- MeSH
- Brain Abscess * diagnosis therapy MeSH
- Discitis diagnosis therapy MeSH
- Skull pathology MeSH
- Humans MeSH
- Meningitis, Bacterial * etiology therapy MeSH
- Osteomyelitis diagnosis etiology therapy MeSH
- Spondylarthritis diagnosis therapy MeSH
- Empyema, Subdural * diagnosis therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Discitis diagnosis etiology drug therapy MeSH
- Child MeSH
- Feces microbiology MeSH
- Blood microbiology MeSH
- Humans MeSH
- Salmonella enteritidis MeSH
- Spondylitis diagnosis etiology drug therapy MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Time-to-Treatment MeSH
- Tertiary Care Centers MeSH
- Discitis diagnostic imaging drug therapy microbiology MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Zygapophyseal Joint diagnostic imaging microbiology MeSH
- Orthopedic Procedures MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Spondylitis diagnostic imaging drug therapy microbiology MeSH
- Staphylococcal Infections diagnostic imaging drug therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
The pathogenesis of degenerative disc disease is a complex and multifactorial process in which genetics, mechanical trauma, altered loading and nutrition present significant etiological factors. Infection of the intervertebral disc with the anaerobic bacterium Propionibacterium acnes is now also emerging as a potentially new etiological factor. This human commensal bacterium is well known for its long association with the inflammatory skin condition acne vulgaris. A key component of inflammatory responses to P. acnes in acne appears to be interleukin (IL)-1β. Similarly, in degenerative disc disease (DDD) there is compelling evidence for the fundamental roles of IL-1β in its pathology. We therefore propose that P. acnes involvement in DDD is biologically very plausible, and that IL-1β is the key inflammatory mechanism driving the host response to P. acnes infection. Since there is a solid theoretical basis for this phenomenon, we further propose that the relationship between P. acnes infection and DDD is causal.
- MeSH
- Models, Biological MeSH
- Intervertebral Disc Degeneration etiology physiopathology MeSH
- Discitis complications microbiology MeSH
- Gram-Positive Bacterial Infections complications microbiology MeSH
- Interleukin-1beta metabolism MeSH
- Humans MeSH
- Propionibacterium acnes growth & development MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Dysregulated systemic immune responses during infectious spondylodiscitis (IS) may impair microbial clearance and bone resorption. Therefore, the aim of the study was to examine whether circulating regulatory T cells (Tregs) are elevated during IS and whether their frequency is associated with alterations in T cells and the presence of markers of bone resorption in the blood. A total of 19 patients hospitalized with IS were enrolled in this prospective study. Blood specimens were obtained during hospitalization and 6 weeks and 3 months after discharge. Flow cytometric analysis of CD4 and CD8 T cell subsets, the percentage of Tregs and serum levels of collagen type I fragments (S-CrossLap) were performed. Out of 19 enrolled patients with IS, microbial etiology was confirmed in 15 (78.9%) patients. All patients were treated with antibiotics for a median of 42 days, and no therapy failure was observed. Next, a significant serum C-reactive protein (S-CRP) decrease during the follow-up was observed, whereas the frequencies of Tregs remained higher than those of controls at all-time points (p < 0.001). In addition, Tregs demonstrated a weak negative correlation with S-CRP and S-CrossLap levels were within the norm at all-time points. Circulating Tregs were elevated in patients with IS and this elevation persisted even after the completion of antibiotic therapy. Moreover, this elevation was not associated with treatment failure, altered T cells, or increased markers of bone resorption.
- MeSH
- Anti-Bacterial Agents therapeutic use metabolism MeSH
- Biomarkers metabolism MeSH
- Discitis * diagnosis drug therapy metabolism MeSH
- Humans MeSH
- Prospective Studies MeSH
- T-Lymphocytes, Regulatory * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Článek popisuje případ sepse při purulentní spondylodiscitidě a pyelitidě u 80letého pacienta končící úmrtím nemocného. Příznaky, pro něž přichází do nemocnice, byly zcela nespecifické a méně vyjádřené než v rámci typického klinického obrazu daného onemocnění. Článek se věnuje některým odlišnostem v reakcích imunitního systému geriatrického pacienta a snaží se na základě alterovaných buněčných reakcí vysvětlit možnost chybné interpretace příznaků systémové infekce. Ta může být u starého člověka, pokud probíhá nepovšimnuta, až fatální. Cílem tohoto sdělení je upozornit na některá úskalí diagnostiky i terapie sepse a spondylodiscitidy u geriatrických pacientů a atypičnost klinického obrazu závažného život ohrožujícího onemocnění ve vyšším věku.
The article describes a case of sepsis with purulent spondylodiscitis and pyelonephritis in an 80-years-old patient, which ends with death of the patient. The patient comes to the hospital with completely non-specific and less pronounced symptoms than in a usual clinical type of the disease. The article deals with the dif-ferences in the response of immune system of geriatric patients. It also tries to explain the possibility of misinterpretation of the symptoms of a systemic infection on the basis of the altered cellular responses. These systemic infections could be fatal if unnoticed, especially for the old man. The aim of this article is to focus on some of the difficulties of diagnosis and therapy of sepsis and spondylodiscitis in the geriatric patients and to point out the atypical nature of the clinical picture of severe life-threating illness in elderly age.
- Keywords
- sepse ve stáří, spondylodiscitída,
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Lumbar Vertebrae MeSH
- Diagnostic Errors MeSH
- Discitis * diagnosis MeSH
- Fatal Outcome MeSH
- Immune System physiopathology MeSH
- Humans MeSH
- Pyelonephritis * diagnosis drug therapy MeSH
- Aged, 80 and over MeSH
- Sepsis * diagnosis MeSH
- Aging MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Publication type
- Case Reports MeSH
BACKGROUND CONTEXT: Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. PURPOSE: This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. STUDY DESIGN/SETTING: This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. PATIENT SAMPLE: The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. OUTCOME MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. METHODS: Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. RESULTS: Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p<.001). Delayed surgery also resulted in shorter hospital stays (42.76 days) compared to conservative therapy (55.53 days) and early surgery (26.33 days) (p<.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days postadmission (p=.02). Risk factors for increased mortality included age (p<.05), multiple organ failure (p<.05), and vertebral body destruction (p<.05), whereas delayed surgery (p<.05) and the presence of an epidural abscess were associated with reduced mortality (p<.05). CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days postadmission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Length of Stay MeSH
- Discitis * therapy mortality surgery microbiology MeSH
- Conservative Treatment MeSH
- Critical Illness MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
Vzácný zánět meziobratlového disku a přiléhajících obratlových těl by měl být zvažován u pacientů, kteří si stěžují na kruté bolesti zad v kombinaci se zvýšenou teplotou a neurologickým deficitem nebo bez něj. Spondylodiscitida bývá provázena zvýšenou sedimentací a koncentrací C-reaktivního proteinu. Nespecifické klinické a laboratorní známky s dlouho normálním obrazem na klasickém rentgenovém vyšetření páteře jsou zaměňovány za degenerativní nebo nádorové onemocnění páteře. Pomocí MR vyšetření lze spolehlivě rozpoznat nejen spondylodiscitidu, ale i přidružené abscesy se vztahem k nervovým strukturám. Podle výsledku MR páteře je možné stanovit vhodnou léčebnou strategii konzervativní nebo chirurgickou. Časná správná diagnóza zabrání závažným mechanickým nebo neurologickým komplikacím. Prezentujeme svízelné hledání příčiny krutých bolestí zad u prvního nemocného a objasňování protrahované horečky u druhého pacienta. V obou případech byl vedoucí příznak provázen doplňkovým klinickým atributem - v prvním případě odpoledními subfebriliemi, u druhého pacienta výraznými lumbalgiemi. Po úvodních bolestech levého kolene, silných dorzalgiích a horečkách onemocnění probíhala podobně. Složité pátrání k rozpoznání dvouetážové spondylodiscitidy trvalo 1,5 měsíce. Vyvinuté paravertebrální abscesy bylo nutné řešit operací, zatímco raná stadia lze úspěšně léčit pouze antibiotiky.
A rare inflammation of the intervertebral disc and adjacent vertebral bodies should be taken into consideration in patients who complain of severe back pain combined with an elevated temperature with or without a neurological deficiency. Spondylodiscitis is as a rule associated with an elevated sedimentation rate and concentration of C-reactive protein. Non-specific clinical and laboratory signs with a normal picture for a prolonged period are mistaken for degenerative or tumourous affections of the spine. By means of MR examination it is possible to diagnose reliably not only spondylodiscitis but also associated abscesses of nervous structure. Based on results of MR of the spine it is possible to elaborate a suitable therapeutic strategy - conservative or surgical. An early correct diagnosis will prevent serious mechanical or neurological complications. The authors describe the laborious search for the cause of crucial back pain in the first patient and elucidation of protracted fever in the second patient. In both instances the leading symptom was associated by a supplementary clinical attribute - in the first case subfebrile temperatures in the afternoon and in the second patient by marked lumbalgia. After initial pain of the left knee, severe backache and fever, the course of the disease in te two patients was similar. The complicated search to diagnose the two-level spondyldiscitis took 1.5 months. The developed paravertebral abscesses had to be treated by surgery, while their early stages can be successfully treated by antibiotics only.
- MeSH
- Abscess etiology therapy MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Back Pain diagnosis etiology drug therapy MeSH
- Diagnostic Imaging methods MeSH
- Discitis etiology surgery MeSH
- Research Support as Topic MeSH
- Clinical Laboratory Techniques statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Osteomyelitis etiology surgery MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
- Comparative Study MeSH
