Spondylodiscitis and endocarditis, the strange couple

Abstract Background The association between spondylodiscitis and infective endocarditis (IE) was first reported in 1965 but only a few data are available in the literature about this clinical picture. Early diagnosis of infective endocarditis as the source of spondylodiscitis is often difficult. The aim of this study was to evaluate the proportion of spondylodiscitis in patients with IE and to determine its clinical features. Methods We retrospectively analyzed 355 consecutive patients (127 women) admitted to our department with definite diagnosis of IE. Mean age was 65 years (SD 15.3). IE occurred on native valves in 223 patients (63%) and it involved the aortic valve in 191 cases (54%), mitral valve in 138 cases (39%) and tricuspid valve in 26 (7%). Spondylodiscitis occurred in 24 patients (7%). The diagnosis of spondylodiscitis was made on the basis of typical clinical and radiologic signs. Long-term follow-up was obtained by structured telephone interviews. Average duration of follow-up was three years. Primary endpoint was to establish clinical features of patients with IE complicated by spondylodiscitis. Results At univariable analysis spondylodiscitis was associated with male sex (p=0.043), diabetes (p=0.049), drug abuse (p=0.017) and enterococcus infection (p=0.043). At multivariable analysis diabetes (p=0.014) and drug abuse (p=0.006) were independently correlated with the presence of spondylodiscitis. Other clinical features were not associated with the presence of spondylodiscitis (age, BMI, chronic renal failure, paravalvular extension of infection, vegetation length, EuroScore 2, PCR and procalcitonin levels, type of valve infected). Mortality was similar between patients with and without spondylodiscitis. Conclusions The association of spondylodiscitis and infectious endocarditis should always be suspected, expecially in patients with a high risk profile. Hence, patients with spondylodiscitis should be submitted to echocardiography, mainly when the infective organism is an Enterococcus. Conversely, patients with IE should undergo screening for methasthatic infection. Funding Acknowledgement Type of funding source: None

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Endocarditis with spondylodiscitis: clinical characteristics and prognosis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01991-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefano Del Pace ◽

Valentina Scheggi ◽

Giacomo Virgili ◽

Sabina Caciolli ◽

Iacopo Olivotto ◽

...

Keyword(s):

Drug Abuse ◽

Systolic Function ◽

Multivariable Analysis ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Prognostic Impact ◽

Metastatic Infection ◽

Few Data

Abstract Background The association of infective endocarditis (IE) with spondylodiscitis (SD) was first reported in 1965, but few data are available about this issue. This study aimed to evaluate the prevalence of SD in patients with IE, and to determine the clinical features and the prognostic impact of this association. Methods We retrospectively analysed 363 consecutive patients admitted to our Department with non-device-related IE. Radiologically confirmed SD was revealed in 29 patients (8%). Long-term follow-up (average: 3 years) was obtained by structured telephone interviews; in 95 cases (13 of whom had been affected by SD), follow-up echocardiographic evaluation was also available. Results At univariable analysis, the combination of IE with SD was associated with male gender (p = 0.017), diabetes (p = 0.028), drug abuse (p = 0.009), Streptococcus Viridans (p = 0.009) and Enterococcus (p = 0.015) infections. At multivariable analysis, all these factors independently correlated with presence of SD in patients with IE. Mortality was similar in patients with and without SD. IE relapses at 3 years were associated with the presence of SD (p = 0.003), Staphylococcus aureus infection (p < 0.001), and drug abuse (p < 0.001) but, at multivariable analysis, only drug abuse was an independent predictor of IE relapses (p < 0.001; HR 6.8, 95% CI 1.6–29). At echocardiographic follow-up, SD was not associated with worsening left ventricular systolic function or valvular dysfunction. Conclusions The association of IE with SD is not rare. Hence, patients with IE should be screened for metastatic infection of the vertebral column, especially if they have risk factors for it. However, SD does not appear to worsen the prognosis of patients with IE, either in-hospital or long-term.

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First-episode primary psychosis with comorbid drug abuse and drug–induced psychosis: diagnostic stability and clinical evolution at long-term follow up

10.26226/morressier.5785edccd462b80296c98fb0 ◽

2016 ◽

Author(s):

Chiara Di Pace

Keyword(s):

Drug Abuse ◽

First Episode ◽

Drug Induced ◽

Diagnostic Stability ◽

Clinical Evolution ◽

Long Term Follow Up ◽

Drug Induced Psychosis

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Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-05-0075 ◽

2012 ◽

Vol 25 (02) ◽

pp. 109-115 ◽

Cited By ~ 19

Author(s):

M. Thomas ◽

J. M. Weh ◽

J. Bleedorn ◽

K. Wells ◽

W. J. Roach

Keyword(s):

Intervertebral Disc ◽

Herniated Disc ◽

Intervertebral Disc Disease ◽

Disc Disease ◽

Vertebral Canal ◽

Telephone Interviews ◽

Disc Material ◽

Long Term Follow Up

SummaryObjective: To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.Methods: Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews.Results: Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9–82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6–155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9–60%; median 30.1%). Mean RFP = 19.8% (range 4.8–45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88–735 days).Clinical significance: Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

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