:110-3. [PMID: 24375602 DOI: 10.2146/ajhp130246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of a patient who received ceftaroline fosamil as salvage therapy for a methicillin-resistant Staphylococcus aureus (MRSA) epidural abscess is reported. SUMMARY A 48-year-old white woman arrived at the emergency department (ED) with an altered mental status. She had been to the ED two days prior with complaints of sudden-onset and worsening neck pain. She had a history of compacted disks in her neck secondary to a motor vehicle accident that occurred three years prior but that did not require surgical intervention. Computed tomography and magnetic resonance imaging scans confirmed an epidural abscess with wound cultures growing MRSA. The admitting physician indicated that the patient was severely septic. Acyclovir, ceftriaxone, and vancomycin were initiated for empirical treatment due to suspected meningitis. Paired blood cultures also continued to grow MRSA in four of four bottles collected four days after admission. This indicated that antimicrobial therapy was not successfully eradicating the MRSA found in the blood and the patient's clinical status was deteriorating. Ceftaroline was used as salvage therapy, resulting in rapid clearance of MRSA from the blood and the patient becoming afebrile in 24 hours. Blood culture tests on hospital day 11-one day after ceftaroline initiation-were clear of MRSA. The patient was discharged to a long-term-care facility and ordered ceftaroline fosamil 600 mg i.v. every 12 hours for four weeks. CONCLUSION A MRSA epidural abscess in a 48-year-old woman was successfully treated with ceftaroline fosamil 600 mg every 12 hours as salvage therapy.
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Affiliation(s)
- John Bucheit
- John Bucheit, Pharm.D., is Pharmacy Practice Resident, Pharmacy Department; Rebeccah Collins, Pharm.D., is Residency Director, Antimicrobial Stewardship; and Prajwol Joshi, M.D., is Infectious Disease Physician, Infectious Disease, Memorial Regional Medical Center, Mechanicsville, VA
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Abstract
The formation of spinal epidural abscess following acupuncture is very rare. We herein report the case of a 54-year-old woman who presented with progressive low back pain and fever with a root sign. She underwent surgical decompression, with an immediate improvement of the low back pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture. The characteristics of spinal epidural abscess that develop after acupuncture and how to prevent such complications are also discussed.
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Affiliation(s)
- Chih-Wei Yang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C
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Affiliation(s)
- Radhika Dasararaju
- Transfusion Medicine, The University of Alabama at Birmingham, Birmingham.
| | - Wickliffe J Many
- Infectious Disease Department, The University of Alabama at Birmingham, Montgomery
| | - Jyoti S Samant
- Infectious Disease Department, The University of Alabama at Birmingham, Montgomery
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29
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Kavanagh RG, Burke NG, Green C, Synnott K. Hip pain and cauda equina syndrome. Ir Med J 2013; 106:244-245. [PMID: 24282896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acute cauda equina syndrome secondary to a spinal epidural abscess as a result of a psoas abscess is very uncommon. We report the case of a 64-year old with a 6-day history of left hip pain, which progressively worsened until she presented to the emergency department with systemic infective symptoms and classical acute cauda equina syndrome. A good clinical outcome was achieved by urgent posterior decompression, followed by CT-guided drainage of the psoas abscess and appropriate antibiotic treatment.
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Affiliation(s)
- R G Kavanagh
- Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin 7.
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Bozzola E, Bozzola M, Magistrelli A, Calcaterra V, Larizza D, Lancella L, Villani A. Paediatric tubercular spinal abscess involving the dorsal, lumbar and sacral regions and causing spinal cord compression. Infez Med 2013; 21:220-223. [PMID: 24008856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tubercular spinal localization is very rare (5%) in paediatric age. We report the unusual case of a child with a history of bacillus Calmette-Guerin vaccination who presented with lymphadenitis in the absence of pulmonary involvement. Despite appropriate anti-tubercular therapy, the patient developed spinal tuberculosis with cord compression. Urgent surgical decompression was performed: laminectomy was done at D3-D5 levels and the higher abscess was then flushed using a catheter, decompressing the cauda equina. Our findings suggest that diagnosis of tuberculosis should be considered even in light of anamnestic vaccination at birth, and that surgical treatment should be rapidly provided in the event of spinal cord compression to avoid devastating sequelae.
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Affiliation(s)
- Elena Bozzola
- Department of Pediatric, Pediatric and Infectious Diseases Unit, Bambino Gesu Childrens Hospital, IRCCS, Rome; Department of Internal Medicine, University of Pavia, Pavia; Department of Radiology, Bambino Gesu Childrens Hospital, IRCCS, Rome, Italy
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31
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Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z. Spinal epidural abscess: in search of reasons for an increased incidence. Isr Med Assoc J 2013; 15:493-496. [PMID: 24340840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Spinal epidural abscess (SEA) is a rare disease with a potentially devastating outcome, and a reported incidence traditionally estimated at 0.2-2 cases/10,000 hospital admissions. Since the implementation in October 2007 of a program to increase medical personnel's awareness of SEA, we have documented a sharp increase in the incidence of SEA at our medical center OBJECTIVES To investigate the cause of the increased incidence of SEA. METHODS All cases diagnosed with SEA during the period 1998-2010 were retrospectively reviewed. Cases diagnosed before 2007 were compared with those diagnosed thereafter. RESULTS From January 1998 to October 2007 SEA was diagnosed in 22 patients (group A), giving an annual incidence of 0.14-0.6 cases per 10,000 admissions. During the period November 2007 to April 2010, 26 additional patients were diagnosed (group B), yielding an incidence of 0.81-1.7 cases per 10,000 admissions (P < 0.01). The two groups did not differ significantly in epidemiological, clinical or laboratory characteristics, or in the causative bacteria isolated. CONCLUSIONS The threefold rise in the incidence of SEA observed at a tertiary medical center in Tel Aviv since November 2007 was not explained by different host characteristics or by more virulent bacterial isolates. We suggest that heightened awareness of the clinical presentation and timely utilization of MR imaging has resulted in more cases being identified.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Noga Carmi-Oren
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Avi Hassner
- Quality Control and Risk Management, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mervyn Shapiro
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Zvi Lidar
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Tomek M, Cheshire NJW, Rudarakanchana N, Samarasinghe D, Bicknell CD. Salmonella mycotic thoracoabdominal aortic aneurysm associated with chronic lymphocytic leukemia. Ann Vasc Surg 2013; 27:1186.e17-21. [PMID: 23981545 DOI: 10.1016/j.avsg.2012.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/05/2012] [Accepted: 11/16/2012] [Indexed: 11/18/2022]
Abstract
Non-typhoidal Salmonella infections typically cause self-limiting gastroenteritis. However, extraintestinal focal infections, including mycotic aneurysms of the aorta, can also occur. We present the case of a 71-year-old man with chronic lymphocytic leukemia (CLL) and a large type V thoracoabdominal mycotic aneurysm infected with Salmonella enteritidis, complicated by thoracolumbar spondylodiscitis, paravertebral collections, and epidural abscess. This is the first report of Salmonella aortitis in the setting of CLL, and the unusual extent of local infective invasion seen here with Salmonella enteritidis infection raises a suspicion of CLL-related immunosuppression as a direct predisposing factor. This case illustrates the need to consider the possibility of an immune defect, even in CLL patients with normal leukocyte counts. The underlying mechanisms are unclear, but are likely to involve defects in cell-mediated immunity, thought to be of particular importance in invasive infections with intracellular pathogens such as Salmonella spp.
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MESH Headings
- Aged
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/immunology
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/immunology
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/therapy
- Aortitis/diagnosis
- Aortitis/immunology
- Aortitis/microbiology
- Aortitis/therapy
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Debridement
- Discitis/microbiology
- Epidural Abscess/microbiology
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Risk Factors
- Salmonella Infections/diagnosis
- Salmonella Infections/immunology
- Salmonella Infections/microbiology
- Salmonella Infections/therapy
- Salmonella enteritidis/isolation & purification
- Tomography, X-Ray Computed
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Affiliation(s)
- Michal Tomek
- Imperial Vascular Unit, St. Mary's Hospital, Imperial College London, London, UK
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33
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Larsen AK. [Thoracic epidural abscess without neurological deficits]. Ugeskr Laeger 2013; 175:584-585. [PMID: 23608011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This case report describes a patient, who had a thoracic epidural abscess without neurological deficits. The patient had epidural analgesia due to a flail chest trauma. After 14 days he developed radicular pain during bolus injection through the catheter, as well as fever and elevated white cell count and C reactive protein. An acute magnetic resonance imaging revealed a thoracic epidural abscess. The initial treatment was high dose antibiotic therapy followed by an acute surgical laminectomy. The patient never developed any neurological signs and was kept on high dose oral opioids and gabapentin in order to secure sufficient analgesia.
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Affiliation(s)
- Anne-Karina Larsen
- Anæstesiologisk Afdeling, Sygehus Lillebælt, Vejle Sygehus, Kabbeltoft 25, 7100 Vejle, Denmark.
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Kumar A, Jain P, Singh P, Divthane R, Badole CM. Citrobocter kasori spinal epidural abscess: a rare occurrence. J Indian Med Assoc 2013; 111:67-68. [PMID: 24000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.
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Affiliation(s)
- Ashok Kumar
- Department of Orthopaedics and Traumatology, Mahatma Gandhi Institute of Medical Sciences, Sewagram 442102, India
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Abstract
BACKGROUND CONTEXT Postoperative spondylodiscitis (PSD) is a known complication of lumbar disc surgery. The etiology of the disease is usually bacterial, but several uncommon infectious agents have also been described; however, there are no reports about postoperative colonization with Mycobacterium bovis bacille Calmette-Guérin after lumbar discectomy. PURPOSE To describe the case of PSD caused by M. bovis BCG, and to discuss diagnostic and therapeutic interventions as well as possible pathogenic mechanisms of the disease. STUDY DESIGN Case report and review of the literature. METHODS A 31-year-old man was operated on because of L4-L5 lumbar disc herniation. Two months later, the patient presented with gradual increase of back pain, and magnetic resonance imaging confirmed PSD. He started to receive antibacterial treatment and was reoperated on because of progressive neurological deficits due to epidural abscess. Neurological status improved, but a fistula developed with intermittent pus drainage from the operative scar. RESULTS Microbiological cultures were repeatedly obtained from the pus, but all the initial stains and cultures were negative. Four months after the reoperation, the culture for M. bovis BCG from the pus appeared to be positive. The patient received antituberculosis regimen, including isoniazid, rifampin, ethambutol, and ofloxacin. The clinical symptoms resolved, and antituberculosis treatment was discontinued after 14 months. CONCLUSIONS Mycobacterium bovis BCG must be considered in the differential diagnosis of PSD. Microbiological analysis and radiological studies are vital components in diagnosis; if there is any suspicion of BCG osteomyelitis, proper diagnostic and therapeutic management must be instituted without delay to avoid an unfavorable outcome.
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Affiliation(s)
- Tõnu Rätsep
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
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36
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Abstract
Bacteroides fragilis is a rare causative agent of spondylodiscitis. The pathophysiology of B. fragilis in spondylodiscitis remains largely unclear because of its rare occurrence. We herein report a case of spondylodiscitis complicated by an epidural abscess and meningitis; B. fragilis was detected in the blood of the patient. Moreover, the patient had a splenic abscess that was confirmed on magnetic resonance imaging. The patient completely recovered with antimicrobial therapy alone.
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Affiliation(s)
- Takeshi Kawakami
- Department of General Internal Medicine, Tsukuba Medical Center Hospital, Japan
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Yaita K, Komatsu M, Oshiro Y, Yamaguchi Y. Postoperative meningitis and epidural abscess due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae: a case report and a review of the literature. Intern Med 2012; 51:2645-8. [PMID: 22989843 DOI: 10.2169/internalmedicine.51.8068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
17-year-old man had been involved in a traffic accident. He underwent a bilateral craniotomy with artificial dura mater to remove bilateral acute subdural hematomas. Seven months later, a right cranioplasty was performed using frozen auto-bone, and he developed extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae meningitis and an epidural abscess. Since his general status was poor, we could not remove the foreign body (artificial dura mater). He was successfully treated with meropenem and chronic suppression with oral trimethoprim-sulfamethoxazole. By describing this case and the results of a review of the pertinent literature, we discuss the importance of ESBL-producing Klebsiella pneumoniae meningitis in posttraumatic/postoperative patients.
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Affiliation(s)
- Kenichiro Yaita
- Division of Infectious Diseases, Kenwakai Otemachi Hospital, Japan.
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Zhang L, Cai WH, Huang B, Chen LW, Zhang N, Ni B. Single-stage posterior debridement and single-level instrumented fusion for spontaneous infectious spondylodiscitis of the lumbar spine. Acta Orthop Belg 2011; 77:816-822. [PMID: 22308629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spontaneous infectious spondylodiscitis (SIS) is an uncommon condition. The purpose of this retrospective study of 10 adult patients (6 males and 4 females, average age 52 years), all with lumbar SIS and epidural abscess, was to analyze the efficacy of single-stage posterior debridement plus single-level interbody grafting with autologous bone, and transpedicular screw-rod instrumentation. The mean follow-up period was 43 months, with a minimum of 30 months. The back pain was relieved within 3 to 8 days after surgery. Neurologic deficits, present in 5 cases, all improved. Solid fusion was achieved at 6 months in all 10 cases. The mean VAS for pain improved from 7.5 to 1.6, the mean Oswestry Disability Index from 57.8% to 8.1%. The mean physical component of SF-36 (PCS) improved from 32.4% to 54.7%, the mean mental component of SF-36 (MCS) improved from 33.8% to 57.2%. All these changes were significant (p < 0.001). No recurrence of infection was noted. The outcome was quite satisfactory in terms of fusion rate and quality of life.
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Affiliation(s)
- Liang Zhang
- Dept of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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39
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Kaswan KK, Vanikar AV, Feroz A, Patel HV, Gumber M, Trivedi HL. Nocardia infection in a renal transplant recipient. Saudi J Kidney Dis Transpl 2011; 22:1203-1204. [PMID: 22089782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Opportunistic infection occurs in up to 20% renal transplant patients and is associated with a high mortality. We report a 47-year-old diabetic female with 1-year-old deceased donor renal allograft on triple drug immunosuppression. She developed cytomegalovirus retinitis at ten months post-transplant followed by nocardiasis manifested by hemiparesis with comatose state due to lumbar epidural and multiple brain abscesses, in spite of immediately curtailing immunosuppression. She recovered with linezolid and cotrimoxazole and was discharged two weeks later. She is maintaining stable graft function with serum creatinine 1.4 mg/dL on cyclosporin 2.5 mg/kg/day and prednisone10 mg/day with maintenance therapy for nocardiasis.
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Affiliation(s)
- K K Kaswan
- Department of Nephrology and Transplantation Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases & Research Centre, Ahmedabad, Gujarat, India
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40
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Ellanti P, Morris S. Spontaneous spinal epidural abscess. Ir Med J 2011; 104:281-282. [PMID: 22132600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.
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Affiliation(s)
- P Ellanti
- Department of Trauma Orthopaedics, AMNCH, Tallaght, Dublin 24.
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41
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Tuyumu K, Nakaya A, Miyauchi J, Okamoto S. [Epidural abscess in the spine extended from pulmonary zygomycosis during consolidation chemotherapy for acute lymphoblastic leukemia]. Rinsho Ketsueki 2011; 52:718-721. [PMID: 21897081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 37-year-old woman with acute lymphoblastic leukemia developed fever and pneumonia during persistent neutropenia after consolidation chemotherapy. Pneumonia was rapidly followed by the formation of abscess in adjacent subcutaneous tissues, muscles and bones. She subsequently developed sudden onset of paraplegia and loss of all sensation below Th4. Epidural abscess was detected by MRI. Emergency drainage was performed, but the patient died 4 days after the operation. Rhizopus oryzae grew from culture of the epidural abscess. Since the incidence of zygomycosis appears to have increased over the recent years, clinicians should be aware of the possibility of zygomycosis in case of any infection that is resistant to antibiotics.
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Affiliation(s)
- Keiko Tuyumu
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital
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42
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Chen SH, Chang WN, Lu CH, Chuang YC, Lui CC, Chen SF, Tsai NW, Chang CC, Chien CC, Huang CR. The clinical characteristics, therapeutic outcome, and prognostic factors of non-tuberculous bacterial spinal epidural abscess in adults: a hospital-based study. Acta Neurol Taiwan 2011; 20:107-113. [PMID: 21739389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Nontuberculous bacterial spinal epidural abscess (SEA) is a serious infectious disease of spines. Despite proper management, SEA remains a disease of high morbidity. The epidemiological data in southern Taiwan is still lacking. METHODS We analyzed the clinical features, laboratory data, magnetic resonance imaging findings, and therapeutic results of 45 bacterial SEA patients, collected during a study period of six years (2003- 2008). RESULTS The 45 adult SEA patients, 32 were men and 13 women, aged 17-81 years (mean = 62 years). Thoracic and lumbosacral spines were the most commonly affected segments. Staphylococcus aureus was the most commonly implicated pathogen, accounting for infections in 67% (29/43) of the culture-proven cases, and 41% (12/29) of the S. aureus strains were oxacillin resistant. Gram-negative pathogens were implicated in 30% (13/43) of the culture-proven cases. Of the 45 patients, 19 underwent antibiotic treatment alone and 26 underwent medical and surgical treatments. The therapeutic results showed that 28 patients had a good prognosis and 17 had a poor prognosis. The significant prognostic factors included higher age, presence of diabetes mellitus and chronic heart disease, and initial presentation of altered consciousness. CONCLUSION S. aureus was the most commonly implicated pathogen of adult SEA, and most S. aureus strains were oxacillin resistant. A relatively high incidence of Gram-negative infection was observed in this study. The epidemiological characteristics of the implicated pathogens must receive special consideration when selecting the empirical antibiotics. Despite adequate management, many adults with bacterial SEA had a high incidence of poor prognosis.
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Affiliation(s)
- Shang-Hang Chen
- Department of Neurology, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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43
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Goto K, Ohi T, Namba A, Uemura N, Kitaguchi H. [Successful treatment of methicillin-resistant staphylococcus aureus meningitis by intrathecal injection of vancomycin]. Brain Nerve 2011; 63:417-421. [PMID: 21441646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 70-year-old Japanese man developed fever, headache, and lumbago, presumably due to an epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) in the L5-S2 region. On the night of admission to our hospital, he showed disorientation to places and abnormal eating behavior, indicating a complication of MRSA meningitis. Cerebrospinal fluid (CSF) examination confirmed this diagnosis. Although he was treated with venous infusion of vancomycin and meropenem, the CSF culture remained positive for MRSA even a week after the treatment, and Gram-positive cocci were also seen in the CSF. An intrathecal injection of vancomycin (10mg/day) was subsequently added, which resulted in absence of the organism on Gram-stained CSF smear and CSF culture a week later. His condition improved without any adverse effects. Vancomycin cannot freely penetrate the blood-brain barrier (BBB); therefore, when administered intravenously, its concentration in the CSF is insufficient. Therefore, intrathecal injection of vancomycin is necessary to achieve the desired bacteriocidal level in the CSF. Thus, intrathecal administration of vancomycin seems a very effective and safe treatment for MRSA meningitis.
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Affiliation(s)
- Kazuya Goto
- Department of Neurology, Kurashiki Central Hospital,Miwa, Kurashiki-city, Okayama, Japan
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44
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Abstract
Spinal infection may involve the vertebrae, the intervertebral discs, and the adjacent intraspinal and paraspinal soft tissues. It often starts with subtle and insidious clinical signs and symptoms and may development to a debilitating and even life threatening disease. Spinal infections occur with increasing incidence and are nowadays a disease of everyday's practice for physicians treating spinal disorders. Traditionally, conservative treatment consisting of antibiosis and immobilisation is considered the first tier therapy. However, due to a considerably high rate of vertebral column instability or neurological impairment caused by the infected tissue, comprehensive experience with surgical measures have been acquired over the last decades. Thanks to tremendous improvements of surgical implants and techniques, surgical treatment has already begun to challenge conservative treatment to eventually become the first tier therapy for spinal infections in the future. This review seeks to give an overview of epidemiology, pathogenesis, diagnostic evaluation, and current nonsurgical and surgical therapy of spinal infections on the basis of the existing literature, which consists largely of retrospectively acquired data of single-centre experience with sample sizes of less than 100 patients treated with individually defined indications and treatment algorithms, and followed with various outcome parameters.
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Affiliation(s)
- M Stoffel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität Munchen, Munich, Germany
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45
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Ducoulombier V, Dehecq E, Luraschi H, Prudhomme C, Bessard D, Houvenagel E. [Kingella kingae spondylodiscitis in an adult]. Med Mal Infect 2010; 41:110-2. [PMID: 21093187 DOI: 10.1016/j.medmal.2010.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/05/2010] [Accepted: 09/30/2010] [Indexed: 11/20/2022]
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46
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Shaoqi H, Lixing L, Chengxuan T, Guojing Y. Epidural abscess T5T8 due to methicillin-resistent staphylococcus aureus in an immunocompetent patient. Acta Orthop Belg 2010; 76:706-708. [PMID: 21138231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 28-year-old man was admitted with severe thoracic pain, a body temperature of 37.20, paraplegia and sphincter disturbances. MRI revealed an epidural abscess T5T8. A decompressive laminectomy T5T8 was performed and the abscess was removed. A methicillin-resistent Staphylococcus aureus was cultured. Vancomycin was administered. Six months later muscle testing showed values from 3/5 to 4/5. MRI is the first choice diagnostic tool. Laminectomy, drainage and intravenous antibiotics constitute the basic treatment. Antibiotics alone can be sufficient in case of whole spine involvement, lumbosacral localization without neurological symptoms, fixed neurological deficit, complete paralysis for more than 72 hours, or severe concomitant medical problems.
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Affiliation(s)
- He Shaoqi
- Department of Orthopaedic Surgery, Third affiliated Hospital of Wenzhou Medical School, Wenzhou, Zhejiang, China
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47
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El Baaj M, Lazrak K, Tabache F, Hassikou H, Hadri L. [Citrobacter freundii spondylitis and sickle cell disease: a case in Morocco]. Med Trop (Mars) 2010; 70:387-389. [PMID: 22368940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Infectious complications of sickle cell disease are common and can be serious and difficult to diagnose. Epidemiological aspects of these infections are well documented. The most common germ in children is pneumococcus followed by Haemophilus influenzae and minor salmonella. In adults gram-negative germs including minor salmonella are the most frequent. The purpose of this report is to describe a case of a Citrobacter freundii spondylitis with prevertebral abscess extending to dorsal and lumbar spinal areas. Diagnosis was made during work-up for persistent vaso-occlusive manifestations. Treatment consisted of percutaneous lumbar drainage associated with antibiotherapy.
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Affiliation(s)
- M El Baaj
- Service de médecine interne, Hôpital Militaire Moulay Ismail, Meknès, Maroc.
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48
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Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 2010; 19:575-82. [PMID: 19937064 PMCID: PMC2899831 DOI: 10.1007/s00586-009-1216-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 10/10/2009] [Accepted: 11/05/2009] [Indexed: 12/19/2022]
Abstract
The aim of this study is to determine the predictive values of laboratory indicators of pyogenic vertebral osteomyelitis (PVO) and a potential cure if the microorganism cannot be identified. Forty-five consecutive patients with PVO were enrolled. Antibiotic therapy with or without surgery was performed according to microorganism. In the negative-culture (NC) group, cefazolin was administered in cases of hematogenous PVO, and vancomycin was administered in cases of postoperative or procedure-related PVO. The clinical, laboratory, and radiological findings were followed up with regard to an appropriate response to antimicrobial therapy. Nine patients were treated with antibiotics alone. We were able to identify the microorganism in 34 cases (75.6%). Ten cases in NC group were cured without recurrence, but one was not. Identification of the microorganisms did not have any significant influence on the treatment outcome, duration of antibiotic administration or normalization of laboratory profiles. For erythrocyte sedimentation rate (ESR) values over 55 mm/h and C-reactive protein (CRP) values of 2.75 mg/dL at fourth week after antibiotic administration by means of ROC curve analysis, we expect significantly high rates of treatment failure by Pearson chi(2) test (chi(2) = 4.344, Odds ratio = 5.15, p = 0.037, 95% CI 1.004-26.597). Even in patients with negative culture findings, it is expected that a good outcome will be achieved by the administration of cefazolin or vancomycin for about 6 weeks. It is concluded that antibiotics selected according to the etiological setting can be initiated without the need to start empirical antibiotics. In every instance at fourth week after the initiation of antibiotic therapy, the values of CRP and ESR can provide meaningful information regarding whether clinicians need to reevaluate the effectiveness of antibiotics by performing follow-up imaging studies and monitoring the patient's clinical manifestations.
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Affiliation(s)
- Sang Hoon Yoon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea
| | - Sang Ki Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea
| | - Yong Jun Jin
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
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Starakis I, Mazokopakis EE, Bassaris H. Unusual manifestations of brucellosis: a retrospective case series in a tertiary care Greek university hospital. East Mediterr Health J 2010; 16:365-370. [PMID: 20795417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Brucellosis remains a diagnostic puzzle. We retrospectively studied the case notes of 105 patients with brucellosis who were admitted in the Department of Internal Medicine of the University of Patras Hospital, a tertiary care institution serving an extended rural area in western Greece, from 2003 to 2006. Five unusual causes of brucellosis were identified: hepatic, epidural and thyroid abscesses, intrahepatic cholestatic liver disease and pancytopenia. Virtually every human organ and system can be involved in brucellosis, which highlights the need to include brucellosis in the differential diagnosis, especially in endemic areas.
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Affiliation(s)
- I Starakis
- Department of lnternal Medicine, University of Patras Hospital, Rion, Greece.
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50
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Kumar A, Singh AK, Badole CM, Patond KR. Tubercular epidural abscess in children: report of two cases. Indian J Tuberc 2009; 56:217-219. [PMID: 20469734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Tubercular spinal epidural abscess (SEA) is an uncommon infectious occurrence. SEA was first described in 1761. Clinical prospects of tubercular SEA are graver, if not promptly diagnosed and treated appropriately. We present two cases of spinal epidural abscess of tubercular etiology who progressed to paraplegia over the course of disease. MRI pointed towards an epidural abscess in the dorsal spine. Histopathological analysis revealed SEA, tubercular in nature in both cases. Patients responded to surgical decompression and anti-tubercular therapy (ATT). Such type of clinical entities has least been documented.
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Affiliation(s)
- Ashok Kumar
- Department of Orthopaedics, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra.
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