cefotaxime and Spinal-Diseases

We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described.. Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies.. The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter.. The patient made a good recovery and is free of recurrence 4 years after surgery.. Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Cefotaxime; Combined Modality Therapy; Discitis; Fistula; Floxacillin; Humans; Ischemia; Lung Diseases; Male; Metronidazole; Middle Aged; Nervous System Diseases; Osteomyelitis; Pneumococcal Infections; Pneumonia, Pneumococcal; Postoperative Complications; Respiratory Tract Fistula; Spinal Cord; Spinal Diseases; Spondylitis; Streptococcus pneumoniae; Thoracic Vertebrae; Tomography, X-Ray Computed; Tracheal Diseases; Treatment Outcome

Spinal epidural abscess is rare in children. We describe the case of a 5 year old girl with vertebral osteomyelitis and spinal epidural abscess. Diagnosis was made by magnetic resonance imaging and scintigraphic study with HMDP99Tc. Treatment with intravenous cefotaxime (200mg/kg/day) and cloxacillin (200mg/kg/day) for 15 days followed by oral cloxacillin (100mg/kg/day) for a further 15 days produced a satisfactory clinical outcome.

Topics: Administration, Oral; Cefotaxime; Cephalosporins; Child, Preschool; Cloxacillin; Drug Therapy, Combination; Epidural Abscess; Female; Follow-Up Studies; Humans; Injections, Intravenous; Osteomyelitis; Penicillins; Spinal Diseases; Time Factors

Spinal epidural abscess (SEA) is rare in children, especially in newborns and infants, groups in which only very few cases have been reported. Because of the nonspecificity of presenting symptoms in children the diagnosis may be delayed, resulting in major permanent neurological deficits. In this paper, we report a case of cervical SEA in a 6-week-old infant who initially presented with fever and developed quadriparesis 19 days prior to admission. After emergency anterior decompression of the abscess the neurological function was improved immediately. Five months after surgery the neurological status was normal, an MR study showing disappearance of the epidural abscess and spinal cord indentation, and progressive fusion of the C3, C4 and C5 vertebral bodies. Anterior decompression without bone graft can provide an excellent prognosis in case of an anterior cervical SEA in infants.

Topics: Abscess; Cefotaxime; Cervical Vertebrae; Drug Therapy, Combination; Epidural Space; Female; Hip Joint; Humans; Infant; Radiography; Spinal Diseases; Spinal Fusion; Staphylococcal Infections; Treatment Outcome; Vancomycin

A case of paraspinal abscess formation from Haemophilus paraphrophilus is presented.. To describe a case of paraspinal abscess formation from H. paraphrophilus, a fastidious commensal organism of the mouth and pharynx. A precise bacteriologic identification can be difficult; techniques for such identification are discussed.. Spinal abscess caused by H. paraphrophilus is unusual and can be very difficult to diagnose.. The etiology, clinical presentation, technical examinations, and treatment are reviewed.. Prolonged antibiotic treatment was curative, although surgery was considered.. Bacteriologic diagnoses in these rare infections are difficult. Antibiotic therapy was curative in the patient described.

Topics: Abscess; Anti-Infective Agents; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Therapy, Combination; Female; Haemophilus; Haemophilus Infections; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Spinal Diseases

Haemophilus aphrophilus is rarely implicated as an aetiology of spinal epidural abscess. A 73-year-old woman with liver cirrhosis who developed H. aphrophilus bacteraemia complicated with vertebral osteomyelitis and spinal epidural abscess is presented. Without surgical decompression, she was successfully treated with cefotaxime for 3 weeks, followed by maintenance with ciprofloxacin for another 10 weeks. The clinical features of eight previously reported cases of vertebral osteomyelitis without epidural abscess due to H. aphrophilus are reviewed.

Topics: Abscess; Aged; Bacteremia; Cefotaxime; Ciprofloxacin; Epidural Space; Female; Haemophilus; Haemophilus Infections; Histocytochemistry; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Osteomyelitis; Spinal Diseases