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PubMed2006

Bone and joint infection due to Streptococcus pneumoniae in two immunocompetent adults.

Bone and joint infections due to Streptococcus pneumoniae are uncommon in adults in the absence of risk factors (e.g. alcohol abuse, immunodepression, or preexisting joint disease). We report two cases in previously healthy adults. The clinical picture was septic arthritis of the knee in one patient and discitis with an extensive epidural abscess in the other. The characteristics of S. pneumoniae bone and joint infections are reviewed, with emphasis on risk factors. The therapeutic strategy is discussed in the light of the recent upsurge in S. pneumoniae strains with reduced susceptibility to penicillin.

Adolescent↗
PubMedDate not supplied

Vertebral osteomyelitis: a case report of a patient presenting with acute low back pain.

OBJECTIVE: To report and discuss a case of vertebral osteomyelitis presenting to a chiropractic clinic. CLINICAL FEATURES: A 65-year-old man presented to a chiropractic clinic with acute low back pain. A lumbar spine magnetic resonance image was obtained with and without contrast in both the sagittal and axial planes. The diagnostic impression was osteomyelitis and discitis across the L2-3 disk space with epidural abscess posterior to L3 and a paravertebral abscess. The patient was referred for medical management. A computed tomography-guided fine needle aspiration was performed and confirmed a Staphylococcus aureus infection. The L2-3 level was surgically debrided and fused after a regimen of antibiotic therapy. CONCLUSIONS: This case report presents a typical clinical presentation of vertebral osteomyelitis and reviews the diagnostic imaging, pathophysiology of spontaneous vertebral osteomyelitis, and treatment options in the management of this condition.

Aged↗
PubMed2004

Extended pericranial flap and bone graft reconstruction in anterior skull base surgery.

OBJECTIVES: The objectives of this study was to establish a rationale for repairing large anterior skull base defects with an extended pericranial flap and split calvarial bone graft; to define large anterior skull base defects as those spanning the anterior cranial measuring at least 3.0 x 4.0 cm; and to describe the surgical technique and compare it with alternative strategies. Study design Thirty-four patients underwent anterior craniofacial resection of anterior skull-based tumors of varying histology with reconstruction using an extended pericranial flap and split calvarial bone graft. RESULTS: The survival of the pericranial flap and bone graft was maintained in 33 of 34 patients. There was 1 episode of postoperative cerebrospinal fluid leak, 1 episode of osteomyelitis of the bone graft and an epidural abscess, and 1 episode of asymptomatic pneumocephalus. CONCLUSION: Split calvarial bone graft with an extended pericranial flap is an effective technique for reconstructing large anterior skull base defects.

Bone Transplantation↗
PubMedDate not supplied

Radiographic changes induced after cervical facet radiofrequency denervation.

BACKGROUND CONTEXT: Paraspinal infections after zygapophyseal (facet) radiofrequency denervation (RFD) are a serious but rare complication of this procedure. We are aware of only one case report of an epidural abscess after facet joint injection. PURPOSE: To report post-procedure inflammatory changes after cervical facet RFD. STUDY DESIGN: Case report. PATIENT SAMPLE: A 35-year-old Caucasian female. METHODS: Retrospective case review. RESULTS: The patient underwent cervical RFD and was admitted to the hospital 7 days after her procedure with severe neck pain. Magnetic resonance imaging (MRI) with contrast revealed what appeared to be evidence of a paraspinal muscle abscess although blood tests were negative. She was treated with antibiotic therapy, yet she never developed systemic signs of infection. A follow-up MRI without contrast revealed no evidence of infection, and she was discharged home on hospital day 6. At her first follow-up visit, she was still experiencing scalp pain and paraspinal muscle spasm. During subsequent follow-up visits, she has continued to improve clinically without experiencing signs of infection. Another follow-up MRI 6 weeks after her discharge home revealed persistent minimal left paraspinal enhancement at C2-3, possibly representing post-procedure granulation tissue with no evidence of abscess. CONCLUSIONS: Post-procedural MRI findings after radiofrequency lesioning can resemble radiographic findings associated with a paraspinal abscess. Patients with radiographic findings consistent with abscess should only be treated if clinical signs or symptoms of systemic infection are present.

Adult↗
PubMed1997

Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy.

BACKGROUND: Abdominal sacral colpopexy using permanent mesh is an established technique for repair of vaginal vault prolapse. Infection is not a frequent complication. We report two cases of lumbosacral osteomyelitis treated with intravenous antibiotics without mesh removal. CASES: The first patient had known advanced degenerative arthritis. Unremitting severe low back pain 5 years after abdominal sacral colpopexy prompted magnetic resonance imaging (MRI), revealing osteomyelitis and diskitis. The second patient developed symptoms 2 months postoperatively, and MRI indicated osteomyelitis with epidural abscess. Both patients received intravenous antibiotics, and neither required surgical debridement or mesh removal. CONCLUSION: Osteomyelitis can present remote from the operation and can be difficult to diagnose. Protracted parenteral antibiotic therapy can be definitive treatment without mesh removal.

Aged↗
PubMed2002

Group B Streptococcus endogenous endophthalmitis : case reports and review of the literature.

PURPOSE: To report five cases of group B Streptococcus endogenous endophthalmitis (GBSEE) and to review the literature. DESIGN: Retrospective, noncomparative, interventional case series and literature review. PATIENTS: All patients with this condition treated at the Singapore National Eye Centre from 1994 through 2001. INTERVENTIONS: Core or complete vitrectomy and intravitreal and systemic antibiotics. METHODS: A review of the systemic and ocular characteristics and treatment. MAIN OUTCOME MEASURE: Visual outcome. RESULTS: Group B Streptococcus endogenous endophthalmitis developed in four patients after the onset of septic arthritis and in one patient with cervical epidural abscess after acupuncture, presenting as a diffuse endophthalmitis. Group B Streptococcus was isolated in the blood, vitreous, and joints. Despite the use of high-dose intravenous antibiotics within 72 hours of ocular presentation, intravitreal antibiotic injection, and vitrectomy (two eyes), all eyes lost light perception and became phthisical. A survey of the literature revealed that GBSEE is rare and that 17 cases have been reported since 1985. For purposes of analysis, four of these cases were excluded because of inadequate details and our five cases were included. Group B Streptococcus endogenous endophthalmitis was found to arise from hematogenous spread from cutaneous sites of infection (16.7%), pharyngitis (11.1%), and pneumonia (11.1%). Septic arthritis (38.9%) and endocarditis (33.3%) were concomitant sites of infection along with endophthalmitis. The septic arthritis typically involved multiple joints. Four patients (22.2%) had diabetes mellitus and three had other underlying predisposing illness. Although most patients received intravenous (83.3%) and intravitreal (55.6%) antibiotics and four eyes underwent therapeutic vitrectomy, useful vision was preserved in only four eyes. Two patients died of sepsis. CONCLUSIONS: Group B Streptococcus endogenous endophthalmitis is a devastating condition often associated with septic arthritis. The visual prognosis is poor, despite therapy.

Aged↗
PubMed1987

Unilateral proptosis secondary to diffuse condensing osteomyelitis.

Osteomyelitis of the skull is an uncommon disease in the present days, mainly due to the advent of modern and more effective antibiotics. Hematogenous osteomyelitis is very rare. Osteomyelitis of the skull is usually not associated with sclerosis which is commonly seen in the rest of the skeleton. There are only few occasional case reports of condensing osteomyelitis wherein there was sclerosis of the bone associated with osteomyelitis of the skull and epidural abscess. An unusual case of diffuse condensing osteomyelitis of the skull producing unilateral proptosis is reported. The clinical, radiological features and microbiological aspects are presented. The proptosis was treated by excision of the bone behind the eyeball and thus relieving the proptosis and the impaired vision. The patient was given broad spectrum antibiotics for a period of two months. Further management problems are discussed.

Adult↗
PubMed1998

Epidural and pericranial abscesses complicating frontal sinusitis in a comatose child.

Most complications of sinusitis have a significant risk of severe morbidity and possibly mortality. Therefore a keen awareness of the subtle signs and symptoms of bacterial spread beyond the paranasal sinuses must be maintained. This increased awareness is especially important in mentally retarded and psychomotor handicapped children because they can develop a rapidly fatal course despite the absence of any warning signs.

Abscess↗
PubMed2001

Vascular access infections in patients undergoing dialysis with special emphasis on the role and treatment of Staphylococcus aureus.

Access-related infections are the most important causes of the loss of vascular access for dialysis. These infections also may lead to devastating consequences, including sepsis with multiorgan failure; endocarditis; or metastatic infections such as vertebral osteomyelitis, epidural abscess, or endophthalmitis. A small percentage of these complications are fatal; overall, dialysis-related bloodstream infections are the second leading cause of death in patients undergoing hemodialysis, accounting for up to 10% of all deaths, and approximately three-fourths of all deaths caused by infection in patients undergoing dialysis. Moreover, vascular placement and complications account for approximately one fourth of all admissions and hospital days among patients on dialysis.

Bacteremia↗
PubMed2001

Clinical consequences of infected arteriovenous grafts in hemodialysis patients.

Arteriovenous (AV) graft infection is a serious adverse event in hemodialysis patients; however, there is little published literature describing its consequences. We identified prospectively all AV graft infections occurring at our institution during a 4.5-year period. We analyzed immediate complications, as well as long-term consequences, including the need for subsequent vascular-access procedures and duration of catheter-dependent dialysis therapy. Ninety graft infections were identified in 78 patients, yielding a rate of 8.2 infections/100 graft-years. Patients with graft infection were much more likely to have a low serum albumin level (<3.5 g/dL) in the month preceding the infection compared with noninfected controls (73% versus 18%; P < 0.001). Infections occurred within 1 month of graft placement in 15%, at 1 to 12 months in 44%, and longer than 1 year from surgery in 41%. The pathogen was a gram-positive coccus in 97% of cases, particularly Staphylococcus aureus (60%) and Staphylococcus epidermidis (22%). The initial graft infection entailed hospitalization for a mean of 7.5 days. Eleven patients (12%) developed a total of 17 major complications, including death (5 patients), clinical sepsis requiring vasopressors (4 patients), septic arthritis (3 patients), epidural abscess (1 patient), endocarditis (1 patient), osteomyelitis (1 patient), myocardial infarction (1 patient), and cerebrovascular accident (1 patient). After removal of an infected graft, patients were catheter dependent for a median of 3.8 months. The duration of catheter dependence was less than 3 months in 36%, 3 to 6 months in 38%, 6 to 12 months in 14%, and greater than 1 year in 12%. During the period of catheter dependence, patients required a mean of 9.7 access procedures, including graft removal (1.0 procedure), nontunneled dialysis catheters (4.4 procedures), tunneled dialysis catheters (3.0 procedures), and new permanent accesses (1.4 procedures). In addition, patients averaged 0.85 episodes of bacteremia while they were catheter dependent. In conclusion, graft infection results in substantial morbidity, prolonged dependence on dialysis catheters, and multiple vascular-access procedures.

Anti-Bacterial Agents↗
PubMed1997

[Endocranial complications of acute and chronic otitis media in children and adolescents].

BACKGROUND: After introduction of antibiotics endocranial complications in otitis media are less common, but there are still diagnostic and therapeutic problems. PATIENTS: 124 patients (5 months-16 years) underwent mastoidectomy. The number, type and therapy of otitic complications is presented. RESULTS: Nine percent of the patients showed up with endocranial complications. Besides lateral sinus thrombosis (five patients), meningitis (five patients) and epidural abscess (five patients), one cerebral and one cerebellar abscess was found. Four patients developed more than one complication. THERAPY: A complete mastoidectomy was performed with exploration of the dura and punction of the lateral sinus. In several cases these procedures gave the first diagnostic hint for endocranial complications. CONCLUSION: The occurrence of endocranial complications in the era of antibiotics should not be underestimated. Cholesteatoma is still a main risk factor for severe complications. If there is any doubt, further imaging studies (CT, MRI) are necessary. Diagnosis and therapy makes a close cooperation between neurosurgeon and ear surgeon and other specialties mandatory.

Acute Disease↗
PubMed1999

A Reconstruction Method Using Musculopericranial Flaps that Prevents Cerebrospinal Fluid Rhinorrhea and Intracranial Complications after Extended Anterior Skull Base Resection.

Anterior skull base defects after extended anterior skull base resection including unilateral orbit and the dura were reconstructed using the temporal musculopericranial (TMP) flaps or frontal musculopericranial (FMP) flap in 14 patients. Dural defect was reconstructed with the TMP or FMP flap by making it overlap on the remaining dura around the defects. These flaps were also used, in principle, for the separation of the nasal cavity. For bone defects on the anterior skull base, a bone graft was transplanted in the place between the flap for dural reconstruction and the flap for the separation of the nasal cavity. Bone grafting was nor performed in patients who had an extensive defect and for whom a free flap was used for the separation. After surgery, CSF rhinorrhea did not occur in the 14 patients. Twelve patients did not develop any postoperative complications. Two patients had epidural abscess, but with debridement and the drainage to the nasal cavity, they did not develop severe intracranial complications. We conclude that reconstruction using musculopericranial flaps is a reliable and versatile method with minimum invasion and the shortest operation hours. In particular, musculopericranial flap for dura reconstruction was highly efficacious for the prevention of CSF rhinorrhea.

Journal Article↗
PubMed2006

An uncommon cause of paraplegia: Salmonella spondylodiskitis.

BACKGROUND/OBJECTIVE: Salmonella spondylodiskitis is an uncommon type of vertebral infection. The aim of this study was to present a case of progressive paraplegia caused by Salmonella spondylodiskitis and epidural abscess after endoscopic cholecystectomy. METHODS: The patient underwent posterior instrumentation and posterior fusion between T6 and T12, hemilaminotomies at levels T8-T9-T10, and drainage of the abscess. Through a left thoracotomy, anterior T8-T10 corpectomy, debridement, anterior stabilization, and fusion were conducted. RESULTS: Fifteen months later, final follow-up showed no complications secondary to the vertebral and hip surgeries, and neurological status improved to Frankel grade E. Laboratory investigations showed no evidence of Salmonella infection. CONCLUSION: Immunocompromised patients who undergo endoscopic intervention are vulnerable to Salmonella infections. One must consider Salmonella infection in those who develop acute progressive spondylodiskitis.

Cholecystectomy, Laparoscopic↗
PubMed1999

Brucellar spondylitis: review of 35 cases and literature survey.

Thirty-five patients aged 14-74 years (average, 54 years) who had brucellar spondylitis were treated between January 1991 and December 1997. The time from onset of symptoms to diagnosis of spondylitis ranged from 1 week to 8 months (median, 9 weeks). Back or neck pain (100% of patients), fever (66%), and constitutional symptoms (57%) were the most common symptoms. Cultures of blood specimens from 26 patients (74%) were positive for Brucella melitensis. The duration of antimicrobial therapy (median, 120 days; range, 45-535 days) varied according to clinical response and the presence of epidural and paravertebral masses. One of the 35 patients underwent surgical treatment of a spinal epidural abscess. Therapy failed for 9 patients (26%; 95% confidence interval [CI], 12%-43%), and 5 (14%; 95% CI, 5%-30%) had a relapse. There were no deaths or severe sequelae in this study. Brucellar spondylitis causes considerable suffering and absenteeism from work, but long-term clinical responses are favorable.

Adolescent↗
PubMed2006

Outbreak of Serratia marcescens infections following injection of betamethasone compounded at a community pharmacy.

BACKGROUND: In June 2001, following the report of 4 patients with Serratia marcescens meningitis who received epidural injections of betamethasone compounded at a community pharmacy, we initiated an outbreak investigation. METHODS: All patients who received injections of betamethasone from the production lot common to the 4 patients were evaluated. A case patient was defined as a patient who received compounded betamethasone and had S. marcescens isolated from a sterile site or clinical and laboratory evidence of infection. We cultured all recovered betamethasone, environmental specimens from the pharmacy, and medications recovered from an ambulatory surgery center. The California Board of Pharmacy reviewed the procedures used to prepare the betamethasone. RESULTS: We identified 11 patients with culture-confirmed S. marcescens (8 patients) or clinical infection (3 patients) following injection of compounded betamethasone from 25 May through 31 May 2001. Case patients had meningitis (5 patients, with 3 deaths), epidural abscesses (5 patients), or an infected hip (1 patient). S. marcescens was isolated from 35 (69%) of 51 betamethasone vials recovered, from pharmacy specimens of 1% carboxymethylcellulose stock solution, from pharmacy surfaces, and from multiple parenteral materials used at the ambulatory surgery center. Pulsed-field gel electrophoresis patterns of S. marcescens isolates of representative specimens from patients, the betamethasone, the pharmacy, and the ambulatory surgery center were identical. Deficient practices in compounding of betamethasone included inadequate autoclaving temperatures and failure to perform terminal sterilization. CONCLUSIONS: This outbreak of serious S. marcescens infection followed improper compounding of betamethasone in a community pharmacy. Enforceable national standards for pharmaceutical compounding are needed to reduce the risk of such outbreaks.

Bacterial Typing Techniques↗
PubMedDate not supplied

Rifampin in the treatment of serious staphylococcal infections.

Eight patients with serious staphylococcal infections such as endocarditis, meningitis, epidural abscess, shunt and graft infections were treated with nafcillin, cephalothin or vancomycin in combination with rifampin. In vitro antibiotic sensitivities demonstrated that the Staphylococcus aureus and Staphylococcus epidermidis were highly sensitive to rifampin with minimum inhibitory and bactericidal levels of .0078-.25 micrograms/ml. In all patients reviewed and reported, when serum bactericidal levels were measured before and after the addition of rifampin, there was a positive correlation between microbiological and clinical outcome. Thus, in selected patients with life-threatening infections caused by S. aureus and S. epidermidis rifampin should be considered an adjunctive therapy.

Adult↗
PubMed2002

Discitis associated with pregnancy and spinal anesthesia.

UNLABELLED: Discitis (inflammation of the intervertebral disk) most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery (1) with a postoperative incidence of 1%-2.8% (2). It is also a complication of discography-the intradiscal injection of saline or contrast material (3). The incidence of postdiscography discitis is 1%-4% (3); no cases have been reported when prophylactic antibiotics have been used, supporting the theory of bacterial contamination (3). Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial (4). Honan et al. (5) reported 16 cases of spontaneous discitis and reviewed another 52 patients from the literature. In their series, patients tended to have one or more comorbid conditions, such as diabetes, vertebral fracture, or a preexisting spine injury. Spontaneous discitis has also been associated with advanced age, IV drug abuse, IV access contamination, urinary tract infection, and immunocompromised states (5,6). No cases of infectious discitis associated with pregnancy and spinal anesthesia have been reported in the English literature. Discitis presents as spasmodic pain in the back that may be referred to the hips or groin (7). The pain may radiate to the lower extremities. The erythrocyte sedimentation rate is usually increased. Radiological changes in discitis include narrowing of the intervertebral disk space, vertebral sclerosis, and erosion of the end plates. The best diagnostic measure may be magnetic resonance imaging (MRI) or a combination of bone and gallium scanning (2). The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess, and paralysis. IMPLICATIONS: This is a case report of a disk infection (discitis) caused by the bacteria, Streptococcus bovis after spinal anesthesia for cesarean delivery. S. bovis rarely causes discitis, and spinal anesthesia for labor and delivery has not been reported as a cause of discitis.

Adult↗