Muffoletto a, nader r, westmark r, nauta hj, garges kj, hadjipavlou ag. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. Magnetic resonance imaging of bacterial and tuberculous. Request pdf a comparative study of pyogenic and tuberculous. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. Salmonella osteomyelitis is an uncommon complication of salmonella infection, especially the salmonella vertebral osteomyelitis svo.
Discitisosteomyelitis ghaffari a, lanier l, sistrom c, slater r, shah j, rajderkar d, mancuso a, schmalfuss i university of florida, gainesville, fl the authors have no financial relationships to disclose for this educational activity. Skeletal tuberculosis tb refers to tb involvement of the bones andor joints. Imaging of the spine is an important aspect of the diagnosis and management of a patient with potential spinal infection. To develop criteria to distinguish among pyogenic infection, nonpyogenic infection, and neoplastic processes in the spine by means of computed tomography ct, the authors retrospectively analyzed 17 cases of pyogenic infection 20 sites, 40 cases of neoplastic disease 56 sites, and five cases of granulomatous infection eight sites. Aug 08, 2019 pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain. Features of inflammation of the disc space on mri are increased t2weighted signal increased fluid, irregularity of the endplates and oedema of the adjacent bone with progressive bone destruction and disc space narrowing.
Infection may also involve the adjacent intervertebral disc space, which has no direct blood supply in adults. Tuberculosis of the spine accounts for 1% of all tuberculous infections, and 25% to 60% of all bone and joint infections are caused by tuberculosis 1, 6. The most common source of spinal infections is a bacterium called staphylococcus aureus, followed by escherichia coli. However, the biopsy diagnostic yield of percutaneous spinal biopsy for detecting infection ranges from 30 to 40% and aspiration of or 2 ml of. Most frequently, staphylococcus aureus is the etiological agent implied in the infection, responsible for 55%90% of the cases18. Often, discitis is a bacterial infection, but it may be viral. In contrast, during the early phases of infection, spinal tuberculosis may. Classically, spinal tuberculosis is thought to begin in the. Feb 28, 2020 pyogenic vertebral osteomyelitis is the most commonly encountered form of vertebral infection. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults.
Pyogenic vertebral osteomyelitis is the most commonly encountered form of vertebral infection. Features of tuberculous spondylitis included paraspinal soft. Objectives to describe a large series of patients with vertebral osteomyelitis vo, and to compare the clinical, biological, radiological, and prognostic features of pyogenic pvo, tuberculous tvo, and brucellar vertebral osteomyelitis bvo. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. Tb can also affect the meninges of the spine, causing an intense pachymeningitis that enhances dramatically. Gadolinium contrast can be helpful to demonstrate inflammation. Characteristic cerebrospinal fluid csf findings of tbm include a lymphocyticpredominant pleiocytosis, elevated protein, and low glucose. Tbm is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Mr imaging features are nonspecific with respect to the causative organism for patients with brain abscesses. Vertebral osteomyelitis is a type of osteomyelitis infection and inflammation of the bone and bone marrow that affects the vertebrae.
Classically, spinal tuberculosis is thought to begin in the anteriorjinferior portion of the vertebral body 6, 7. Nontuberculous mycobacteria ntm are most commonly isolated from the cervical lymph nodes and submandibular glands of young tb lymphadenitis has been identified at the anterior and. No patients in either group had a prior history of malignancy, cirrhosis, or chronic renal failure. In the united states, the incidence of discitis is approximately 1 out of every 100,000 people, meaning it is not a common spinal disease. It is a rare bone infection concentrated in the vertebral column. Diskspace narrowing occurs secondarily and therefore usually is limited relative to paras pinal epidural. Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. Pdf pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. The mr findings in our patients generally were more typical of neoplasm than of infection. Approximately 80% of spinal infection is caused by s. Tuberculous involvement of the lymph glands can be secondary to infection from m.
The average age of the 18 patients at the time of vp was 73. Mr imaging characteristics of tuberculous spondylitis vs. Hematogenous pyogenic facet joint infection of the subaxial cervical spine. Salmonella potsdam causing lumbar vertebral osteomyelitis. Evaluation and management of pyogenic and tubercular spine infections. Granulomatous infections originate from mycobacterium tuberculosis, brucella, fungi, and parasites such as hydatid disease. Tuberculosis definition tuberculosis tb is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. Differentiation of tuberculous from pyogenic brain abscesses. Tuberculous spondylitis radiology reference article. Discrimination of tuberculous spondylitis from pyogenic. Pott disease, also known as tuberculous spondylitis, is a classic presentation of extrapulmonary tuberculosis tb. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence. Ebraheims educational animated video describes the condition of bone infection and osteomyelitis in asimple and easy way, telling you all you need to. Spinal infections can be caused by either a bacterial or a fungal infection in another part of the body that has been carried into the spine through the bloodstream.
It is important to differentiate tuberculous spondylitis from pyogenic spondylitis because proper treatment of the different types can reduce the rate of disability and functional impairment 2. Surgical treatments, which include anterior or posterior approach. The purpose of this study was to determine the accuracy of mri for discrimination between tuberculous spondylitis and pyogenic spondylitis. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Skeletal tb in children accounts for 1035% of pediatric extrapulmonary tb systemic symptoms found in only 33% of patients less than 50% of children have concurrent pulmonary tb lesions can develop more than 10 years after the initial infection typical presentation solitary bone lesion with local signs of inflammation. Spread of infection can occur beneath the longitudinal ligaments involving the adjacent vertebral bodies. Mri images of 5 patients with spine infection and 81 patients with spine neoplasm were retrospectively analysed in order to identify criteria that will help in distinguishing infection from neoplasm and in differentiating the forms of spine infection. Approach to cns infection location sded, leptomeningeal, parenchymal, spine classic and important hsv, cjd, abscess key to differentiate toxo vs pcnsl, tb vs pyogenic, abscess vs gbmmettcl mimics.
Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain abscesses can be. Prompt characterization of the presence and extent of disease, along with potential infectious etiologies, is essential for the patient to avoid delayed or improper treatment that may result in increased morbidity and mortality. Both are acidfast bacilli, which may cause caseating granulomas fungal infection. Feb 21, 2019 lung abscess aka pyogenic lung infection pneumonia, necrotising pneumonia. Although tb can be treated, cured, and can be prevented if persons at risk take certain. Pdf pyogenic, tuberculous, and brucellar vertebral. Pdf concomitant spine infection with mycobacterium. Vertebral osteomyelitis and discitis may occur together or. Infection after vertebroplasty vp is a rare but serious complication.
The value of mr imaging in comparative analysis of spinal. Nine patients had bacterial infection and the other nine patients were confirmed with tb infection. Features of tuberculous spondylitis included paraspinal soft tissue. Tuberculous spondylitis has been common in developing countries, and the number of patients with the disease. Tuberculosis of spine presentation and treatment bone. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of. It is associated with significant morbidity and can lead to severe functional impairment. It is caused by a bacterial microorganism, the tubercle bacillus or mycobacterium tuberculosis. Tuberculous spondylitis and pyogenic spondylitis are both common causes of spinal infection. Disc involvement occurred in 93% of infections and only 1% of neoplasms. Spinal tuberculosis accounts for around 2% of all cases of tuberculosis and around 15% of extrapulmonary tuberculosis cases. Spondylodiscitis infection of the intervertebral disc vertebral osteomyelitis if infection invades the endplates or the verteb. The association between tb and human immunodeficiency virus infection is welldocumented.
Two cases in the tb group had diabetes, whereas 4 had diabetes in the pyogenic spondylitis ps group. However, on t2weighted images, the disk space and surrounding marrow have lower signal intensity in the neuropathic spine than in pyogenic spondylitis, 41, fig 12b. Previous literatures showed most pathogens for infection after vp were bacteria. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis. Bone tuberculosis definition of bone tuberculosis by. Pyogenic spondylitis tuberculosis pyogenic well defined paraspinal abnormal mass. These findings may reflect the characteristics of the tuberculous organism relative to the.
Lung abscess is a severe, localised suppurative infection in the substance of the lung. As for pyogenic spondylodiscitis, tss can re sult from arterial. Most of the patients respond to medications though. Infectious spondylitis is defined as an infection by a specific organism of one or more components of the spine, namely the vertebra, intervertebral discs, paraspinal soft tissues, and epidural space.
Infections can also begin in the bone itself if an injury exposes the bone to germs. A comparative study of pyogenic and tuberculous spondylodiscitis. These findings may reflect the characteristics of the tuberculous organism relative to. The current trend is a decrease in spinal infections due to good nutritional and hygienic status, but an increase in the resistant strains of the organism of pyogenic spondylitis 1, 2. Evaluation and management of pyogenic and tubercular spine. There is consensus that the most common lesion of pyogenic spinal infection is lumbar. The diagnosis tends to be delayed because of a nonspecific initial early manifestations andor low degree of suspicion. We reported our treatment experiences of cases with infectious spondylitis after vp, and compared the differences between developed pyogenic and tb spondylitis.
Ebraheims educational animated video describes the condition of bone infection and osteomyelitis in asimple and easy way, telling you all you need to know about those conditions. Pdf comparison of pyogenic spondylitis and tuberculous. Pyogenic spondylodiscitis pyogenic spondylodiscitis affects most frequently the lumbar spine, involving only one vertebral segment one intervertebral disk and adjacent vertebral bodies. Aetiologically spinal infections can be described as pyogenic, granulomatous and parasitic. Severe pyogenic infection of bone and local tissue that requires immediate treatment. Concomitant spine infection with mycobacterium tuberculosis and pyogenic bacteria. Approach to cns infection location sded, leptomeningeal, parenchymal, spine classic and important hsv, cjd, abscess key to differentiate toxo vs pcnsl, tb vs pyogenic, abscess vs. This guy may need emergency spinal surgery world spine care. Bone infection, osteomyelitis, briefly everything you need. These findings may reflect the characteristics of the tuberculous organism relative to the agedependent pattern of vertebral microcirculation. Infection can also arise following surgery or injection of the disc space or via contiguous spread from adjacent soft tissue infection. Discitis is a spinal disc infection and inflammation.
It is difficult to differentiate tuberculous spondylitis and pyogenic. Other causes of pyogenic infections of the spine include streptococcus, pneumococcus, enterococcus, escherichia coli, salmonella, pseudomonas aeruginosa, and klebsiella. Mar 01, 2009 on radiographs and ct scans, a neuropathic spine caused by traumatic paralysis or in association with syringomyelia or diabetes mellitus may resemble infectious spondylitis. Tuberculosis of spine presentation and treatment bone and spine. Tuberculous spondylitis versus pyogenic spondylitis. Spondylodiscitis infection of the intervertebral disc vertebral osteomyelitis if infection invades the endplates or the vertebral body. Infections of spine spine infection tuberculosis of spine differential diagnosis of infections of spine spinal tuberculosis pyogenic infections of spine fungal slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Differentiation between tuberculous spondylitis and. Most frequently, staphylococcus aureus is the etiological agent implied in the infection, responsible for 55%90% of the cases. It can develop from direct open spinal trauma, from infections in adjacent structures, from hematogenous spread of bacteria to a vertebra, or postoperatively. We reported a case of a 29yearold female who presented with serious lower back pain and severe limitation of motion for 50 days with no obvious inducements. Differentiation between tuberculous and pyogenic spondylodiscitis. Bone infection, osteomyelitis, briefly everything you. Tb and msk infections in children dr joanna kaszniabrown consultant radiologist bristol, uk.
Discrimination of tuberculous spondylitis from pyogenic spondylitis. Neural deficit means weakness in the limbs and in late cases complete loss of motor power and loss of bladder bowel control. Tb spine needs to be operated if there is a neural deficit which is not responding to medications or is worsening in spite of medications. Regarding prior medical history, 3 cases in the tuberculosis tb group had pulmonary tb, and 1 case had both pulmonary and intestinal tb. Discitis is usually caused by an infection that develops in one of the spines vertebral bones andor intervertebral discs.
Cases of vertebral osteomyelitis are so rare that they constitute only 2%4% of all bone infections. It is important to differentiate tuberculous spondylitis from pyogenic spondylitis, because proper treatment for the different types may reduce the rate of disability and functional impairment 1, 6, 7. In most cases, pyogenic spondylodiscitis affects the lumbar spine. Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. The most common route for spinal infection is through hematogenous spread of the microorganism from a. Although infection can be caused by pyogenic, granulomatous, autoimmune, idiopathic, and iatrogenic conditions, pyogenic spondylitis is the most common spinal infection, and tuberculosis continues to be a major problem in developing countries and is resurgent in western world with the onset of human immunodeficiency virus hiv.
Pyogenic spondylodiscitis affects most frequently the lumbar spine, involving only one vertebral segment one intervertebral disk and adjacent vertebral bodies. Differentiation of tuberculous from pyogenic brain. Vertebral osteomyelitis and discitis may occur together or independently. In these cases, tb is more likely to be extrapulmonary. Comparison of pyogenic spondylitis and tuberculous spondylitis. Infection of the spine is an ancient disease, with changes consistent with tuberculosis described in human skeletons dating back to the iron age. Nov 12, 2018 infection after vertebroplasty vp is a rare but serious complication. Additionally, nearly 1 in 10 pyogenic vertebral osteomyelitis pvo. Imaging findings of these 2 diseases can be challenging to distinguish, yet crucial because the treatments for these infections are particularly different 2. Imaging findings of these 2 diseases can be challenging to distinguish, yet crucial because the treatments for these infections are particularly differen. On radiographs and ct scans, a neuropathic spine caused by traumatic paralysis or in association with syringomyelia or diabetes mellitus may resemble infectious spondylitis.
A descriptive and comparative study of 219 cases article pdf available in annals of the rheumatic diseases 5612. Mriearly pyogenic infection within bone marrow typically results in inflammatory exudate, replacement of fat by stimulation of bone marrow to produce white blood cells in response to the infection, some vascular proliferation, and some degree of minor ischemia. Objectives to describe a large series of patients with vertebral osteomyelitis vo, and to compare the clinical, biological, radiological, and prognostic features of pyogenic pvo, tuberculous tvo, and brucellar vertebral osteomyelitis bvo methods a retrospective multicentre study, which included 219 adult patients with vo with confirmed aetiology, who were diagnosed. Ts was frequently associated with active tuberculosis of other organs 0% vs.
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