rifampin and Spondylitis

We report the first Italian case of Mycobacterium chimaera disseminated infection in a patient with a history of cardiac surgery. The patient was initially diagnosed with sarcoidosis and started on immunosuppressive therapy. Ten months later she developed a vertebral osteomyelitis: M. chimaera was isolated from bone specimen. A review of the literature shows that M. chimaera infection occurs specifically in this population of patients, due to contamination of heater-cooler units used during cardiosurgery. Devices responsible for the transmission were produced by Sorin Group Deutschland. Mycobacterium chimaera infection should be included in the differential diagnosis for patients undergoing cardiac surgery.

Topics: Acinetobacter Infections; Aged; Bacteremia; Diagnostic Errors; Drug Therapy, Combination; Equipment Contamination; Female; Heart Valve Prosthesis Implantation; Heating; Humans; Linezolid; Lumbar Vertebrae; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Osteomyelitis; Postoperative Complications; Prednisone; Rifampin; Sarcoidosis; Spondylitis; Vertebroplasty; Water Microbiology

Brucellosis is a zoonotic disease widely seen in endemic regions and that can lead to systemic involvement. The musculoskeletal system is frequently affected, and the disease can exhibit clinical involvements such as arthritis, spondylitis, spondylodiscitis, osteomyelitis, tenosynovitis and bursitis. Spondylitis and spondylodiscitis, common complications of brucellosis, predominantly affect the lumbar and thoracic vertebrae. Epidural abscess may occur as a rare complication of spondylitis. Spinal brucellosis and development of epidural abscess in the cervical region are rare. Development of epidural abscess affects the duration and success of treatment. Spinal brucellosis should be considered in patients presenting with fever and lower back-neck pain in endemic regions, and treatment must be initiated with early diagnosis in order to prevent potential complications.

Topics: Adult; Animal Husbandry; Animals; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Doxycycline; Epidural Abscess; Humans; Magnetic Resonance Imaging; Male; Occupational Exposure; Rifampin; Spondylitis; Streptomycin

Brucellosis, a zoonotic infection caused by the genus Brucellae, is an ancient condition linked to the consumption of milk and milk products. The disease has global importance due to its impact. Therapeutic options for brucellosis rely mostly on uncontrolled, nonrandomized, non-blinded studies. The choice and duration of therapy are related to patient characteristics and the presence of a focal disease. The usual therapy of acute brucellosis is a combination of doxycycline plus rifampicin for 6 weeks. An aminoglycoside could be substituted for rifampin for the initial week of combination therapy. Other alternatives include a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a fluoroquinolone plus rifampicin. The presence of spondylitis or endocarditis usually indicates that the required treatment will be of a longer duration or a combination of therapy. The article has the discussion of some recent patents related to antibiotic susceptibility and Brucellosis.

Topics: Anti-Bacterial Agents; Bone Diseases, Infectious; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Patents as Topic; Rifampin; Spondylitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Debridement; Ethambutol; Humans; Isoniazid; Male; Rifampin; Spondylitis; Streptomycin; Tuberculosis, Spinal; Wound Healing

The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis.. The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient.. During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy.. Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed.

Topics: Anti-Bacterial Agents; Brucellosis; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Humans; Rifampin; Spine; Spondylitis; Streptomycin

Brucellosis, a zoonosis with worldwide distribution, is a systemic infection and still an important public health problem in Turkey. The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined. In a prospective and randomized study, we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis. Patients were randomly assigned to receive antimicrobial combination therapy. Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl, 500 mg every 6 h orally for 45 days (ST), 21 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days (SD), 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (DR), 19 patients received ofloxacin, 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (OR), and 22 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (SDR). Initial therapeutic failure occurred in 2 patients (10%) in the ST regimen group, 4 patients (19%) in the SD group, 3 patients (15%) in the DR group and 5 patients (26%) in the OR regimen. In addition, 2 patients (10%) in the DR group and 5 patients (26%) in the OR regimen relapsed during the follow-up period. There was no relapse in any patients in the ST, SD, and SDR groups. The response rates were 90% in the ST and 81% in the SD groups. In contrast, there was a maximum good response (100%) and no relapse in the SDR group. In conclusion, a combination of doxycycline, streptomycin, and rifampicin can be recommended as therapy for brucellar spondylitis and to reduce relapse rates.

Topics: Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Rifampin; Spondylitis; Streptomycin; Treatment Outcome

To compare the effectiveness of doxycycline-rifampin (DR) combination therapy with that of the classic doxycycline-streptomycin (DS) combination in patients with brucellosis.. A randomized, double-blind study, with a mean follow-up of 15.7 months.. A 1000-bed teaching hospital in Barcelona, Spain.. Ninety-five patients (68 men and 27 women; mean age, 39 years) diagnosed with brucellosis on the basis of both clinical and serologic findings; 81 of these patients had blood cultures positive for Brucella melitensis.. Forty-four patients received doxycycline, 100 mg every 12 hours, and rifampin, 15 mg/kg body weight per day in a single morning dose, for 45 days; 51 patients received the same dose of doxycycline for 45 days plus streptomycin, 1 g/d for 15 days.. Therapeutic failure and relapse during the follow-up period.. The mean time to defervescence was 4.2 days for the DR group and 3.2 days for the DS group (P greater than 0.2). The actuarial probability of therapeutic failure or relapse at 12 months of follow-up (Kaplan-Meier) was 14.4% in the DR group and 5.9% in the DS group (difference, 8.5%; 95% Cl, -4.8% to 21.6%; P greater than 0.2). All three patients with spondylitis in the DR group failed therapy compared with one of four patients in the DS group. Excluding patients with spondylitis, the actuarial failure rate was 4.9% and 4.3% in the DR and DS groups, respectively, at 12 months of follow-up (difference, 0.6%; Cl, -8.1% to 9.4%; P greater than 0.2).. Doxycycline-rifampin combination therapy for 45 days is as effective as the classic DS combination in most patients with brucellosis; however, DR therapy might be less effective in those patients with spondylitis.

Topics: Adolescent; Adult; Aged; Brucellosis; Child; Double-Blind Method; Doxycycline; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Probability; Recurrence; Rifampin; Spondylitis; Streptomycin

The clinical efficacy of perioperative chemotherapy regimen (rifampicin, doxycycline, levofloxacin, ceftriaxone) was evaluated for lumbar brucellosis spondylitis patients with neurological injury.. In Beijing Ditan Hospital affiliated with Capital Medical University, 32 patients with lumbar brucellosis spondylitis underwent surgery and triple perioperative chemotherapy (rifampicin, doxycycline, levofloxacin) between 2011 and 2021 due to neurological injury, and 34 patients matched up with the triple group underwent rifampicin, doxycycline, levofloxacin, and ceftriaxone. Both groups were compared in terms of changes in inflammation index, low back/leg pain, lumbar function, neurological function, and adverse drug reactions.. There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), low back pain visual analogue scale (VAS), leg pain VAS, lumbar Oswestry disability index (ODI) and nerve function injury rate between the two groups before chemotherapy (. For lumbar brucellosis spondylitis with neurological injury, quadruple perioperative chemotherapy of rifampicin, doxycycline, levofloxacin and ceftriaxone can significantly reduce perioperative inflammation, and improve low back/leg pain, as well as promoting neurological function recovery in the short term.

Topics: Brucellosis; Ceftriaxone; Doxycycline; Humans; Inflammation; Levofloxacin; Low Back Pain; Lumbar Vertebrae; Retrospective Studies; Rifampin; Spondylitis; Treatment Outcome

The purpose of this study was to determine the clinical value of triple antibiotic therapy consisting of doxycycline, compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis.. A retrospective analysis was performed on 100 patients with brucellosis spondylitis admitted to the First Affiliated Hospital of Hebei North University from March 2016 to June 2019. Patients were divided into the following two groups: the control group (n = 50) treated with dual antibiotic therapy (rifampicin + compound sulfamethoxazole), and the observation group (n = 50) treated with triple antibiotic therapy (rifampicin + doxycycline + compound sulfamethoxazole). The treatment effect, low back pain relief, levels of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP), as well as the adverse reactions were compared between the two groups.. The response rate of the observation group was significantly higher than that of the control group (. The triple antibiotic therapy of doxycycline, compound sulfamethoxazole and rifampicin is effective in the treatment of brucellosis spondylitis. It can significantly alleviate patients' back pain and inflammation with a high safety profile, which is worthy of clinical application.

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Inflammation; Low Back Pain; Male; Retrospective Studies; Rifampin; Spondylitis; Sulfamethoxazole

Bacillus Calmette-Guérin (BCG)-associated osteomyelitis is a rare adverse event following BCG vaccination, and there have been no previous reports of BCG-associated cervical spondylitis. Here, we describe the case of a 3-year-old immunocompetent girl who developed BCG-associated cervical spondylitis and was successfully treated by prompt surgical drainage of the abscess and administration of isoniazid and rifampicin for 9 months without sequelae.

Topics: Abscess; Antitubercular Agents; BCG Vaccine; Cervical Vertebrae; Child, Preschool; Female; Humans; Immunocompetence; Isoniazid; Mycobacterium bovis; Osteomyelitis; Rifampin; Spondylitis; Tuberculosis

Topics: Adult; Anti-Bacterial Agents; Bacterial Proteins; Brucella melitensis; Brucellosis; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Phylogeny; Polymerase Chain Reaction; Republic of Korea; Rifampin; Sequence Analysis, DNA; Spondylitis

Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients.. Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit.. The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection.. Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time.. With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9.

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Decompression, Surgical; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Kyphosis; Laminectomy; Lumbar Vertebrae; Middle Aged; Pyrazinamide; Retrospective Studies; Rifampin; Spinal Fusion; Spondylitis; Thoracic Vertebrae; Tuberculosis, Spinal

Extrapulmonary and, in particular, spinal tuberculosis (TB) constitutes a minor but significant part of the total TB incidence. In spite of this, almost no studies on the genetic diversity and drug resistance of Mycobacterium tuberculosis isolates from spinal TB patients have been published to date. Here, we report results of the first Russian and globally largest molecular study of M. tuberculosis isolates recovered from patients with tuberculous spondylitis (TBS). The majority of 107 isolates were assigned to the Beijing genotype (n = 80); the other main families were T (n = 11), Ural (n = 7), and LAM (n = 4). Multidrug resistance (MDR) was more frequently found among Beijing (90.5%) and, intriguingly, Ural (71.4%) isolates than other genotypes (5%; P < 0.001). The extremely drug-resistant (XDR) phenotype was exclusively found in the Beijing isolates (n = 7). A notable prevalence of the rpoB531 and katG315 mutations in Beijing strains that were similarly high in both TBS (this study) and published pulmonary TB (PTB) samples from Russia shows that TBS and PTB Beijing strains follow the same paradigm of acquisition of rifampin (RIF) and isoniazid (INH) resistance. The 24-locus mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) subtyping of 80 Beijing isolates further discriminated them into 24 types (Hunter Gaston index [HGI] = 0.83); types 100-32 and 94-32 represented the largest groups. A genotype of Russian successful clone B0/W148 was identified in 30 of 80 Beijing isolates. In conclusion, this study highlighted a crucial impact of the Beijing genotype and the especially prominent role of its MDR-associated successful clone B0/W148 cluster in the development of spinal MDR-TB in Russian patients.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Drug Resistance, Bacterial; Female; Genotype; Humans; Isoniazid; Male; Microbial Sensitivity Tests; Middle Aged; Minisatellite Repeats; Mutation; Mycobacterium tuberculosis; Prevalence; Rifampin; Russia; Spondylitis; Tuberculosis, Spinal; Young Adult

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cervical Vertebrae; Clindamycin; Drug Therapy, Combination; Embolism; Female; Gram-Positive Bacterial Infections; Headache; Humans; Lemierre Syndrome; Myalgia; Peptostreptococcus; Retropharyngeal Abscess; Rifampin; Spondylitis; Tomography, X-Ray Computed; Young Adult

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Spondylitis; Treatment Outcome; Young Adult

A 31-year-old HIV-negative man presented to our clinic with a 6-month history of back pain and a swelling at the back. Radiological studies revealed lumbar vertebral destruction. Ultrasound of the mass showed a septated cystic mass with turbid fluid. Diagnostic aspiration revealed thick pus and smear microscopy detected acid-fast bacilli. Xpert MTB/RIF assay detected Mycobacterium tuberculosis with no rifampicin resistance.

Topics: Abscess; Adult; Diagnosis, Differential; Diagnostic Imaging; Drug Resistance, Bacterial; Fatal Outcome; Humans; Lumbar Vertebrae; Male; Nucleic Acid Amplification Techniques; Rifampin; Rural Population; Spondylitis; Tanzania; Tuberculosis, Spinal

Tumor necrosis factor (TNF) is essential for host defense against Mycobacterium tuberculosis, and the risk of reactivation of latent tuberculosis infection (LTBI) increases with anti-TNF therapy. This study estimated the prevalence of LTBI and evaluated the safety and completion rate of short-course therapy with isoniazid plus rifampin for 3 months to treat LTBI in a cohort of Korean arthritis patients before initiating anti-TNF therapy. We retrospectively studied the files of 112 consecutive patients to evaluate LTBI before starting anti-TNF drugs. Screening tests were performed, including a tuberculin skin test and chest radiography. LTBI treatment was indicated in 41 patients (37%). Of these, three patients refused the LTBI treatment. Of the 38 patients who underwent LTBI treatment, 36 (95%) took isoniazid plus rifampin for 3 months. Six patients (16%) showed transient elevations of liver enzymes during the LTBI treatment. Overall, 35 patients (92%) completed the LTBI treatment as planned. In conclusion, LTBI was diagnosed in one-third of Korean arthritis patients before initiating anti-TNF therapy. A high percentage of these patients completed 3 months of LTBI treatment with isoniazid plus rifampin without serious complications.

Topics: Adult; Antibiotics, Antitubercular; Arthritis, Rheumatoid; Female; Humans; Korea; Male; Middle Aged; Retrospective Studies; Rifampin; Spondylitis; Spondylitis, Ankylosing; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha

1) To identify patients of brucella spondylitis and sacroiliitis amongst patients of 'infective spondylitis' and 'sacroiliitis', 2) To study clinical and radiographic features and outcome of brucella spondylitis.. We reviewed 21 patients of infective spondylitis and 12 of sacroiliitis attending our hospital between March and September 2000 and followed them to identify patients of brucella spondylitis and brucella sacroiliitis, using serological tests.. 1) Twenty six patients (17 spondylitis and nine sacroiliitis) were detected to have brucella infection to be the cause of their illness. 2) Brucella spondylitis is commonly mistaken for tuberculous spondylitis in our country. Thus leading to a delay in the diagnosis as well as occurrence of angular deformity and neurological deficit, which are reportedly uncommon in this condition. 3) Consumption (or handling) of unpasteurized milk (tabela milk) and occasional animal contact were found to be the source of infection in the general population. 4) Predominantly lumbar spine involvement, end-plate erosion of L4, L3, L5, decreased intervertebral disc space, repair with'formation of an osteophyte, simultaneous involvement of several sites and association of spondylitis with sacroiliitis were important radiographic features.. Brucellosis exists in the general population, high clinical suspicion especially when there is history of animal contact or consumption of unpasteurized milk, familiarity with clinical and radiological features of brucella spondylitis and detection of antibodies to brucella by ELISA will help us detect and treat these patients in time.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Brucella abortus; Brucella melitensis; Brucellosis; Doxycycline; Enzyme-Linked Immunosorbent Assay; Female; Humans; India; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Sacroiliac Joint; Spondylitis; Trimethoprim, Sulfamethoxazole Drug Combination

This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. Magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. Culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.

Topics: Abscess; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; RNA, Ribosomal, 16S; Spinal Diseases; Spine; Spondylitis

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Low Back Pain; Middle Aged; Rifampin; Spondylitis

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

This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated.. In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for Brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache.. Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy.. Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.

Topics: Adolescent; Adult; Agglutination Tests; Anti-Bacterial Agents; Brucella abortus; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Rifampin; Spondylitis

Report of a rare case of spinal actinomycosis in a young immunocompetent woman.. To show the difficulties in diagnosing spinal actinomycosis.. Spinal actinomycosis is rare and usually occurs as a result of a contiguous (abdominal, pelvic, or thoracic) spread of the infection. This localization represents less than 5% of the infectious sites and was mainly, before the penicillin era, a postmortem discovery.. A case is reported of a 34-year-old Algerian woman who had fever, persistent cough, right-side thoracic pain, and progressive severe back pain. Radiographs, computed tomographic scan, and magnetic resonance imaging demonstrated lytic areas on the vertebral bodies of T11 and T12 and a paravertebral mass, without disk involvement. A surgical biopsy of T12 and the paravertebral abscess was performed.. Presence of characteristic sulfur granules and gram-positive filamentous bacteria in surgical biopsy tissues and isolation of Actinobacillus actinomycetemcomitans in cultures led to the diagnosis of vertebral actinomycosis. The patient was virtually free of pain and fever after a 3-month regimen of ofloxacin and rifampicin (Rifadine, Marion-Merell, France) and was without recurrence after 18 months of follow-up.. Actinomycosis of the spine, caused by the spread of a paraspinal abscess, is extremely rare. The previously poor prognosis has been transformed by antibiotics.

Topics: Abscess; Actinomycosis; Adult; Anti-Infective Agents; Drug Combinations; Female; Humans; Magnetic Resonance Imaging; Ofloxacin; Rifampin; Spinal Diseases; Spine; Spondylitis

To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection.. Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection.. From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound.. The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Retrospective Studies; Rifampin; Spondylitis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The spinal form of brucellosis is still a disabling disease in many countries outside North America and northern and central Europe. Fifteen consecutive cases of spinal brucellosis diagnosed and treated over a 20-year period were reviewed retrospectively. Six patients were farmers, while 10 patients had a history of ingestion of unpasteurized milk or other dairy products. A high index of suspicion is necessary for the diagnosis, since there are no pathognomonic signs or symptoms. Radiological assessment of the disease was reviewed and highlights in the differential diagnoses were stressed. The diagnosis was based on actual culture of Brucella bacilli in seven patients. The principal treatment of brucellosis of the spine is conservative, namely, immobilization and antimicrobial therapy. We have found both a combination of ofloxacin and rifampin and ofloxacin monotherapy efficient as the early regimens used in this series. Three patients had to undergo surgery, since a diagnosis could not be made in any other way.

Topics: Adolescent; Adult; Aged; Brucella melitensis; Brucellosis; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immobilization; Male; Middle Aged; Neurologic Examination; Ofloxacin; Osteomyelitis; Rifampin; Spine; Spondylitis; Tomography, X-Ray Computed

A 33-year-old patient from former Yugoslavia presented with low back pain and fever. Plain X-rays and myelography were normal, but a technetium-99m scan was suspect for vertebral osteomyelitis. Serology and blood cultures were positive for Brucella (melitensis). Antibiotic therapy with tetracycline and rifampicine rapidly improved the signs and symptoms of the infection. A retrospective analysis of 11 cases of Brucellosis treated in the Kantonsspital, Chur, over the years 1973 to 1992 revealed that 9 patients were foreign workers from rural areas in the Mediterranean region (Spain, Portugal, Italy, Yugoslavia, Greece). The majority had a history of consuming milk and dairy products from their own farm animals up to a few months before the onset of symptoms. Blood cultures were positive in 5 cases (B. melitensis) while the remaining 6 had high titers of agglutinating antibodies. A diagnostic delay of several weeks to months was typical. Because Brucellosis usually presents with unspecific often flu-like symptoms, with unspecific laboratory findings, and with a varying array of organ manifestations a high index of suspicion is essential for a timely diagnosis.

Topics: Adolescent; Adult; Brucella melitensis; Brucellosis; Diagnostic Imaging; Emigration and Immigration; Female; Humans; Male; Retrospective Studies; Rifampin; Rural Population; Spondylitis; Switzerland; Tetracycline

The tuberculous spondylitis is still the most frequent form of tuberculous osteitis. The establishment of diagnosis is difficult, because of the most non-specific symptoms. The most important diagnostic aid is the tomography. A definite diagnosis is given only by histological examination of the affected tissue. The therapy is based on the chemotherapy and also on the operative removal of the affected focus. The chemotherapy must be carried out by regular control of the patients through years. The vertebrotomy is carried out by different approaches according to localisation of the focus. By observing these therapeutic rules it is possible to obtain very good results. Certainly the concept "complete healing" by tuberculous osteitis is very problematic. It is better to speak of an active or an inactive process.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Radiography; Rifampin; Spondylitis; Streptomycin; Tuberculosis, Spinal

Topics: Administration, Oral; Aged; Anticoagulants; Benzyl Compounds; Blood Coagulation; Coumarins; Humans; Male; Middle Aged; Rifampin; Spondylitis; Time Factors; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aged; Drug Combinations; Drug Tolerance; Ethambutol; Female; Follow-Up Studies; Hepatitis A; Humans; Liver; Liver Function Tests; Male; Meningitis; Middle Aged; Pelvic Inflammatory Disease; Rifampin; Spondylitis; Sputum; Tuberculosis, Pulmonary

Topics: Adrenal Cortex Hormones; Bronchitis; Humans; Isoniazid; Male; Middle Aged; Prognosis; Rifampin; Spondylitis; Streptomycin; Tuberculosis, Pulmonary; Tuberculosis, Spinal