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Spinal Infections – Natural History

September 30, 2011 By Leave a Comment

For infections to occur in the spine, there has to be an infecting source in the body. Following infection there is an increased pain with or without significant generalized sepsis.

Blood-borne infection probably begins in the capillary loop or postcapillary venous channels in the end plate. Slowing of the circulation leads to sludging which in turn is responsible for suppurative inflammation, tissue necrosis, bony collapse, and spread of the infection into the adjacent intervertebral disc spaces.

End plate erosions that are the first radiographic findings.

The infection can extend anteriorly to create a paravertebral abscess or posteriorly to cause an epidural abscess. [Read more...]

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Filed Under: Musculoskeletal Infections, Spine

Clinical Presentration and Diagnosis of Spinal Infection

September 5, 2011 By 1 Comment

 

Pain is the most common presenting symptom of spinal infection and the typical pain occurs with changes in position and activity. There are associated constitutional symptoms

Spinal deformity may be a late presentation of the disease. Paralysis is a serious complication, but rarely the presenting complaint.

On local examination localized tenderness, paraspinal spasm, limitation of motion of the involved spinal segments are indicators.

In cervical spine torticollis may be the presenting feature.

Elderly and immunosuppressed individuals may present with minimal symptoms

Abscess formation in spine is difficult to ascertain unless the abscess points out superficially. [Read more...]

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Common Organisms Causing Spinal Osteomyelitis

August 8, 2011 By Leave a Comment

Pyogenic organisms 

[Organisms that produce pus]

  • Actinomyces
  • Aerobacter aerogenes
  • Bacteroides
  • Brucella
  • Corynebacterium
  • Clostridium perfringens
  • Enterobacter aerogenes
  • Escherichia coli
  • Gonococcus
  • Klebsiella
  • Micrococcus
  • Proteus
  • Pseudomonas
  • Bacillus pyocyaneus
  • Salmonella enteritidis
  • Salmonella oranienburg
  • Salmonella panama
  • Salmonella paratyphi A and B
  • Salmonella suipestifer
  • Salmonella typhimurium
  • Salmonella typhosa
  • Serratia marcescens
  • Staphylococcus aureus
  • Staphylococcus alba
  • Staphylococcus epidermidis
  • Streptococcus (microaerophilic)
  • Streptococcus (alpha)

Non pyogenic Organisms

  • Mycobacterium Tuberculosis

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An Overview Of Infections Of Spine

August 8, 2011 By Leave a Comment

Like organs of body, spine is prone to infections. Before the use of antibiotics, 40% to 70% of the patients with spinal infections use to die. But advances in chemotherapy have dramatically altered the natural history of these diseases.

In modern times, spinal infections are relatively rare and account for about 2% to 4% of all osteomyelitis infections and the and mortality has come down to 1% to 20%, depending on the patient group and the infecting agent.

One of the unique and serious complication of the spinal infection is paralysis and is reported to occur in 50% of patients with spinal infections. [Read more...]

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Clinical Photograph of Tuberculosis of Sternoclavicular Joint

July 17, 2011 By Leave a Comment

27 years old male with tuberculosis of right sternoclavicular joint.

tuberculosis of clavicle

Tuberculosis of Right Sternoclavicular Joint

The patient was treated successfully with antitubercular drugs.

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Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , ,

Xray Of Chronic Calcaneal Osteomyelitis

April 4, 2011 By Leave a Comment

This xray is of 22 years old male who complained of off an don discharge and swelling on the posterior aspect of ankle.
There was no discharge at the time he presented to our OPD but a swelling with hyperpigmentation was visible.

The xray revealed a radiolucent shadow that contained a sclerotic shadow.

Calcaneal Osteomyelitis

Calcaneal Osteomyelitis

Though the xray is not of good quality but I hope you can appreciate the sclerotic sequestrum [ dead bone] surrounded by a radiolucent cavity.

Calcaneal osteomyelitis is difficult to treat and patient was made aware of his situation. He was offered resection of sequestrum and opening the mouth of the cavity as treatment but he refused.

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Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , , ,

Atypical Tuberculosis

February 25, 2011 By 2 Comments

Atypical tuberculosis is a disease caused by organisms in genus mycobacterium but are different from mycobacterium tuberculosis.  They are not passed from person to person and are generally referred to as non-tuberculosis mycobacterium (NTM) or mycobacterium other than tuberculosis (MOTT).

Though all of them are acid-fast bacilli, and may closely resemble M. tuberculosis when examined microscopically, they differ from each other in their growth requirements and growth characteristics on culture,  time required to grow in culture media and biochemical and genetic characteristics. [Read more...]

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Xrays Of Fracture Of Distal End Tibia Comminuted Fracture and Fibula Fracture

February 11, 2011 By 1 Comment

These are the xrays of the patient with exposed plate in leg.

Here are the xrays after the injury. These xrays show comminuted fracture in distal tibia with fracture lines extending till articular area, something like Pilon fracture. Also seen is fracture of the fibula.

fracture-tibia-distal-third-comminuted-ap

Comminuted Fracture of Distal End Of Tibia

Lateral view [Read more...]

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Filed Under: Ankle Injuries, Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , , ,

Anyplex MDR-TB Test – New Test For Detection Of Multidrug Resistance Tuberculosis Developed

August 4, 2010 By Leave a Comment

Tuberculosis is a chronic infection that has made a worldwide resurgence due to advent of HIV and AIDS. In addition to this there is rise of drug-resistant mycobacterium tuberculosis which further threatens the global TB control efforts. Therefore it is very necessary to have diagnostic measures that detect resistance of the drugs to a particular strain fast. Conventional methods take months to detect the resistance and the search is on for new ways to detect the resistance or multi drug resistance in patients of tuberculosis. [Read more...]

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Fungal Osteomyelitis of Caprals and Metacarpal Bones – Anteroposterior Xray

June 17, 2010 By Leave a Comment

Fungal infection of bone is very rare. A 39 year old man, laborer by profession presented to out patient department with complaints of multiple discharging sinus in dorsum and palmar aspect of hand.

The problem had been there for about 4 months and severity had increased in spite of treatment with antibacterial and antitubercular drugs.
An xray was taken which revealed osteomyelitis of metacarpals and carpals.

In the xray all metacarpals except thumb metacarpals were involved and so were distal row of carpal bones. Note that metacarpals are sclerotic and deformed. Compare them with normal metacarpal of the thumb. Carpal bones can be compared to proximal row of carpal bones which are normal.

A culture for fungi cam positive and patient was put on antifungal drugs.

Unfortunately, he neve returned back for follow up.

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Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , , ,
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