Abstract

Mini Review

Persistent Lumbar Pain and Fever: Osteomyelitis as Diagnosis Challenge

Alicia Cárdenas García*, Sara García Mateo, María Rodríguez Pérez, José Carlos Sureda Gil, María Teresa Gómez Álvarez, Francisco de Borja Hernández Moreno and Anna de Paola Prato

Published: 28 March, 2024 | Volume 8 - Issue 1 | Pages: 005-009

Objective: This study aimed to evaluate the clinical characteristics and diagnostic challenges associated with osteomyelitis in patients presenting with persistent lumbar pain and fever.
Methods: We conducted a descriptive observational study, reviewing four cases of osteomyelitis diagnosed at our hospital’s Emergency Department in 2022. Data on patient demographics, medical history, clinical presentation, diagnostic methods, and treatment outcomes were analyzed.
Findings: The cases included middle-aged to elderly men, with predisposing factors such as urological interventions and immunodeficiency. Imaging studies, particularly CT-scan and MRI, were instrumental in diagnosing lumbar spondylodiscitis. Biopsies revealed lymphoplasmacytic infiltrates and treatment responses were positive in all cases after eight months of follow-up. The study highlights the importance of considering osteomyelitis in the differential diagnosis of lumbar pain and fever, necessitating multidisciplinary collaboration for timely management.

Read Full Article HTML DOI: 10.29328/journal.aceo.1001019 Cite this Article Read Full Article PDF

Keywords:

Osteomyelitis; Lumbar pain; Fever; Spondylodiscitis; Infectious spondylitis; Diagnostic challenges; Urological complications

References

  1. Yoon SH, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB, et al. Pyogenic Vertebral Osteomyelitis: Identification of Microorganisms in 68 Cases and Performance of Diagnostic Guidelines. J Bone Joint Surg Am. 2019 Jul 17;101(14):e68. doi: 10.2106/JBJS.18.00986. PMID: 31318715.
  2. Babic M, Simpfendorfer CS. Lumbar Spondylodiscitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
  3. Tee JW, Mavrogenis AF, Hey HWD, Wang M, Wong ACL. Osteomyelitis of the Spine: A Review. Clin Spine Surg. 2020 Feb;33(1):4-10. doi: 10.1097/BSD.0000000000000918. PMID: 31913985.
  4. Bernard L, Dinh A, Ghout I, Simo D, Zeller V, Issartel B, Le Moing V, Belmatoug N, Lesprit P, Bru JP, Therby A, Bouhour D, Dénes E, Debard A, Chirouze C, Fèvre K, Dupon M, Aegerter P, Mulleman D; Duration of Treatment for Spondylodiscitis (DTS) study group. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet. 2015 Mar 7;385(9971):875-82. doi: 10.1016/S0140-6736(14)61233-2. Epub 2014 Nov 5. PMID: 25468170.
  5. Eren EE, Gümüş C, Gümüş H, Yılmaz F, Eren B. Multimodal management of pyogenic spondylodiscitis: outcomes in 24 patients. Medicina (Kaunas). 2021 Jul 20;57(8):796. doi: 10.3390/medicina57080796. PMID: 34440943; PMCID: PMC8386233.
  6. Choufani E, Combellle L, Becker A, et al. Efficacy and safety of ceftriaxone for the treatment of bone and joint infections in children: a systematic review and meta-analysis. BMC Pediatr. 2020 Sep 9;20(1):430. doi: 10.1186/s12887-020-02338-1. PMID: 32907647; PMCID: PMC7484177.
  7. Diehn FE, Maus TP, Morris JM, et al. Effectiveness of percutaneous versus surgical treatment for spinal pyogenic osteomyelitis: systematic review and meta-analysis. AJNR Am J Neuroradiol. 2020 Apr;41(4):660-667. doi: 10.3174/ajnr.A6495. Epub 2020 Mar 19. PMID: 32193267.
  8. Du W, Tan X, Li J, et al. Short-term efficacy of percutaneous endoscopic debridement combined with postural drainage positioning for treating lumbar spinal pyogenic infection. BMC Musculoskelet Disord. 2020 Sep 14;21(1):614. doi: 10.1186/s12891-020-03648-1. PMID: 32928198; PMCID: PMC7498889.
  9. Pintado García V, Gómez-Junyent J, Rodríguez-Pardo D. Pyogenic vertebral osteomyelitis: Diagnosis and management. Rev Esp Quimioter. 2021;34(5):411–22.
  10. Arora S, Singh PK, Sharma S, et al. Tubercular spondylodiscitis: Treatment outcomes and impact of HIV infection. J Infect Public Health. 2020 Mar;13(3):448-452. doi: 10.1016/j.jiph.2019.08.010. Epub 2019 Sep 10. PMID: 31519446.
  11. Cebrian Parra JL, Saez-Arenillas Martín A, Urda Martínez-Aedo AL, Lópiz Moro A, Ezquerro Juanco M, García García J. Pyogenic vertebral osteomyelitis: A descriptive analysis of 19 cases. Rev Esp Cir Ortop Traumatol. 2020 Nov;64(6):475-481. doi: 10.1016/j.recot.2019.12.003. Epub 2020 Feb 14. PMID: 32067866.
  12. Ihekire O, Anyanwu GE, Chukwu CN, et al. Management of pyogenic spondylodiscitis: A retrospective analysis of 49 cases. J Craniovertebr Junction Spine. 2020 Jul-Sep;11(3):220-224. doi: 10.4103/jcvjs.JCVJS_98_19. PMID: 33133325; PMCID: PMC7551977.
  13. Lin TY, Chen WY, Chen CY, et al. Clinical features and microbiological findings of osteoarticular infections caused by Streptococcus dysgalactiae subsp. equisimilis in southern Taiwan. J Microbiol Immunol Infect. 2020;53(3):464–469.
  14. Liu Z, Chen Y, Zhao Y, et al. The risk factors for delayed diagnosis of spinal infections: A case-control study. Medicine (Baltimore). 2019;98(13):e14908.
  15. Magombeyi S, Majoni SW, Chinouya MJ, Rusakaniko S. Health system's response and intersectoral collaboration for tuberculosis elimination in Zimbabwe. Pan Afr Med J. 2020 Dec 3;37:35. doi: 10.11604/pamj.2020.37.35.21418. PMID: 33409046; PMCID: PMC7772352.
  16. Mendelsohn D, Desai A, Ben-Zvi T, et al. Tuberculous spondylodiscitis: a retrospective analysis of 25 cases in a single center. Clin Rheumatol. 2021;40(3):1003–1009.
  17. Qureshi NA, Parasnis A, Kalia R, et al. Osteomyelitis in children: A review of 16 cases from a tertiary care center in Oman. J Craniovertebr Junction Spine. 2020;11(4):296–300.
  18. Ryu S, Lee S, Lee SH, et al. The diagnostic accuracy of CT-guided percutaneous biopsy of spinal infection. Eur Radiol. 2020;30(2):1167–1175.
  19. Sieper J, et al. Management of osteomyelitis in adults. Clin Microbiol Infect. 2020 Jan;26(1):2-7. doi: 10.1016/j.cmi.2019.09.018. Epub 2019 Sep 27. PMID: 31568864.
  20. Park KH, Cho OH, Lee JH, Park JS, Ryu KN, Park SY, Lee YM, Chong YP, Kim SH, Lee SO, Choi SH, Bae IG, Kim YS, Woo JH, Lee MS. Optimal Duration of Antibiotic Therapy in Patients With Hematogenous Vertebral Osteomyelitis at Low Risk and High Risk of Recurrence. Clin Infect Dis. 2016 May 15;62(10):1262-1269. doi: 10.1093/cid/ciw098. Epub 2016 Feb 24. PMID: 26917813.
  21. Conterno LO, et al. Management of bone infections in orthopedic surgery: pharmacokinetic and pharmacodynamic considerations. Expert Rev Anti Infect Ther. 2021 Feb;19(2):169-179. doi: 10.1080/14787210.2021.1877250. Epub 2021 Feb 10. PMID: 33430621.
  22. Soriano A, et al. Clinical implications of microbiology results in the management of bacteremic vertebral osteomyelitis. Eur J Clin Microbiol Infect Dis. 2018 Aug;37(8):1575-1580. doi: 10.1007/s10096-018-3305-3. Epub 2018 May 22. PMID: 29789881.
  23. Bai Y, et al. Comparison of health-related quality of life and complications in patients undergoing surgery for diabetic and nondiabetic foot osteomyelitis: a prospective observational cohort study. BMC Musculoskelet Disord. 2020 Oct 8;21(1):670. doi: 10.1186/s12891-020-03632-9. PMID: 33032654; PMCID: PMC7547571.
  24. Saeed K, et al. Vertebral osteomyelitis: update on imaging and management. Br J Hosp Med (Lond). 2019 Mar 2;80(3):158-164. doi: 10.12968/hmed.2019.80.3.158. PMID: 30839042.
  25. Enoch DA, et al. The Changing Face of Staphylococcus aureus Bacteraemia: Epidemiology and Associated Mortality Over Three Decades in one UK Health Trust. Infect Dis Ther. 2018 Sep;7(3):327-331. doi: 10.1007/s40121-018-0204-7. Epub 2018 Jul 3. PMID: 29971535; PMCID: PMC6125499.
  26. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004 Jul 24-30;364(9431):369-79. doi: 10.1016/S0140-6736(04)16727-5. PMID: 15276398.
  27. Gouliouris T, et al. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2020 Oct;50(5):920-929. doi: 10.1016/j.semarthrit.2020.07.002. Epub 2020 Jul 4. PMID: 32713597.
  28. Shobaki M, et al. Healthcare-Associated Infections and the Diagnostic Challenges of Biofilms in Orthopedics. Int J Environ Res Public Health. 2021 May 21;18(10):5341. doi: 10.3390/ijerph18105341. PMID: 34064009; PMCID: PMC8156547.
  29. Rodriguez D, et al. Osteomyelitis in the Elderly: Diagnosis and Management. J Am Acad Orthop Surg. 2019 Jun 15;27(12):e556-e565. doi: 10.5435/JAAOS-D-17-00717. PMID: 30550441.
  30. Kim C, et al. Pyogenic vertebral osteomyelitis: Analysis of 49 cases focusing on demographical and diagnostic trends. J Clin Neurosci. 2020 Jan; 71:65-69. doi: 10.1016/j.jocn.2019.10.029. Epub 2019 Oct 22. PMID: 31653578.
  31. Luzzati R, et al. Unusual Clinical Presentation of Staphylococcus lugdunensis Endocarditis: A Case Report and Literature Review. Infect Drug Resist. 2021 Mar 11; 14:1017-1022. doi: 10.2147/IDR.S294715. PMID: 33727861; PMCID: PMC7963881.
  32. Cooper C, et al. The management of infections in older people with fractures. Aging Clin Exp Res. 2018 Dec;30(12):1409-1417. doi: 10.1007/s40520-018-1014-1. Epub 2018 Aug 1. PMID: 30069628.
  33. Garcia-Pardo G, et al. Comparison of bone-to-bone contact between magnetic resonance imaging and computed tomography scan in lumbar spine. Eur J Orthop Surg Traumatol. 2021 Oct;31(7):1347-1354. doi: 10.1007/s00590-021-02951-w. Epub 2021 May 18. PMID: 34001926.

Figures:

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?