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International Orthopaedics Jan 2024Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps once Candida is suspected. This systematic review summarized all cases of Candida spondylodiscitis reported to date concerning baseline demographics, symptoms, treatment, and prognostic factors.
METHODS
A PRISMA-based search of PubMed, Web of Science, Embase, Scopus, and OVID Medline was performed from database inception to November 30, 2022. Reported cases of Candida spondylodiscitis were included regardless of Candida strain or spinal levels involved. Based on these criteria, 656 studies were analyzed and 72 included for analysis. Kaplan-Meier curves, Fisher's exact, and Wilcoxon's rank sum tests were performed.
RESULTS
In total, 89 patients (67% males) treated for Candida spondylodiscitis were included. Median age was 61 years, 23% were immunocompromised, and 15% IV drug users. Median length of antifungal treatment was six months, and fluconazole (68%) most commonly used. Thirteen percent underwent debridement, 34% discectomy with and 21% without additional instrumentation. Median follow-up was 12 months. The two year survivorship free of death was 80%. The two year survivorship free of revision was 94%. Younger age (p = 0.042) and longer length of antifungal treatment (p = 0.061) were predictive of survival.
CONCLUSION
Most patients affected by Candida spondylodiscitis were males in their sixties, with one in four being immunocompromised. While one in five patients died within two years of diagnosis, younger age and prolonged antifungal treatment might play a protective role.
Topics: Male; Humans; Middle Aged; Female; Candida; Antifungal Agents; Discitis; Candidiasis; Immunocompromised Host
PubMed: 37792014
DOI: 10.1007/s00264-023-05989-2 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Discitis; Tuberculosis; Epidural Abscess; Magnetic Resonance Imaging
PubMed: 36995788
DOI: 10.1590/0037-8682-0617-2022 -
European Review For Medical and... Apr 2019Epidemiological features of musculoskeletal infections are in continuous evolution. The incidence of emerging causative pathogen is arising. Nevertheless, up to 50% of...
OBJECTIVE
Epidemiological features of musculoskeletal infections are in continuous evolution. The incidence of emerging causative pathogen is arising. Nevertheless, up to 50% of osteoarticular infections shows negative cultures. Septic arthritis, with or without concurrent osteomyelitis, are most common in newborn while osteomyelitis frequently affects older patients. We retrospectively analyzed all the children affected by musculoskeletal infections treated at the Children's Hospital Bambino Gesù in ten years, focusing on the results of an early diagnostic and therapeutic management.
MATERIALS AND METHODS
The study population consists of 150 children with acute septic arthritis, osteomyelitis and discitis, treated from 2006 to 2016, excluding patients with less than 12 months of follow-up and previous treatment sustained in others hospitals. A wide spectrum of data has been extracted from clinical charts, laboratory studies and imaging. Patients were categorized into 3 groups on the base of their age. The diagnostic and therapeutic protocol consisted of intravenous empirical treatment while diagnosis was ongoing then switched to oral treatment, according to the pathogen and the systemic symptoms.
RESULTS
Only 31% of pathogens were identified. The most common was Staphylococcus aureus methicillin-sensible (MSSA) but an increase of cases caused by Kingella Kingae and Staphylococcus aureus methicillin-resistant (MRSA) was observed. The mean antibiotic treatment was 6.8 weeks. It's important to underline a significant correlation between age and C-reactive protein serum levels.
CONCLUSIONS
Among others frequent pathogens, MRSA shows a high rate of physis involvement. Musculoskeletal infections represent a challenge in skeletally immature patients because of their potential severe complications. Timing of diagnosis and consequent targeted treatment is fundamental to avoid complications and functional sequelae.
Topics: Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Child; Child, Preschool; Discitis; Humans; Infant; Infant, Newborn; Osteomyelitis; Retrospective Studies; Staphylococcal Infections
PubMed: 30977884
DOI: 10.26355/eurrev_201904_17488 -
Archives of Disease in Childhood Feb 2006
Topics: Discitis; Humans; Infant; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiography
PubMed: 16428364
DOI: 10.1136/adc.2005.080804 -
Journal of Veterinary Internal Medicine Nov 2022Computed tomography (CT) findings of dogs with discospondylitis have not been widely described despite increased availability of this imaging modality.
BACKGROUND
Computed tomography (CT) findings of dogs with discospondylitis have not been widely described despite increased availability of this imaging modality.
OBJECTIVES
Describe the CT features of discospondylitis in a population of clinically affected dogs with discospondylitis diagnosed by magnetic resonance imaging (MRI).
ANIMALS
Forty-one dogs (63 affected discs) with MRI-identified discospondylitis presented to a single referral hospital between 2012 and 2022.
METHODS
Retrospective, single center, descriptive case series with analysis of MRI-identified discospondylitis sites and concomitant CT imaging. Computed tomographic features of MRI-affected sites including intervertebral disc space (IVDS), endplates, vertebral body, epidural space and paraspinal tissues were described.
RESULTS
The most frequently found changes were: (1) endplate involvement (87.3%) most frequently bilateral (94.5%), with erosion (61.9%) and multifocal osteolysis (67.3%); (2) periosteal proliferation adjacent to the IVDS (73%) and spondylosis (66.7%); and (3) vertebral body involvement (66.7%) involving one-third of the vertebra (85.7%) with multifocal osteolysis (73.5%). Other less prevalent features included an abnormal IVDS (narrowed or collapsed), sclerosis of the adjacent vertebral body or endplates, presence of disseminated idiopathic skeletal hyperostosis or vacuum artifact.
CONCLUSIONS AND CLINICAL IMPORTANCE
We determined that bilateral endplate erosion and periosteal proliferation were very common in dogs with discospondylitis. Careful evaluation of CT in all 3 planes (dorsal, sagittal, transverse) is necessary to identify an affected IVDS. These described CT features can aid in the diagnosis of discospondylitis in dogs but equivocal cases might still require MRI.
Topics: Animals; Dogs; Discitis; Dog Diseases; Intervertebral Disc; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteolysis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 36208075
DOI: 10.1111/jvim.16551 -
European Spine Journal : Official... Dec 2013Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more... (Review)
Review
INTRODUCTION
Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management.
METHODS
Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health.
RESULTS
Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment.
CONCLUSIONS
A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.
Topics: Adult; Algorithms; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Delayed Diagnosis; Diagnostic Imaging; Discitis; Drug Resistance, Microbial; Epidural Abscess; Female; Humans; Incidence; Male; Middle Aged; Mycoses; Parasitic Diseases; Prognosis; Spine; Spondylitis; United States
PubMed: 23756630
DOI: 10.1007/s00586-013-2850-1 -
Journal of Feline Medicine and Surgery Jul 2020This study describes the imaging features of feline discospondylitis on MRI, comparing them with CT and radiographic findings where available.
OBJECTIVES
This study describes the imaging features of feline discospondylitis on MRI, comparing them with CT and radiographic findings where available.
METHODS
The medical records of cats diagnosed with discospondylitis, presented to three referring institutions, were reviewed. MRI, CT and radiographic features were assessed by two of the authors independently.
RESULTS
Fourteen sites of discospondylitis were retrospectively identified in 13 cats. The L7-S1 intervertebral disc space (IVDS) was affected in 7/14 (50%) cases. Characteristic MRI features included a hyperintense nucleus pulposus signal on T2-weighted (T2W) imaging (n = 10/14 [71%]) and short tau inversion recovery (STIR) imaging (n = 11/13 [85%]), with contrast enhancement in all (n = 11/11); involvement of adjacent vertebral endplates (n = 11/14 [79%]) and hyperintense neighbouring soft tissue on T2W (n = 11/14 [79%]) and STIR (n = 10/13 [77%]), with contrast enhancement in all (n = 11/11); and the presence of spondylosis deformans (n = 10/14 [71%]). Other features included narrowed or collapsed IVDS (n = 8/14 [57%]), contrast enhancement of vertebral bodies (n = 5/11 [46%]), epidural space involvement (n = 5/14 [36%]), compression of the spinal cord or nerve roots (n = 5/14 [36%]), paraspinal abscessation (n = 3/14 [21%]) and meningeal signal intensity abnormalities with contrast enhancement (n = 5/6 [83%]). These latter findings may indicate secondary focal meningitis. Radiographs were available covering five sites (in four cats) and CT covering three sites (in two cats). The most common radiological features were collapse or narrowing of the affected IVDS (80%) and endplate erosion (60%). No changes suggestive of discospondylitis were identifiable on radiography or CT in two sites (one cat), despite being identifiable on MRI. Repeated radiography in one case did not reveal complete radiological resolution following 9 months of treatment.
CONCLUSIONS AND RELEVANCE
The results of this study indicate consistent MRI features of feline discospondylitis that should be considered in the diagnosis of this condition.
Topics: Animals; Cat Diseases; Cats; Discitis; Intervertebral Disc; Magnetic Resonance Imaging; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 31418630
DOI: 10.1177/1098612X19869705 -
Acta Bio-medica : Atenei Parmensis Jul 2020Spondylodiscitis (SD) is one of the main causes of back pain. Although the low mortality, high morbidity is related to spondilodiscitys, leading spine instability,... (Review)
Review
Spondylodiscitis (SD) is one of the main causes of back pain. Although the low mortality, high morbidity is related to spondilodiscitys, leading spine instability, chronic pain or neurological deficit. Diagnostic imaging plays a primary role in diagnosing spondylodiscitis. However different accuracy is highlighted by different diagnostic tool, depending also on timing of disease which represents a cardinal element for the phenotypic manifestation of the disease, beyond spatial resolution and tissue characterization proper of specific modality imaging. Conventional Radiology (CR), Computed Tomography (CT) and MRI (Magnetic Resonance Imaging) all have proven to be of primary importance in the approach to spondylodiscitis, although magnetic resonance imaging has demonstrated the greatest advantage in identifying the disease from its earliest stages, demonstrating high sensitivity and specificity (92% and 96%, respectively). This review focus on the role of different imaging modality in the approach to the spondylodiscitis, also addressing the role of interventional radiology that is pivotal not only for a diagnosis of certainty through biopsy, but also for a minimally-invasive treatment of paravertebral abscesses spondylodiscitis-related.
Topics: Biopsy; Discitis; Humans; Magnetic Resonance Imaging; Spine; Tomography, X-Ray Computed
PubMed: 32945287
DOI: 10.23750/abm.v91i8-S.9994 -
Internal Medicine (Tokyo, Japan) Jul 2022
Topics: Clarithromycin; Discitis; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium chelonae
PubMed: 34924460
DOI: 10.2169/internalmedicine.8539-21 -
The American Journal of Emergency... Aug 2022Contrast-enhanced magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosing pyogenic spinal infection (PSI), but it is not always available. Our...
BACKGROUND/OBJECTIVE
Contrast-enhanced magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosing pyogenic spinal infection (PSI), but it is not always available. Our objective was to describe pyogenic spinal infection imaging characteristics in patients presenting to a community emergency department (ED) and estimate the computed tomography (CT) sensitivity for these infections.
METHODS
We examined the MRI reports from a cohort of 88 PSI patients whom we enrolled in a prospective cohort study and report the prevalence of each PSI type (spinal epidural abscess/infection, vertebral osteomyelitis/discitis, septic facet, and paravertebral abscess/infection) according to contemporary nomenclature. In a 14 patient subcohort who underwent both CT and MRI studies, we report the sensitivity for each PSI from a post hoc blinded overread of the CT imaging by a single neuroradiologist.
RESULTS
Of the 88 PSI patients, the median age was 55 years, and 31% were female. The PSI prevalence included: spinal epidural abscess/infection (SEA) in 61(69%), vertebral osteomyelitis/discitis (VO/D) in 54 (61%), septic facet (SF) in 15 (17%), and paravertebral abscess/infection (PVA) in 53 (60%). Of the SEAs, 82% (50/61) were associated with other spinal infections, while 18% (11/61) were isolated SEAs. The overall CT sensitivity in a masked overread was 79% (11/14) for any PSI, 83% (10/12) for any infection outside the spinal canal, and only 18% (2/11) for SEA.
CONCLUSION
Patients found to have vertebral osteomyelitis/discitis, septic facet, and paravertebral infections frequently had a SEA coinfection. CT interpretation by a neuroradiologist had moderate sensitivity for infections outside the spinal canal but had low sensitivity for SEA.
Topics: Discitis; Epidural Abscess; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Prospective Studies; Tomography, X-Ray Computed
PubMed: 35689961
DOI: 10.1016/j.ajem.2022.05.050