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IDCases 2024() is a gram positive, coagulase-negative (CoNS) that occurs as a commensal pathogen on the human skin. It recently has been recognized in causing nosocomial...
() is a gram positive, coagulase-negative (CoNS) that occurs as a commensal pathogen on the human skin. It recently has been recognized in causing nosocomial infections involving the bloodstream, urinary tract, heart, bone, and joints, particularly in immunosuppressed patients or individuals with prosthetic devices. Previously, was underreported as it was difficult to identify in the clinical microbiology laboratory; however, due to advances in molecular identification methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), more clinical cases are being identified in human isolates and appropriately treated. osteoarticular infections are usually associated with polymicrobial infections and presence of orthopedic prostheses in immunocompromised adults. This pathogen has an even rarer presentation of bone and joint infections (BJIs) in immunocompetent individuals without orthopedic devices. Our case is of a 65-year-old immunocompetent male with diet-controlled diabetes mellitus type 2 and end-stage renal disease (ESRD) on hemodialysis who presented with worsening mid-thoracic pain after a ground-level fall and was diagnosed with biopsy-proven thoracic discitis/osteomyelitis, associated with recurrent catheter-related bloodstream infection (CRBSI). It illustrates the importance of recognizing as an emerging human pathogen, even in immunocompetent individuals without orthopedic hardware, requiring prompt targeted treatment of native BJIs to prevent unfavorable outcomes.
PubMed: 38681075
DOI: 10.1016/j.idcr.2024.e01962 -
Radiology Case Reports Jul 2024Vertebral osteomyelitis is a well-documented disease entity in literature with various known etiologies. However, vertebral diskitis-osteomyelitis secondary to an...
Vertebral osteomyelitis is a well-documented disease entity in literature with various known etiologies. However, vertebral diskitis-osteomyelitis secondary to an infected aortic aneurysm is an uncommon and life-threatening complication. We present the case of a 65-year-old male patient who presented with chronic low back pain that acutely worsened for 1 to 1.5 months and was diagnosed with vertebral diskitis-osteomyelitis secondary to a contiguous infection from an adjacent mycotic aortic aneurysm. To our knowledge, this is one of the few cases reported of vertebral diskitis-osteomyelitis secondary to mycotic aortic aneurysm. We discuss the findings on CT and MRI, as well as the value of imaging in guiding management.
PubMed: 38680736
DOI: 10.1016/j.radcr.2024.02.039 -
The American Journal of Case Reports Apr 2024BACKGROUND Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and...
BACKGROUND Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and management are required to prevent long-term and irreversible complications, including spinal deformities and vertebral instability. CASE REPORT This report is of a 21-month-old girl with a 3-week history of difficulty in walking and constipation due to L1-L2 spondylodiscitis following a gluteal skin burn. The family had sought medical advice multiple times, but results of all investigations were unremarkable. Her initial spine X-ray was negative but her spine magnetic resonance imaging (MRI) showed a picture suggestive of spondylodiscitis, which then responded to empiric treatment with broad-spectrum antibiotics. The patient showed complete resolution of clinical symptoms and her bowel habits came back to normal after 6 months of complete antibiotics treatment. Her repeat spine MRI showed a significant improvement of her spondylodiscitis. CONCLUSIONS This report has highlighted the importance of rapid diagnosis and management of infantile spondylodiscitis and the challenging approach to treatment when no infectious organism can be identified, as well as the early initiation of antibiotics therapy when appropriate in pediatric patients to avoid serious neurological complications associated with spondylodiscitis. Thus, it is essential to assess children with refusal to walk, gait problems, or back discomfort, especially when they are associated with high inflammatory markers.
Topics: Humans; Female; Discitis; Infant; Anti-Bacterial Agents; Magnetic Resonance Imaging; Early Diagnosis; Lumbar Vertebrae
PubMed: 38669213
DOI: 10.12659/AJCR.943010 -
Journal of Thoracic Imaging Apr 2024The objective of this study is to identify and detail the radiologic manifestations of surgical site and disseminated Mycobacterium chimaera (MC) infection. The aim is...
PURPOSE
The objective of this study is to identify and detail the radiologic manifestations of surgical site and disseminated Mycobacterium chimaera (MC) infection. The aim is to facilitate early identification and diagnosis of MC, considering its indolent nature and the challenges involved in clinically and pathologically establishing the diagnosis.
PATIENTS AND METHODS
This was a retrospective cohort study reviewing computed tomography (CT), positron emission tomography (PET)/CT, and magnetic resonance imaging examinations in patients over the age of 18 years with a history of open heart surgery and a clinical or pathologic diagnosis of MC. Two radiology residents, a fellowship-trained nuclear medicine radiologist, and a fellowship-trained cardiothoracic radiologist performed consensus reads to determine the imaging findings seen in MC infection.
RESULTS
Twenty-five patients were included. Localized, surgical site infection was more common than disseminated disease. Typical CT findings included peristernal soft tissue thickening, sinus tracts often extending to the cutaneous surface, slowly enlarging fluid collections, and sternal osteolysis. PET/CT findings demonstrated hypermetabolic activity in nearly all patients localized to sites of infection. Imaging findings for disseminated infection included hepatosplenomegaly, lymphadenopathy, involvement of the central nervous system, discitis/osteomyelitis, and distant abscesses.
CONCLUSIONS
Imaging plays a vital role in suggesting possible surgical sites and disseminated MC infection acquired from open heart surgery. Radiologists must keep a high index of suspicion given the indolent nature and subtle imaging change over time. PET/CT is most useful in diagnosis and helps in differentiating between a sterile postoperative fluid collection or scarring and active MC infection and helps provide a target for debridement.
PubMed: 38662632
DOI: 10.1097/RTI.0000000000000779 -
Cryptogenic Stroke Complicated by Infective Endocarditis: Exploring the Multidisciplinary Interplay.Cureus Apr 2024Infective endocarditis (IE) poses a significant clinical challenge due to its non-specific symptoms and variety of complications. Complications can include ischaemic...
Infective endocarditis (IE) poses a significant clinical challenge due to its non-specific symptoms and variety of complications. Complications can include ischaemic stroke, valve dysfunction, discitis, and osteomyelitis, highlighting the complexity of IE management. We present a case of a male in his 40s, admitted with an ischaemic stroke, eventually being found to have underlying IE with a plethora of complications. This case highlights the importance of collaboration among specialists to form a multidisciplinary team, which is essential for the effective delivery of care. Furthermore, there is a critical need to explore the psychological impact of IE on patient outcomes, advocating for a holistic approach that considers psychological well-being alongside medical management. Future research should address these underexplored facets to improve patient care and outcomes in IE.
PubMed: 38659712
DOI: 10.7759/cureus.58945 -
Cureus Mar 2024Intramedullary spinal cord abscess is a rare neurological condition, not commonly suspected and often misdiagnosed. Even after a prompt diagnosis and treatment, most...
Intramedullary spinal cord abscess is a rare neurological condition, not commonly suspected and often misdiagnosed. Even after a prompt diagnosis and treatment, most patients persist with permanent neurological deficits. In adults, factors such as immunocompromised, intravenous drug use, endocarditis, and sepsis could be associated with its development. In this study, we present the case of a 63-year-old male patient who developed a chronic cervical intramedullary spinal cord abscess after being treated for multiple abscesses in the paravertebral and psoas muscles. A diagnosis of cervical intramedullary spinal cord abscess secondary to osteomyelitis and discitis was made. He underwent a two-stage cervical surgery, with drainage of the abscess, spinal stabilization, and intravenous antibiotics. Although rare, vertebral osteomyelitis and discitis may be related to its development. Early diagnosis, prompt abscess drainage, and appropriate antibiotic therapy are of utmost importance to improve prognosis and minimize the long-term sequelae and complications of permanent neurological deficits.
PubMed: 38638746
DOI: 10.7759/cureus.56477 -
Journal of Vascular and Interventional... Jun 2024To determine whether sampling of the disc or bone is more likely to yield positive tissue culture results in patients with vertebral discitis and osteomyelitis (VDO). (Comparative Study)
Comparative Study
PURPOSE
To determine whether sampling of the disc or bone is more likely to yield positive tissue culture results in patients with vertebral discitis and osteomyelitis (VDO).
MATERIALS AND METHODS
Retrospective review was performed of consecutive patients who underwent vertebral disc or vertebral body biopsy at a single institution between February 2019 and May 2023. Inclusion criteria were age ≥18 years, presumed VDO on spinal magnetic resonance (MR) imaging, absence of paraspinal abscess, and technically successful percutaneous biopsy with fluoroscopic guidance. The primary outcome was a positive biopsy culture result, and secondary outcomes included complications such as nerve injury and segmental artery injury.
RESULTS
Sixty-six patients met the inclusion criteria; 36 patients (55%) underwent disc biopsy, and 30 patients (45%) underwent bone biopsy. Six patients required a repeat biopsy for an initially negative culture result. No significant demographic, laboratory, antibiotic administration, or pain medication use differences were observed between the 2 groups. Patients who underwent bone biopsy were more likely to have a history of intravenous drug use (26.7%) compared with patients who underwent disc biopsy (5.5%; P = .017). Positive tissue culture results were observed in 41% of patients who underwent disc biopsy and 15% of patients who underwent bone biopsy (P = .016). No vessel or nerve injuries were detected after procedure in either group.
CONCLUSIONS
Percutaneous disc biopsy is more likely to yield a positive tissue culture result than vertebral body biopsy in patients with VDO.
Topics: Humans; Osteomyelitis; Discitis; Male; Retrospective Studies; Female; Middle Aged; Predictive Value of Tests; Intervertebral Disc; Aged; Adult; Biopsy; Image-Guided Biopsy; Radiography, Interventional
PubMed: 38613536
DOI: 10.1016/j.jvir.2024.02.016 -
Pediatric Radiology May 2024Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as...
Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as discitis-osteomyelitis, is an infection of the intervertebral disc and adjacent vertebrae. The imaging modality of choice is spinal magnetic resonance imaging. Our case is the first description in the English language of the sonographic diagnosis of spondylodiscitis. Pediatric radiologists and sonographers should be acquainted with its features, for both incidental and intentional diagnosis.
Topics: Humans; Female; Discitis; Infant; Ultrasonography; Diagnosis, Differential; Lumbar Vertebrae
PubMed: 38592502
DOI: 10.1007/s00247-024-05920-w -
Journal of Clinical Medicine Mar 2024Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related... (Review)
Review
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with species being the most common invading organisms, while is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.
PubMed: 38592315
DOI: 10.3390/jcm13051478 -
Annals of Medicine and Surgery (2012) Apr 2024Brucellosis, the most common microbial zoonotic disease in the world, is endemic in both industrialized and underdeveloped countries. Between 2 and 53% of patients with...
INTRODUCTION AND IMPORTANCE
Brucellosis, the most common microbial zoonotic disease in the world, is endemic in both industrialized and underdeveloped countries. Between 2 and 53% of patients with brucellosis, patients develop spondylitis, and people between the ages of 50 and 60 are the most commonly affected. It mostly affects the lumbar vertebrae (L4 and L5 in particular) and the thoracic vertebrae.
CASE PRESENTATION
A 52-year-old patient was brought to the neurological clinic after complaining of lower back discomfort, reduced mobility, and lower extremity weakness for 6 weeks. Both the cervical and lumbar columns were the sites of the specific discomfort. MRI showed cervical and lumbar discitis.
CLINICAL DISCUSSION
A high titre of anti-brucella antibodies was found by serology testing. He was treated with oral doxycycline (100 mg, two times daily), rifampicin (900 mg) orally once daily, and gentamicin (400 mg) once daily. The patient had massive improvement after 3 months of treatment.
CONCLUSIONS
This case should serve as a reminder to healthcare providers to keep a high index of suspicion for uncommon infections, including Brucella species, in patients exhibiting discitis symptoms, especially when traditional microbiological gram stain and culture are negative.
PubMed: 38576911
DOI: 10.1097/MS9.0000000000001715