Non-pyogenic infections of the spine

Abstract Subacute and chronic spondylodiscitis can be caused by a wide spectrum of infectious aetiologies including Mycobacterium tuberculosis , Brucella spp. and a variety of fungi including Aspergillus spp., Candida spp. and Cryptococcus neoformans . Knowledge of the local epidemiology and prior e...

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Bibliographic Details
Published in:International journal of antimicrobial agents 2010-08, Vol.36 (2), p.99-105
Main Authors: Skaf, Ghassan S, Kanafani, Zeina A, Araj, George F, Kanj, Souha S
Format: Article
Language:English
Subjects:
Anti-Infective Agents - therapeutic use
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antibodies, Bacterial - blood
Antibodies, Fungal - blood
Antigens, Fungal - blood
Aspergillus
Bacterial diseases
Biological and medical sciences
Brucella - immunology
Brucella - isolation & purification
Brucellosis
Chronic Disease
Discitis - diagnosis
Discitis - microbiology
Discitis - therapy
Diseases of the osteoarticular system
Diseases of the spine
Fungal infection
Fungi - immunology
Fungi - isolation & purification
Global Health
Human bacterial diseases
Humans
Infectious Disease
Infectious diseases
Medical sciences
Miscellaneous
Mycobacterium tuberculosis - immunology
Mycobacterium tuberculosis - isolation & purification
Pharmacology. Drug treatments
Spine
Spondylodiscitis
Tuberculosis
Tuberculosis and atypical mycobacterial infections
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Summary:Abstract Subacute and chronic spondylodiscitis can be caused by a wide spectrum of infectious aetiologies including Mycobacterium tuberculosis , Brucella spp. and a variety of fungi including Aspergillus spp., Candida spp. and Cryptococcus neoformans . Knowledge of the local epidemiology and prior exposure might suggest the aetiology. Non-invasive diagnostic approaches, such as blood culture or antibody titres in the case of Brucella or antigen detection in the case of fungal infections, can be helpful in reaching the diagnosis. However, direct aspiration or tissue biopsy is usually necessary to identify the causative organism. Specimens are usually sent for pathology, special stains, cultures and, when indicated, molecular analysis. To minimise morbidity and mortality, antibiotic treatment should be initiated promptly directed against the suspected organism, and later adjusted according to the confirmed aetiology. Surgical treatment is reserved for recurrent infection, unstable spinal segment or marked kyphosis in the face of any neurological deficits and uncontrollable pain. Surgical approaches are dictated by the anatomic location of the offending lesion. Once medical treatment fails and surgery becomes warranted, we advocate the use of a two-stage surgical treatment for non-fixed kyphosis and a three-stage operation for fixed kyphosis.
ISSN:0924-8579
1872-7913
DOI:10.1016/j.ijantimicag.2010.03.023