<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style=&quo...<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.展开更多
BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous syst...BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.展开更多
BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced centr...BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.展开更多
Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae ...Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.展开更多
Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is c...Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is considerably difficult for a physician to diagnose quickly because of incomplete patient history of foreign bodies ingestion and/or insufficient experiences.Patient concerns:We describe the case of a 56-year-old man who was admitted to an emergency medical department owing to a low to moderate fever for 7 days.After a series of examinations,the patient was diagnosed with esophageal perforation(EP)caused by a fishbone that was swallowed half a month ago.Diagnoses:About 12 days after the onset of fever,he was diagnosed with EP based on the gastric endoscopic images combined with histological section and sufficient history of the disease.About 2 months later,the patient has obvious back pain and lack of strength in two legs and was diagnosed with vertebral body infection.Interventions:Antibiotic therapy,multi-disciplinary team(MDT),and surgical intervention had been exerted.Outcomes:It is very fortunate for this patient to have a good prognosis due to a timely diagnosis and proper management.Muscle power has attained level 5.Lessons:Several lessons can be learned from this case;for example,physicians should be alerted to the EP,endoscopic intervention should be prompt,antibiotics should be used regularly,and so on.展开更多
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.
文摘BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.
文摘BACKGROUND Prevotella oris-induced meningitis and Prevotella oris-induced meningitis concomitant with spinal canal infection are extremely rare.To the best of our knowledge,only 1 case of Prevotella oris-induced central system infection has been reported.This is the second report on meningitis combined with spinal canal infection due to Prevotella oris.CASE SUMMARY We report a case of a 9-year-old boy suffering from meningitis and spinal canal infection.The patient presented to the neurosurgery department with lumbosacral pain for 1 mo and headache and vomiting for 1 d.He had been treated with cephalosporin and nonsteroidal anti-inflammatory drugs for fever,otalgia and pharyngalgia in a local hospital 2 mo prior to this admission.During hospitalization,magnetic resonance imaging suggested meningitis and L3-S1 lumbosacral dural sac infection.The cerebrospinal fluid and blood cultures were negative,but the cerebrospinal fluid specimen indicated the presence of Prevotella oris by metagenomic next-generation sequencing.Previous cases of Prevotella oris infection were retrieved from PubMed to characterize the clinicopathological features and identify the prognostic factors and related antimicrobial treatment of infection due to Prevotella oris.CONCLUSION This report shed light on the characteristics of Prevotella oris infection and highlighted the role of metagenomic next-generation sequencing in pathogen detection.
文摘Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.
文摘Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is considerably difficult for a physician to diagnose quickly because of incomplete patient history of foreign bodies ingestion and/or insufficient experiences.Patient concerns:We describe the case of a 56-year-old man who was admitted to an emergency medical department owing to a low to moderate fever for 7 days.After a series of examinations,the patient was diagnosed with esophageal perforation(EP)caused by a fishbone that was swallowed half a month ago.Diagnoses:About 12 days after the onset of fever,he was diagnosed with EP based on the gastric endoscopic images combined with histological section and sufficient history of the disease.About 2 months later,the patient has obvious back pain and lack of strength in two legs and was diagnosed with vertebral body infection.Interventions:Antibiotic therapy,multi-disciplinary team(MDT),and surgical intervention had been exerted.Outcomes:It is very fortunate for this patient to have a good prognosis due to a timely diagnosis and proper management.Muscle power has attained level 5.Lessons:Several lessons can be learned from this case;for example,physicians should be alerted to the EP,endoscopic intervention should be prompt,antibiotics should be used regularly,and so on.
