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PubMed1977

[Therapy for severe anaerobic infections with clindamycin (author's transl)].

Ten adult patients with severe Bacteroides infections were treated with 0.9 approximately 1.8 g/day of parenteral or oral clindamycin, and a child was treated with 0.3 g/day orally. Remarkable responses and cures were obtained in all the patients, who had no underlying diseases and pure anaerobic infections; a case of sepsis, two cases of liver abscess, a case of subcutaneous abscess and a case of spinal epidural abscess. The other six patients who had ultimately fatal underlying diseases or mixed infections did not respond well to the combination of clindamycin and the other antibiotics therapy, althought bacteriological cures were obtained in all but two cases. Clindamycin was well tolerated and generally nontoxic, nevertheless it was administrated for long term (34 approximately 49 days). But transient development of transaminase was seen in a patient. The data suggested that clindamycin should be considered a first choice antibiotic for the treatment of an aerobic, especially, Bacteroides infections.

Abscess↗
PubMed1994

Sterile epidural and bilateral psoas abscesses in a patient with Crohn's disease.

Crohn's disease primarily affects the distal gastrointestinal tract, yet it is a systemic disease that can involve nearly any organ. A psoas abscess complicating Crohn's disease is uncommon and usually originates from a fistulous communication with an adherent bowel. Spinal epidural abscess, an extremely rare complication, also appears to arise by fistulization from another organ involved with Crohn's disease. Previous reports indicate that abscesses in these two areas usually contain bacterial organisms, often mixed flora, consistent with seeding from a diseased bowel. This report represents the first case of Crohn's disease complicated by both bilateral sterile psoas abscesses and a coexistent sterile epidural abscess without evidence of a fistulous communication from the bowel. We report this case because psoas and epidural abscesses can present without typical signs and symptoms. Once suspected, aggressive diagnostic workup and definitive operative intervention is indicated. Failure to promptly diagnose and treat these abscesses may result in considerable morbidity.

Adult↗
PubMed2006

Quadriparesis from a panspinal extradural abscess following pneumococcal meningitis.

A 63-year-old male presented with marked quadriparesis, three weeks after a pneumococcal meningitis. The MRI-scan was suggestive for extradural abscess in the craniocervical region extending into the lower thoracic spine. Cervical laminectomy was performed and a large abscess was drained. Culture revealed Streptococcus pneumoniae sensitive to benzylpenicillin. The patient was treated with antibiotics for six weeks. His neurological condition recovered completely, and he walked normally, without support, 6 weeks later. Pneumococcal infection of the extradural space is rare. The course of spinal epidural abscess is unpredictable and may present with quadriplegia. Complete recovery of the neurological deficit may occur if the abscess is drained before any ischaemic insult occurs to the cord.

Epidural Abscess↗
PubMed2001

[Diagnostic methods in spinal infections].

A targeted successful treatment of spinal infectious diseases requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging only provides essential informations on the correct topography, localisation, acuity and differential diagnosis of spinal infectious lesions. MRI with its sensitivity concerning soft tissue lesions is a useful tool in detecting infectious alterations of spinal bone marrow, intervertebral disks, leptomeninges and the spinal cord itself. Crucial imaging patterns of typical spinal infections are displayed and illustrated by clinical case studies. We present pyogenic, granulomatous and postoperative variants of spondylodicitis, spinal epidural abscess, spinal meningitis and spinal cord infections. The importance of intravenous contrastmedia application is pointed out.

Diagnosis, Differential↗
PubMed2000

Beware of short-course therapy for Staphylococcus aureus bacteremia without a removable cause.

Staphylococcus aureus bacteremia has long been known to cause significant morbidity and mortality. The optimal treatment of this disease has evolved over the years. Recently, criteria have been established for the use of shorter courses of antibiotic therapy in certain patients, most notably those with an easily removed source of the bacteremia. We present the case of a 55-year-old man with S aureus bacteremia unrelated to an intravascular device. He was treated with "short-course" antibiotic therapy, and lumbar diskitis and an epidural abscess developed.

Anti-Bacterial Agents↗
PubMed1985

[A case of transverse spinal cord syndrome following contamination of a peridural catheter].

Two weeks after removal of a peridural catheter a transverse lesion of the cord with paraplegia developed. At operation a paravertebral abscess, osteomyelitis of the lamina L2 and L3, and epidural abscess, a phlegmonous duritis and myelitis of the conus-cauda region by transmigration was found. The catheter had been in position for four days. The infection was caused by staphylococcus epidermidis. After laminectomy L2 and L3 as well as local and systemic application of antibiotics, according to the results of sensitivity tests, neurological deficits disappeared nearly completely.

Abscess↗
PubMed2005

Iatrogenic (para-) spinal abscesses and meningitis following injection therapy for low back pain.

Low back pain is often treated with paraspinal injections of analgesics and steroids. Infectious complications of these techniques are rare but they can potentially hold high risks for the patients. History and clinical data of all patients admitted to a neurological unit suffering from community acquired purulent meningitis were prospectively analyzed during an 8 year interval (1992 and 2000) with special regard to the previous medical history. One hundred and twenty eight patients were included in the study. Eight out of 128 patients (6.25%) had a history of single or repeated paravertebral (4/8), facet-joint (2/8), peridural (1/8) or spinal (1/8) injections 2-21 days before admission to the hospital. In six out of eight patients either Staphylococcus aureus (4/8) or coagulase-negative staphylococci (2/8) were found in the cerebro spinal fluid (CSF), in two patients no causative organism was detected. One patient died, three survived with sequel. Repeated paraspinal, peridural or spinal injections with analgesic drugs in combination with corticosteroids hold a risk for parameningeal inoculation of bacteria resulting in paraspinal, spinal, and epidural abscesses or meningitis. The absolute frequency of these complications may be rare but they are responsible for a considerable proportion of community acquired purulent CNS infections.

Adolescent↗
PubMed1995

Diagnosis and treatment of intracranial complications of paranasal sinus infections.

Complications and local extension of paranasal sinus infections most often involve the orbit and periorbita. Because of the widespread use of antibiotics since World War II, intracranial extension of maxillofacial sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential for these complications, because late recognition of this condition and delays in treatment can increase morbidity and mortality rates. A comprehensive, current review of sinogenic intracranial complications is presented, with illustrative cases of brain abscess, subdural empyema, meningitis, cavernous sinus thrombosis, epidural abscess, and osteomyelitis. The mechanisms and potential for intracranial spread of infection from the frontal, sphenoid, and ethmoid sinuses are discussed in detail. The management of each type of complication is outlined, including the use of computed tomography and magnetic resonance imaging, and the role of surgical drainage.

Adolescent↗
PubMed2004

Bacterial contamination of epidural catheters: microbiological examination of 502 epidural catheters used for postoperative analgesia.

STUDY OBJECTIVE: To investigate the frequency of bacterial colonization of epidural catheters used for postoperative pain treatment longer than 24 hours in abdominal, thoracic, or trauma surgery patients. DESIGN: Retrospective study. SETTING: Intermediate care facility and general ward of a university hospital. PATIENTS: 502 patients who received epidural catheters after abdominal, thoracic, or vascular surgery at our institution from January 1996 to December 2000. INTERVENTIONS: Placement of an epidural catheter, which was used for postoperative pain treatment, for more than 24 hours. The puncture site dressing included saturation each day with povidone-iodine. MEASUREMENTS AND MAIN RESULTS: Microbiologic monitoring of epidural catheter tips and daily examination of puncture sites with regard to signs of inflammation took place. Four times daily patients were examined to check adequacy of pain treatment and neurologic deficits. Catheter tip cultures were positive in 29 patients (5.8%). Staphylococcus epidermidis was isolated in 22 cases (76%). No case of spinal epidural abscess was observed within 6 months after epidural catheterization. The average catheterization time was 5 days (quartile range: 4 to 6 days). CONCLUSIONS: Meticulous management ensures a relatively low level of bacterial contamination in epidural catheters applied for postoperative pain treatment greater than 5 days. Contamination rarely leads to spinal epidural infection.

Aged↗
PubMedDate not supplied

Salmonella focal intracranial infections: review of the world literature (1884-1984) and report of an unusual case.

Focal intracranial infections are unusual manifestations of salmonellosis. Forty-three such infections have been reported in the world literature. The clinical data for 34 well-documented cases are reviewed. Eleven patients had brain abscess, 19 had subdural empyema, three had epidural abscess, and one had both subdural empyema and brain abscess. Brain abscess occurred more often in adults; in contrast, subdural empyema presented more often in children. Fever, signs and symptoms of increased intracranial pressure, change in mental status, seizures, and focal neurologic deficits were the commonest clinical features. Salmonella serotypes typhi, typhimurium, and enteritidis occurred most frequently. The precipitating factors of these infections included meningitis, trauma, and intracranial hematoma. Surgical drainage combined with systemic antibiotic therapy resulted in the recovery of 21 of 25 patients. A case of embryonal carcinoma plus seminoma of the testis with brain metastases complicated by a salmonella brain abscess is also reported. This is the first report in the world literature of a focal salmonella infection in a neoplastic lesion within the central nervous system.

Adolescent↗
PubMed2001

Pyogenic spondylitis in an S1-S2 immobile segment.

STUDY DESIGN: A case of pyogenic spondylitis in S1-S2 is presented. OBJECTIVE: To describe the diagnosis and management of this rare spondylitis. SUMMARY OF BACKGROUND DATA: The segment including the first and second sacral vertebrae is not mobile. Therefore, discitis of S1-S2 and adjacent spondylitis is very rare. To the authors' knowledge, this is the first reported case of infectious spondylitis in an immobile segment: S1-S2. METHODS: In addition to radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis. Changes consistent with infectious spondylitis were shown, including an epidural abscess. RESULTS: The patient was treated with laparoscopic drainage and biopsy. Staphylococcus aureus was cultured, and adequate antibiotics were administered. Repeat magnetic resonance imaging at approximately 4 months demonstrated normal signal intensity and disappearance of the abscess. CONCLUSION: Findings from this study show that pyogenic spondylitis can occur in immobile S1-S2.

Adolescent↗
PubMed2004

Infectious origins of cauda equina syndrome.

Infections in the spine can lead to a wide range of problems for both the patient and physician. There is perhaps no more devastating complication than the neurological consequences of a cauda equina syndrome due to spinal infection. A variety of organisms and origins can make diagnosis and treatment of spinal infection a difficult task. Both pyogenic and nonpyogenic organisms can cause vertebral involvement and can result in an epidural abscess with neurological compromise. Nonetheless, these two types of infections vary greatly in terms of associated patient demographics, clinical course, and treatments. The purpose of this paper was to review these types of infections and summarize treatment recommendations for this difficult condition.

Debridement↗
PubMed2000

Brucellosis: unusual presentations in two adolescent boys.

Two boys presented with variable signs and symptoms of infectious disease that challenged diagnosis. One of the two patients had aortic valve vegetations and lower extremity aneurysms, and the other had calvarial osteomyelitis, epidural abscess, pleural effusions, and pulmonary nodules. Only after a battery of bacterial and fungal agglutination tests was the unsuspected diagnosis made in each of brucellosis from Brucella canis.

Adolescent↗
PubMed2000

Catastrophic medical complication in psychogenic excoriation.

Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and subsequent paralysis, as a result of compulsive skin picking. Psychogenic excoriation should not be underestimated as a cause of medical complications or as a treatment challenge, particularly in light of the numerous complicating factors often present in such cases.

Cocaine-Related Disorders↗
PubMed1990

[Skin disinfectants for nerve blocks and their long-lasting antimicrobial effects].

Although epidural catheterization has many advantages in anesthesia and in the treatment of acute pain, spinal epidural abscess is a serious complication after the procedure. Since it is presumed that the epidural space is contaminated by bacteria on the skin via the space around the catheter, it seems important to clarify bacterial re-growth after application of skin disinfectant. Therefore, bacterial growths on human back 1, 2 days, and 1 week after application of disinfectants were studied in summer and winter to elucidate whether there are differences between the two seasons. Four disinfectants, 0.5% chlorhexidine in 80% ethyl alcohol (CA), 0.2% benzalkonium in 80% ethyl alcohol (BA), 10% povidone iodine (PI), and 80% ethyl alcohol (EA) were applied on the back of 76 adult healthy volunteers, and the specimens were taken by agar-contact method. The frequencies of positive cultures for bacteria were higher in summer than in winter. The frequencies of positive culture in summer after the applications of CA, BA, PI, and EA were as follows, respectively: 50%, 20%, 5%, and 40% after 1 day; 47%, 50%, 60%, and 50% after 2 days; and 82%, 82%, 70%, and 64% after 1 week. In winter, these frequencies after the application of CA, BA, PI, and EA were as follows, respectively: 0%, 0%, 18%, and 18% after 1 day; 5%, 26%, 32%, and 58% after 2 days; and 21%, 21%, 32%, and 42% after 1 week. We conclude that when an epidural catheter is in situ, more frequent skin disinfection has to be carried out, preferably by CA, in summer than in winter, since the presence of sweat on the back seems to hasten the re-growth of bacteria.

Abscess↗
PubMed2001

[Epidural aspergillosis secondary to lung aspergilloma despite long-term itraconazole treatment].

A 58-year-old man developed spinal cord compression at the T2-T3 level due to an Aspergillus epidural abscess. This presumably immunocompetent patient had been treated for two years by oral itraconazole (200 mg/day) for a lung aspergilloma that occurred seven years after removal of a lung adenocarcinoma. Surgical debridement was performed via a wide posterior approach associated with high-dose amphotericin B. Five months later, the patient's neurological deficit had not improved and the patient died from respiratory failure. Despite a long-term treatment with itraconazole, the infection spread locally from a lung aspergilloma to the epidural space.

Antifungal Agents↗