rifampin and Discitis

MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. There were 11 males and 13 females and their average age was 24 years (11 to 60). 99mTc bone scans were done in 16 patients before MRI. Eleven patients had the diagnosis confirmed by biopsy and the remainder all responded rapidly to specific antituberculous chemotherapy. On T1-weighted images there was a decrease in signal intensity of the involved bone and soft tissues; on T2-weighted images there was increased signal intensity. Depending on the stage of the disease, three different patterns of infection were revealed: osteitis, osteitis with an abscess, and osteitis with or without an abscess plus discitis. The anatomical pattern of involvement, particularly of the soft tissues and the discs, is specific for tuberculous disease. The ability of MRI to detect tuberculosis of the spine earlier than other techniques could reduce bone destruction and deformity and diminish the need for surgical intervention. Despite the specificity of the patterns revealed by MRI, biopsy is recommended during the stage of osteitis to confirm the diagnosis.

Topics: Abscess; Adolescent; Adult; Biopsy, Needle; Cervical Vertebrae; Child; Discitis; Drainage; Female; Humans; Image Interpretation, Computer-Assisted; Isoniazid; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Osteitis; Reproducibility of Results; Rifampin; Thoracic Vertebrae; Time Factors; Tuberculosis, Spinal

Postoperative spondylodiscitis (PSD) and postoperative osteomyelitis (POM) are known complications of lumbar disc surgery. Many infectious agents play a role in its etiology and it is mostly bacterial. A 55-year male patient underwent lumbar microdiscectomy (LMD) for left L4-5 disc hernia. Lumbar magnetic resonance images of the patient in the postoperative eighth week showed an infection, thought to be due to tuberculosis (TB) in the operation site and adjacent vertebrae. The patient who was positive for the QuantiFERON-TB Gold In-Tube (QFT-GIT) test was diagnosed with TB-induced PSD. The patient received anti-TB treatment consisting of ethambutol, isoniazid, pyrazinamide, and rifampin. We report a very rare case of PSD due to TB infection after LMD. Clinical results and management of the patient was compared with other patients with similar characteristics in the literature. Key Words: Discectomy, Osteomyelitis, Spondylodiscitis, Tuberculosis.

Topics: Discitis; Diskectomy; Humans; Interferon-gamma Release Tests; Isoniazid; Male; Rifampin; Tuberculin Test; Tuberculosis

Topics: Aged; Antibiotics, Antitubercular; Discitis; Drug Hypersensitivity Syndrome; Female; Humans; Rifampin; Skin; Tuberculosis, Spinal

Although Brucella spondylitis and Brucella discitis have been frequently reported, Brucella infection of the vertebral arch is rare and has not been previously described. We present the first case of Brucella infection of the thoracic vertebral arch with epidural abscess formation and discuss the clinical key points.. A 57-year-old man of Han nationality with a history of contact with an isolated sheep stomach 2 months previously was admitted with an undulant fever, night sweats, back pain, and weakness. Thoracic magnetic resonance imaging showed laminar destruction of T9 and an epidural abscess at the T9 to 10 level with significant cord compression. Diagnosis of Brucella infection of his vertebral arch was confirmed by a positive blood culture with growth of Brucella melitensis. Total laminectomy, abscess cleansing, and percutaneous pedicular screw fixation was performed initially, followed by antibiotic treatment with a combination of doxycycline and rifampin for 4 months. Recovery was confirmed by clinical, magnetic resonance imaging, and blood culture findings.. This is an unusual case of Brucella infection of the vertebral arch with epidural abscess formation. Effective antibiotic therapy of a sufficient duration and timely performance of surgical treatment are the key points in management of such cases.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Discitis; Doxycycline; Epidural Abscess; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Thoracic Vertebrae; Tomography, X-Ray Computed

Prolonged antimicrobial therapy is recommended for methicillin-susceptible Staphylococcus aureus (MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients (male, 62%; median age, 60.8 years [interquartile range {IQR}, 45.5 to 74.2 years]) with MSSA BJI admitted to a reference regional center with acute (66%) or chronic arthritis (7.5%), osteomyelitis (9.5%), spondylodiscitis (16%), or orthopedic device-related infections (67%). These patients received antistaphylococcal therapy for a median of 26.6 weeks (IQR, 16.8 to 37.8 weeks). Thirty-eight SAE occurred in 30 patients (15%), with a median time delay of 34 days (IQR, 14.75 to 60.5 days), including 10 patients with hematologic reactions, 9 with cutaneomucosal reactions, 6 with acute renal injuries, 4 with hypokalemia, and 4 with cholestatic hepatitis. The most frequently implicated antimicrobials were antistaphylococcal penicillins (ASP) (13 SAE/145 patients), fluoroquinolones (12 SAE/187 patients), glycopeptides (9 SAE/101 patients), and rifampin (7 SAE/107 patients). Kaplan-Meier curves and stepwise binary logistic regression analyses were used to determine the risk factors for the occurrence of antimicrobial-related SAE. Age (odds ratio [OR], 1.479 for 10-year increase; 95% confidence interval [CI], 1.116 to 1.960; P = 0.006) appeared to be the only independent risk factor for SAE. In patients receiving ASP or rifampin, daily dose (OR, 1.028; 95% CI, 1.006 to 1.051; P = 0.014) and obesity (OR, 8.991; 95% CI, 1.453 to 55.627; P = 0.018) were associated with the occurrence of SAE. The high rate of SAE and their determinants highlighted the importance of the management and follow-up of BJI, with particular attention to be paid to older persons, especially for ASP dosage, and to rifampin dose adjustment in obese patients.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Arthritis, Infectious; Bone and Bones; Discitis; Female; Fluoroquinolones; Humans; Hypokalemia; Inflammation; Jaundice, Obstructive; Joints; Male; Middle Aged; Osteomyelitis; Penicillins; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Clindamycin; Discitis; Drug Hypersensitivity; Drug Substitution; Female; Humans; Levofloxacin; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Radionuclide Imaging; Rifampin; Streptococcal Infections; Streptococcus

Topics: Aged; Animals; Anti-Bacterial Agents; Bacteremia; Braces; Cattle; Combined Modality Therapy; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Food Contamination; Gentamicins; Gram-Positive Bacterial Infections; Humans; Lactococcus; Lumbar Vertebrae; Milk; Ofloxacin; Pasteurization; Rifampin

Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Streptomycin; Treatment Outcome

The demographical, clinical, and therapeutical features of patients with brucellar spondylodiscitis (BS) were evaluated in this study. Of the 96 patients with brucellosis, 20 (20.8%) were diagnosed with spondylodiscitis. Patients who had BS were more likely to be older (p = 0.001), have higher erythrocyte sedimentation rates (p = 0.01), and more likely to be anemic (p = 0.017). Lumbar segment (18/20) was frequently involved region. BS was complicated with paravertebral or epidural abscess in seven, radiculitis in six, and psoas abscess in five of cases. Antibiotic regimens including two or three antibiotics with combination of doxycycline, rifampin, and streptomycin were used. In this series, the mean duration of antimicrobial therapy was 18 weeks (range 12-56 weeks). Attention is drawn to this disease given the need for prolonged duration of treatment especially in complicated cases in order to avoid possible sequelae.

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin; Treatment Outcome

A patient was diagnosed with discitis and sacroiliitis due to Mycobacterium xenopi. He had a history of percutaneous nucleotomy performed 15 years earlier (in 1992) at the Clinique du Sport, Paris, France, during an outbreak of nosocomial M. xenopi infection at that institution. In 1997, magnetic resonance imaging performed as part of the routine follow-up program for patients who had surgery at the Clinique du Sport during the outbreak was not interpreted as indicating discitis; this assessment was confirmed by our review of the images. Bone and joint infections due to atypical mycobacteria are rare and can develop very slowly. To our knowledge, this is the first reported case of M. xenopi discitis with secondary extension to the sacroiliac joint in an immunocompetent patient.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Clarithromycin; Cross Infection; Discitis; Disease Outbreaks; Diskectomy, Percutaneous; Drug Therapy, Combination; Ethambutol; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium xenopi; Rifampin; Sacroiliitis; Surgical Wound Infection; Treatment Outcome

We studied the pharmacokinetic and pharmacodynamic parameters of levofloxacin and rifampicin in bone and joint infections. The optimal dose regimen of these two antibiotics has not been documented yet.. We performed plasma dosage for each antibiotic in patients with a bone and joint infection requiring treatment with a levofloxacin and rifampicin combination. We then computed the 6 hours post dose area under the concentration-time curve (AUC(0-6h)), the peak plasma concentration (Cmax), the area under the inhibitory concentration curve (AUIC), and the peak-to-minimum-inhibitory-concentration ratio (Cmax/MIC). The pharmacodynamic results were then compared to the published thresholds of effectiveness. The doses used were levofloxacin 500 mg bid and rifampicin 20mg/kg per day.. The plasma of 17 patients was dosed. The average AUC(0-6h) for levofloxacin was 46.59 mg.h/l, the average Cmax 10.7 mg/l, the average AUIC 932, and the average Cmax/MIC 107.5. The averages for rifampicin were 42.2mg.h/l, 11.8 mg/l, 11,125 and 1514. Given that bone concentration of levofloxacin is 30% that of the plasma concentration, that concentration was divided by three to estimate bone concentration.. The optimal thresholds of pharmacodynamic effectiveness were obtained for most patients with levofloxacin at 500 mg bid. Additional studies are still required to determine the optimal rifampicin dose.

Topics: Adult; Aged; Anti-Bacterial Agents; Area Under Curve; Arthritis, Infectious; Body Mass Index; Discitis; Dose-Response Relationship, Drug; Female; Fracture Fixation, Internal; Gastrointestinal Diseases; Humans; Levofloxacin; Male; Middle Aged; Musculoskeletal Diseases; Ofloxacin; Osteitis; Prospective Studies; Prosthesis-Related Infections; Rifampin; Sacroiliitis; Staphylococcal Infections; Surgical Wound Infection

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.. 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.. Case report and review of the literature.. 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.. 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.. 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.

Topics: Antitubercular Agents; Discitis; Diskectomy; Epidural Abscess; Humans; Intervertebral Disc Displacement; Isoniazid; Lumbar Vertebrae; Male; Mycobacterium bovis; Postoperative Period; Rifampin; Treatment Outcome; Tuberculosis

The standard treatment of brucellar spondylitis with a combination of two antibiotics for 6-12 weeks is associated with high rates of treatment failure and relapse. The present study aimed to assess the safety and efficacy of a treatment strategy based on the prolonged administration of a triple combination of suitable antibiotics. Eighteen patients with brucellar spondylitis were treated with a combination of at least three suitable antibiotics (doxycycline, rifampin, plus intramuscular streptomycin or cotrimoxazole or ciprofloxacin) until the completion of at least 6 months of treatment, when clinical, radiological and serology re-evaluation was performed. If necessary, the treatment was continued with additional 6-month cycles, until resolution or significant improvement of clinical and radiological findings, or for a maximum of 18 months. At presentation, the median age was 66 years (range, 42-85 years) with male predominance. The median duration of therapy was 48 weeks (range 24-72 weeks). Treatment was discontinued early because of side-effects in only one patient. Surgical intervention was required for three patients. At the end of treatment all patients had a complete response. After completion of treatment, all patients were followed up with regular visits. During the follow-up period (duration 1-96 months, median 36.5 months), no relapses were observed. In conclusion, prolonged (at least 6 months) administration of a triple combination of suitable antibiotics appears to be an effective treatment for brucellar spondylitis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Brucella; Ciprofloxacin; Discitis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Discitis; Drug Therapy, Combination; Epidural Abscess; Humans; Intervertebral Disc Displacement; Kingella kingae; Low Back Pain; Male; Neisseriaceae Infections; Ofloxacin; Rifampin; Spinal Neoplasms

Brucellar cervical spondylodiscitis and epidural abscess are serious medical conditions that can cause permanent neurological deficits. Fortunately, they are rare. We report a 34-year-old male patient, complaining of fever and neck pain and stiffness, with increased deep tendon reflexes. A lumbar puncture was normal. Brucella species organisms were isolated from blood cultures, and the Rose-Bengal test and the standard tube agglutination (STA) test were positive. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 51 of treatment, the patient had no symptoms and his physical and neurological examinations were normal. His repeat cervical MRI was almost normal. The STA test was negative at week 20. It is important to consider brucellar cervical spondylodiscitis with epidural abscess in endemic regions.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Epidural Abscess; Humans; Magnetic Resonance Imaging; Male; Rifampin

Topics: Alcoholism; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Discitis; Disease Susceptibility; Humans; Lumbar Vertebrae; Male; Middle Aged; Naproxen; Pneumococcal Infections; Psoas Abscess; Pulmonary Disease, Chronic Obstructive; Rifampin; Tomography, X-Ray Computed

Topics: Abscess; Adult; Albania; Anti-Bacterial Agents; Biopsy, Needle; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Greece; Humans; Magnetic Resonance Imaging; Nerve Compression Syndromes; Rifampin; Spinal Nerve Roots; Streptomycin; Tomography, X-Ray Computed

The purpose of this study was to assess the clinical efficacy of high-dose levofloxacin plus rifampicin in the empirical treatment of non-tuberculous spondylodiscitis in an epidemiological context of low incidence of staphylococcal fluoroquinolone resistance. All consecutive adult patients with spondylodiscitis (January 2003 to December 2006) were empirically treated with high-dose levofloxacin (500 mg every 12 h normalised to renal function and optimised by means of therapeutic drug monitoring whenever feasible) plus rifampicin 600 mg every 24 h. Trough and peak plasma concentrations were targeted at 1-3 mg/L and 6-9 mg/L, respectively, to maximise the concentration-dependent activity of levofloxacin in bone. Follow-up was performed until 9 months after the end of therapy. Forty-eight patients were included. Eleven patients underwent a surgical approach for spine stabilisation. Among the 29 bacterial isolates, Staphylococcus aureus was the most frequent (65.5%) (all meticillin-susceptible strains). Tailored levofloxacin plasma exposure over time was ensured in most cases. Median treatment duration was 15.1 weeks. Overall response rates were: 77.1% at the intent-to-treat analysis; 84.1% among patients who completed therapy (N=44); and 96.3% among those receiving targeted therapy against documented levofloxacin-susceptible isolates (N=27). No patient had evidence of disease relapse at follow-up. Our findings suggest that high-dose levofloxacin regimens may be highly effective in the treatment of non-tuberculous spondylodiscitis and support its putative role in combination with rifampicin against S. aureus.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Discitis; Drug Monitoring; Female; Follow-Up Studies; Gram-Positive Bacterial Infections; Humans; Levofloxacin; Male; Middle Aged; Ofloxacin; Rifampin; Treatment Outcome; Young Adult

We have presented a patient of 71-year-age with brucellar spondylodiscitis, involving the cervical spine, especially the C3-C4 segment. The patient had painful percussion of the cervical spine and passive mobilization of the neck, decreased range of motion, and cervical paravertebral tenderness; but no abnormalities observed on neurological examination. Wright agglutination test for brucella was positive at 1/320. Cervical localization for brucellar spondylodiscitis is an unusual case and should be detected and treated as early as possible. In endemic regions, spinal involvement of brucellosis should be considered in cases with fever, neck and low back pain.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Drug Combinations; Drug Therapy, Combination; Exercise Therapy; Humans; Magnetic Resonance Imaging; Male; Rifampin; Spironolactone; Sulfonamides

Topics: Aged; Bacteremia; Catheterization, Central Venous; Chronic Disease; Daptomycin; Discitis; Humans; Jugular Veins; Male; Methicillin-Resistant Staphylococcus aureus; Pancreatitis; Rifampin; Staphylococcal Infections; Vancomycin; Virginiamycin

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared.

Topics: Adult; Antitubercular Agents; Biopsy; Discitis; Drug Therapy, Combination; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Polymerase Chain Reaction; Pyrazinamide; Rifampin; Thoracic Vertebrae; Tuberculin Test; Tuberculosis, Spinal

A 54-year-old man presented with tuberculous spondylodiscitis associated to E. coli found in an intervertebral disc space needle biopsy. The enterobacteria came from a cholecystitis. The patient was cured by medical treatment, consisting in a non-surgical immobilization, antitubercular quadritherapy in association with a specific antibiotic treatment. No other case of spondylodiscitis caused by a mycobacterial coinfection pathogen has been reported so far.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Aza Compounds; Cervical Vertebrae; Cholecystitis; Discitis; Disease Progression; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Ethambutol; Fluoroquinolones; France; Humans; Immobilization; Isoniazid; Male; Middle Aged; Morocco; Moxifloxacin; Mycobacterium tuberculosis; Pyrazinamide; Quinolines; Radiography; Rifampin; Tuberculosis, Spinal

We reviewed a case of Brucella spondylodiscitis admitted to a referral, university hospital, in Ankara, Turkey. A 75-year-old female was referred to our hospital with low back pain. Previous magnetic resonance imaging yielded cortical destruction of T9-10 and T12-L2 vertebral bodies, focal infectious foci at discs within this range, significant microabscesses at paravertebral areas, which lead to the diagnosis of spondylodiscitis. History of consumption of unpasteurized dairy products led us to first suspect brucellosis yet, the serum agglutination test and blood culture were negative and did mislead us to several other, sometimes invasive, diagnostic tests. The final diagnosis was reached by culturing the specimen obtained through fine-needle aspiration from the paravertebral microabscesses. The exhausting diagnostic journey that started with the suspicion of tuberculosis or malignancy ended with a diagnosis of brucellosis. Brucellosis should be considered in all patients with osteoarthritic complaints in endemic regions, and the "prozone phenomenon" should be kept in mind, before proceeding to high-tech lab tests, imaging, or invasive procedures.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; False Negative Reactions; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Radiography; Rifampin; Serologic Tests; Thoracic Vertebrae; Time Factors; Treatment Outcome

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Diagnosis, Differential; Discitis; Doxycycline; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Rifampin; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheters, Indwelling; Diabetes Complications; Discitis; Endocarditis, Bacterial; Fever; Heart Valve Prosthesis; Humans; Hyperparathyroidism, Secondary; Incidence; Kidney Failure, Chronic; Lumbar Vertebrae; Methicillin Resistance; Prognosis; Renal Dialysis; Rifampin; Spain; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Topics: Abscess; Anti-Bacterial Agents; Brucella; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Fever; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Thoracic Vertebrae; Treatment Outcome

Case report describing spontaneous Corynebacterium diptheria discitis in a patient with chronic renal failure.. To describe this very rare form of discitis and the results of surgical and antibiotic therapy.. University Department of Neurosurgery, Turkey.. A 55-year-old man with chronic renal failure presented with acute low-back pain. Lumbar magnetic resonance imaging (MRI) suggested discitis and osteomyelitis at the L5-S1 level. The L5-S1 disc was operated upon and the discectomy material was sent for pathological and microbiological analysis.. Pathological examination revealed infection and bacterial culture grew C. diptheria. The patient was prescribed combination antibiotic therapy with vancomycin, a third-generation cephalosporin, and rifampicin. Clinical status improved after 8 weeks of therapy. Lumbar MRI revealed remission of the discitis and osteomyelitis after 10 months of follow-up.. Chronic renal failure patients with low-back pain should be investigated for spinal infection. These individuals are prone to low-grade infection in the form of discitis or osteomyelitis. Corynebacterium subspecies rarely cause spontaneous discitis. This case is interesting because of the unusual causal organism and the occurrence of discitis in the setting of chronic renal failure.

Topics: Anti-Bacterial Agents; Cephalosporins; Corynebacterium diphtheriae; Corynebacterium Infections; Diagnosis, Differential; Discitis; Diskectomy; Humans; Kidney Failure, Chronic; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Vancomycin

A 59-year-old male farmer presented with a rare case of spondylodiscitis as a manifestation of systemic brucellosis. The patient presented with radicular pain and restricted mobility of the spine due to localized muscle spasm in addition to systemic complaints. Magnetic resonance imaging demonstrated discovertebral involvement at the L4-5 intervertebral space, indicating infectious spondylodiscitis. The Rose-Bengal test was positive and the serum antibody titer was 1/1280. The patient was treated with streptomycin combined with tetracycline plus rifampicin, with complete recovery. Early diagnosis is important and prompt antibrucellar chemotherapy is effective in most cases. Therefore, spondylodiscitis due to brucellosis should be considered in the differential diagnosis of spinal infections.

Topics: Anti-Bacterial Agents; Brucellosis; Discitis; Drug Therapy, Combination; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Streptomycin; Tetracycline

Spinal tuberculosis (TB) accounts for about 2% of all cases of TB. New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged. Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD). We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD. The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients). Sixty-eight percent of patients were foreign-born subjects from developing countries. None of our patients was HIV-positive. SPD accounted for 48% of cases and SPwD for 52%. Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions. Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups. Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases. Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77). Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin. Median duration of antituberculous chemotherapy was 14 months. Surgical treatment was performed in 24% of patients. There were 2 TB-related deaths. Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries. The reasons for this remain to be elucidated.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Biopsy, Needle; Cause of Death; Developed Countries; Developing Countries; Discitis; Emigration and Immigration; Female; France; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mycobacterium tuberculosis; Paris; Retrospective Studies; Rifampin; Spondylitis; Tuberculosis, Osteoarticular; Tuberculosis, Spinal

Topics: Child, Preschool; Clindamycin; Discitis; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Rifampin; Treatment Outcome