trimethoprim--sulfamethoxazole-drug-combination and Discitis

We describe the first case of typhoid spondylodiscitis in Southeast Asia, and the literature were also reviewed. A 57-year-old diabetic Thai man who presented with a one-month course of progressive low back pain associated with paraparesis and bowel-bladder dysfunction. Examination revealed local tenderness over T12 area, spastic paraparesis, impaired pinprick sensation up to T12 level, and loose anal sphincter tone. Magnetic resonance imaging showed spondylodiscitis of T11 and T12 and epidural abscess causing spinal cord compression. T11 and T12 laminectomy, T11/12 discectomy, and debridement of epidural abscess were performed, and the cultures of the pus grew Salmonella Typhi. He was treated with intravenous ciprofloxacin for three weeks and was discharged from the hospital with oral ciprofloxacin and trimethoprim-sulfamethoxazole for another five months of treatment. The patient was doing well when last seen two months after discontinuation of antimicrobial treatment. In addition, a total of ten cases of typhoid spondylitis/spondylodiscitis were reviewed.

Topics: Anti-Infective Agents; Ciprofloxacin; Diagnosis, Differential; Discitis; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

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: Ampicillin; Anti-Bacterial Agents; Back Pain; Bacteremia; Diagnosis, Differential; Discitis; Haemophilus; Haemophilus Infections; Humans; Intervertebral Disc; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Trimethoprim, Sulfamethoxazole Drug Combination

Anaerobic organisms are a rare cause of spondylodiscitis. Eggerthella lenta is an organism that is not commonly associated with spondylodiscitis. We describe a case of spondylodiscitis due to Eggerthella lenta in an 82-year-old Chinese woman presenting with back pain. The organism was isolated from tissue cultures obtained via radiology-guided biopsy.

Topics: Actinobacteria; Aged, 80 and over; Anti-Bacterial Agents; Back Pain; Discitis; Drug Therapy, Combination; Female; Fractures, Compression; Gram-Positive Bacterial Infections; Humans; Lumbar Vertebrae; Metronidazole; Trimethoprim, Sulfamethoxazole Drug Combination

Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9-10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

Topics: Acute Disease; Administration, Oral; Cefazolin; Debridement; Discitis; Diskectomy; Epidural Abscess; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Paraplegia; Postoperative Care; Postoperative Complications; Recovery of Function; Spinal Cord Compression; Spinal Fusion; Staphylococcal Infections; Thoracic Vertebrae; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Ciprofloxacin; Discitis; Drug Therapy, Combination; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

The case is reported of a patient who developed a vertebral osteomyelitis caused by Enterobacter cloacae. The organism was isolated in cultures of blood and vertebral puncture biopsy samples. The patient was satisfactorily treated with trimethroprim and sulphamethoxazole. Enterobacter cloacae, a Gram negative organism, has been confirmed as the cause of bacteremia in patients with burns, urinary infections, in adults with pneumonia, and in children with joint infections. Spondylodiscitis caused by Enterobacter cloacae has not previously been described.

Topics: Aged; Discitis; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Humans; Radiography; Thoracic Vertebrae; Trimethoprim, Sulfamethoxazole Drug Combination