FUO as first presentation of candida vertebral osteomyelitis; a case report

Candida osteomyelitis is a rare disorder. Its incidence has drastically risen during the last 3 decades. Diagnosis is delayed due to nonspecific symptoms. Thus its management is not done early which leads to increased morbidity. Here we report an immunocompetent case of candida osteomyelitis that presented with prolonged FUO.

A Rare Case of Granulicatella adiacens Vertebral Osteomyelitis

Vertebral osteomyelitis caused by Granulicatella adiacens is rarely described. We report a 45-year-old immunocompetent male with back pain caused by G. adiacens osteomyelitis. This case is remarkable due to the absence of endocarditis. A clinician should therefore consider G. adiacens osteomyelitis even in the absence of concurrent hematogenous spread.

Frequency of various forms of spondylodiscitis on spinal column segments

Introduction: The term spinal infections or spinal column infections usually include processes localized in various parts of spinal column, parts of vertebrae as well as in intervertebral disc. There are three main types of spondylodiscitis. Bacterial spondylodiscitis (vertebral osteomyelitis) is inflammatory process usually involving two (neighboring) vertebrae and intervertebral disc causing the space for the disc between the vertebrae to be narrowed down. The aim of this paper is to present the frequency of various forms of spondylodiscitis on spinal column segments following laboratory, microbiological and radiological diagnostic procedures.Patients and methods: Descriptive research method was used in the work, as it was deemed appropriate for this type of research analysis. Diagnostic procedures used include: laboratory tests, microbiological analysis, MRI scans of cervical spine, MRI scans of thoracic spine, MRI scans of L/S spinal column.Results: Out of 307 patients included in the research, in 109 occurrences spondylodiscitis was verified on various parts of spinal column. Brucellosis spondylodiscitis represents the most frequent form (in 86% of patients), and the majority of occurrences was localized at lumbosacral part of spinal column. During the research, quite unusually, there was also one occurrence of spondylodiscitis with paravertebral abscess on cervical part of spinal column. It is also a type of brucellosis spondylodiscitis. The use of magnetic resonance imaging appears to be gold standard in diagnostics of spondylodiscitis, especially following the application of contrast agent and the use of T1 FS (fat saturation) sequences along with standard tomograms in times T1 and T2. The majority, up to 262 (85.3%) of Elisa tests were related to brucellosis. In 245 out of 307 cases, the result was positive, that is in direct relation to the fact that various forms of brucellosis are present in the areas being examined.Conclusion: Research results indicated that spondylodiscitis was diagnosed in all segments of spinal column. The most frequent occurrences are on L/S part of spinal column and the most frequent form of brucellosis is spondylodiscitis.

Vertebral osteomyelitis is characterised by increased RANK/OPG and RANKL/OPG expression ratios in vertebral bodies and intervertebral discs

Vertebral osteomyelitis (VO) is an infection of the spine mainly caused by bacterial pathogens. The pathogenesis leading to destruction of intervertebral discs (IVDs) and adjacent vertebral bodies (VBs) is poorly described. The present study aimed at investigating the connection between infection and bone/disc metabolism in VO patients. 14 patients with VO (infection group) and 14 patients with burst fractures of the spine (fracture group; control) were included prospectively. Tissue biopsies from affected IVDs and adjacent VBs were analysed by RT-qPCR for mRNA-expression levels of 18 target genes including chemokines, adipokines and genes involved in bone metabolism. Most importantly, the receptor activator of NF-κB/osteoprotegerin (RANK/OPG) expression ratio was drastically elevated in both VBs and IVDs of the infection group. In parallel, expression of genes of the prostaglandin-E2-dependent prostanoid system was induced. Such genes regulate tissue degradation processes via the triad OPG/RANK/RANKL as well as via the chemokines IL-8 and CCL-20, whose expression was also found to be increased upon infection. The gene expression of the adipokine leptin, which promotes inflammatory tissue degradation, was higher in IVD tissue of the infection group, whereas the transcription of omentin and resistin genes, whose functions are largely unknown in the context of infectious diseases, was lower in infected VBs. In summary, similar expression patterns of pro-inflammatory cytokines and pro-osteoclastogenic factors were identified in VBs and IVDs of patients suffering from VO. This suggests that common immuno-metabolic pathways are involved in the mechanisms leading to tissue degradation in VBs and IVDs during VO.

Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.