RESUMEN
Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.
Asunto(s)
Brucelosis/diagnóstico , Absceso Epidural/etiología , Parálisis/etiología , Espondilitis/diagnóstico , Brucelosis/complicaciones , Vértebras Cervicales , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Espondilitis/complicacionesRESUMEN
Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.
Asunto(s)
Humanos , Masculino , Parálisis/etiología , Espondilitis/diagnóstico , Brucelosis/diagnóstico , Absceso Epidural/etiología , Espondilitis/complicaciones , Brucelosis/complicaciones , Imagen por Resonancia Magnética , Vértebras Cervicales , Persona de Mediana EdadRESUMEN
Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.
Asunto(s)
Vértebras Cervicales , Discitis/diagnóstico por imagen , Espondilitis/diagnóstico por imagen , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Vértebras Cervicales/microbiología , Discitis/complicaciones , Discitis/microbiología , Absceso Epidural/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Compresión de la Médula Espinal/etiología , Espondilitis/complicaciones , Espondilitis/microbiología , Infecciones Estafilocócicas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.
Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.
Asunto(s)
Humanos , Masculino , Espondilitis/diagnóstico por imagen , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus , Discitis/diagnóstico por imagen , Vértebras Cervicales/microbiología , Compresión de la Médula Espinal/etiología , Espondilitis/complicaciones , Espondilitis/microbiología , Infecciones Estafilocócicas/diagnóstico , Imagen por Resonancia Magnética , Discitis/complicaciones , Discitis/microbiología , Tomografía Computarizada por Rayos X , Absceso Epidural/etiología , Persona de Mediana EdadRESUMEN
Introducción: las infecciones vertebrales constituyen una afección de baja incidencia, pero con incremento importante en años recientes, el cual está en relación con una población más susceptible por diversas razones. A pesar de nuevos métodos para el diagnóstico, la demora constituye un importante problema.Propósito: revisar y discutir algunos temas actuales acerca de las infecciones vertebrales, la epidemiologia, etiología, fisiopatología, diagnóstico y tipos de tratamientos.Método: se seleccionó la literatura apropiada usando las bases de datos Pubmed, Hinari y Clinical Key.Resultados: la literatura muestra la importancia del correcto y rápido diagnóstico; determinar el agente causal es de primordial importancia para aplicar una adecuada terapia antimicrobiana. El tratamiento conservador produce, generalmente, buenos resultados y el quirúrgico está indicado en déficit o sepsis neurológicos, inestabilidad espinal y/o deformidad y fallo del tratamiento conservador. Se muestra algoritmo para diagnóstico y tratamiento.Conclusiones: aplicar una metodología correcta para el diagnóstico y tratamiento de las infecciones vertebrales, logra resultados satisfactorios(AU)
Introduction: vertebral infections are a disease of low incidence, but with significant increase in recent years. This increase is related to a more susceptible population due to various reasons. Despite the new methods for diagnosis, its delay is a major problem.Objective: review and discuss some current issues about the spine infections, epidemiology, etiology, pathophysiology, diagnosis and types of treatment.Method: select the appropriate literature using PubMed database, Hinari and Clinical Key.Results: the literature shows the importance of correct and rapid diagnosis, which determine the causal agent, is primordial to implement appropriate antimicrobial therapy. Conservative treatment generally produces good results and surgery is indicated in neurological deficit or sepsis, spinal instability and / or deformity and failure of conservative treatment. Diagnostic and treatment algorithm is shown.Conclusions: applying correct methodology for the diagnosis and treatment of spinal infection, satisfactory results are achieved(AU)
Asunto(s)
Humanos , Espondilitis/complicaciones , Enfermedades de la Columna Vertebral/diagnóstico , Productos con Acción AntimicrobianaRESUMEN
We present the case of a 42-year-old man, HIV-positive, with low CD4(+) T cell count (31 cells/µl), who was admitted to Hospital de Infecciosas F. J. Muñiz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200mg. With the latter the patient showed a rapid, complete clinical response.
Asunto(s)
Candidiasis Cutánea/etiología , Infecciones por VIH/complicaciones , Adulto , Antibacterianos/uso terapéutico , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Tirantes/efectos adversos , Recuento de Linfocito CD4 , Candidiasis Cutánea/tratamiento farmacológico , Candidiasis Cutánea/microbiología , Infección Hospitalaria/microbiología , Diabetes Mellitus Tipo 2/complicaciones , Fluconazol/uso terapéutico , Hepatitis Viral Humana/complicaciones , Humanos , Huésped Inmunocomprometido , Vértebras Lumbares/microbiología , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Espondilitis/complicaciones , Espondilitis/microbiología , Espondilitis/terapia , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Sobreinfección , Posición Supina , Vancomicina/uso terapéuticoRESUMEN
BACKGROUND: High prevalence and high costs in the treatment of spine injuries make a cost study necessary. The objective of this paper is to analyze, from the economic point of view, the behavior of traumatic and non-traumatic spinal pathologies in relation to hospital stay. METHODS: Analysis of economic cost per hospital stay (January 2000 to May 2010). RESULTS: 4,173 cases studied, 45% women and 55% men, predominantly elderly and a mean age of 48.9, standard deviation 16.8 years, with a notable increase in hospital expenses in prevalence and peak months: January, February and April; and a decrease in July, October and December. Total expenses for hospital stay were estimated as $85,565,288.00. Traumatic entities consumed $40,404,477.00, and degenerative $21,866,815.00. The months of highest spending were: April, $11,072,683.00, December, $8,423,773.00 and February $8,154,152.00; whereas July showed the lowest spending: $4,874,261.00. Inflation up to July 2011 remained at 3.55% on average, down 2.98 percentage points from 2008 figures. DISCUSSION: there is a clear increase in spending connected with spine condition treatment at hospitals, in particular those resulting from traumatic events. The definition of risk groups for preventive measures is also reflected in the spending records. Spending on hospital treatment of spinal conditions of the elderly reflects an increment in degenerative conditions. CONCLUSION: It is necessary to plan a timely resource distribution by month and year in order to achieve a better and more efficient scheme for health services. The epidemiological basis for the reorientation of the current models is now clear.
Asunto(s)
Traumatismos de la Médula Espinal/economía , Academias e Institutos/economía , Adolescente , Adulto , Factores de Edad , Traumatismos de la Espalda/complicaciones , Traumatismos de la Espalda/economía , Femenino , Gastos en Salud , Costos de Hospital , Humanos , Tiempo de Internación/economía , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Seguridad Social/economía , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/etiología , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/economía , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/economía , Espondilitis/complicaciones , Espondilitis/economía , Adulto JovenRESUMEN
A espondilite anquilosante (EA) é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial. A patologia evolui de forma insidiosa e é potencialmente debilitante, levando a redução da qualidade de vida dos indivíduos acometidos. Este estudo teve como objetivo realizar uma revisão literária das escalas de avaliação em EA (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, EVA Escala Visual Analógica e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) pertinentes à fisioterapia, especificamente dos domínios: função, dor, mobilidade da coluna, rigidez e avaliação global do paciente, presentes na área SM-ARD/Fisioterapia. Foi abordada também uma escala de avaliação radiológica, SASSS (Stoke Ankylosing Spondylitis Spine Score). A revisão estendeu-se de outubro a dezembro de 2006, mediante pesquisas em livros de acervos particulares e públicos e em base de dados. Constatou-se neste estudo a necessidade da realização de pesquisas, metodologias ou complementos visando à validação de instrumentos no Brasil que sirvam de esclarecimento sobre o dinamismo e comportamento da EA diante da intervenção fisioterapêutica.
The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that affects the axial skeleton. The pathology develops in an insidious way and it is potentially debilitated, taking reduction of the life quality. The objective of this study was to make a literature review of the evaluation scales in AS (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, VAS Visual Analog Scale e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) related with physical therapy, specifically of the domains: function, pain, mobility of the column, rigidity and the patient's global evaluation, present in SM-ARD/ physical therapy area. This review showed also a scale of radiologic evaluation, SASSS (Stoke Ankylosing Spondylitis Spine Score). The literature revision was performed from October to December 2006, using books of private and public collections and data basis. It was verified, in this study, the need of researches, methodologies or complements aiming at the validation of instruments in Brazil in order to explain the dynamism and behavior of AS with physical therapy intervention.
Asunto(s)
Espondilitis Anquilosante/patología , Espondilitis Anquilosante/radioterapia , Espondilitis Anquilosante/terapia , Espondilitis/clasificación , Espondilitis/complicaciones , Espondilitis/patología , Espondilitis/radioterapiaRESUMEN
La espodilitis anquilopoyética se caracteriza por brotes leves o moderados de espondilitis activa que alternan con períodos de inactivación total o casi total de la enfermedad con incapacidad. Se presenta el caso de una paciente sometida a artroplastia total de cadera derecha, ya que su enfermedad provocó una artrosis degenerativa de dicha cadera con incapacidad para la marcha. Por los test predictivos realizados por el personal experimentado durante el manejo de la vía aérea en el momento de la intubación a través del fibroscopio fue catalogada como vía aérea difícil (AU)
The ankylopoietic spondylitis is characterized for mild or moderate outbreaks of active spondylitis that alternate with total or almost total periods of inactivación of the disease with incapacity. A case of a patient submitted to a total arthroplasty of the right hip is presented, since this disease caused to her a degenerative arthrosis of the said hip with incapacity for the march. Due to the predictable tests carried out by the experienced personnel during the management of the airway at the intubation moment through the fiberscope was catalogued as a difficult one (AU)
Asunto(s)
Humanos , Espondilitis/complicaciones , Espondilitis/diagnóstico , Artroplastia de Reemplazo de Cadera/métodos , Osteoartritis/complicaciones , Osteoartritis/diagnóstico , Informes de CasosRESUMEN
La espodilitis anquilopoyética se caracteriza por brotes leves o moderados de espondilitis activa que alternan con períodos de inactivación total o casi total de la enfermedad con incapacidad. Se presenta el caso de una paciente sometida a artroplastia total de cadera derecha, ya que su enfermedad provocó una artrosis degenerativa de dicha cadera con incapacidad para la marcha. Por los test predictivos realizados por el personal experimentado durante el manejo de la vía aérea en el momento de la intubación a través del fibroscopio fue catalogada como vía aérea difícil.
The ankylopoietic spondylitis is characterized for mild or moderate outbreaks of active spondylitis that alternate with total or almost total periods of inactivación of the disease with incapacity. A case of a patient submitted to a total arthroplasty of the right hip is presented, since this disease caused to her a degenerative arthrosis of the said hip with incapacity for the march. Due to the predictable tests carried out by the experienced personnel during the management of the airway at the intubation moment through the fiberscope was catalogued as a difficult one.
Asunto(s)
Humanos , Artroplastia de Reemplazo de Cadera/métodos , Espondilitis/complicaciones , Espondilitis/diagnóstico , Osteoartritis/complicaciones , Osteoartritis/diagnóstico , Informes de CasosRESUMEN
A 7.25 m long male humpback whale (Megaptera novaeangliae) with spondylitis was found beached on August 13, 1994 at Ancon, Ecuador (2 degrees 23' S, 80 degrees 47' W). The condition involved at least 11 vertebrae, 7 lumbar (L4 to L11) and 4 caudal (Ca1 to Ca4). Partial fusion of vertebrae was observed as a result of intervertebral bony proliferation, likely impeding full motion. The relatively young age of this specimen and the severity of the deformities suggest an infectious, rather than degenerative, process. The gross findings are most consistent with some type of spondyloarthritis. Although this condition has previously been identified in a number of cetacean species, the pathogenesis, population impact and ecologic implications have not been fully assessed. This is the third case described for humpback whales and the first for a humpback whale from the SE Pacific.
Asunto(s)
Yubarta , Columna Vertebral/patología , Espondilitis/veterinaria , Anfípodos/patogenicidad , Animales , Artritis Infecciosa/etiología , Artritis Infecciosa/patología , Artritis Infecciosa/veterinaria , Infestaciones Ectoparasitarias/etiología , Infestaciones Ectoparasitarias/veterinaria , Ecuador , Resultado Fatal , Masculino , Océano Pacífico , Espondiloartritis/etiología , Espondiloartritis/patología , Espondiloartritis/veterinaria , Espondilitis/complicaciones , Espondilitis/patologíaRESUMEN
Two cases were presented with initial symptoms of inflammatory low back pain and alternate buttock pain. They developed a progressive dyspnea with bilateral mediastinal and hiliar lymphadenopathy and pulmonary interstitial disease as visualized with chest CT scan. Sarcoidosis diagnosis was confirmed by biopsy in both cases--in one case by skin biopsy and in the other by open lung biopsy. These clinical forms of spondyloarthropathy and sarcoidosis were unusual and were compared with similar cases present in the literature.
Asunto(s)
Dolor de la Región Lumbar/etiología , Sarcoidosis/complicaciones , Espondilitis/complicaciones , Adulto , Femenino , Glucocorticoides/uso terapéutico , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Radiografía Torácica , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológico , Espondilitis/diagnóstico por imagen , Espondilitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Discitis/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Espondilitis/diagnóstico por imagen , Veillonella/aislamiento & purificación , Anciano , Discitis/complicaciones , Discitis/microbiología , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Vértebras Lumbares/microbiología , Masculino , Osteomielitis/complicaciones , Osteomielitis/microbiología , Radiografía , Espondilitis/complicaciones , Espondilitis/microbiologíaRESUMEN
To evaluate the involvement of the heart in patients with seronegative spondyloarthropathies by echodopplercardiography, 35 patients including 20 with ankylosing spondylitis, 10 with Reiter's syndrome and 5 with psoriatic arthritis (21 men and 14 women, with ages ranging from 17-68 years and averaging 38.5) were studied. Most were asymptomatic with respect to the cardiovascular system (65.71%) and 12 oligosymptomatic with palpitations as their main complaint. Each patient had an echocardiogram and electrocardiogram. A two-dimensional echocardiogram demonstrated alterations in 19 patients (54.29%), 28.58% asymptomatic and 25.71% symptomatic. This study revealed most of lesions (17/19-84.47%) followed by the Dopplerechocardiography (10/19-52.63%) and the one-dimensional echocardiography (9/19-47.36%). Abnormal aortic valves were found in 10 patients, in 7 thickenning and in 3 calcifications. The mitral valve was involved in 11 patients, in 8 thickenning, in 1 calcification and in 2 valve prolapse. In ankylosing spondylitis aortic valve disease was found in 8 patients. Dopplerechocardiography evidenced the presence of aortic regurgitation in 4 patients and mitral insufficiency in 3. The Q-T interval was increased in 19 patients, there was one first degree auriculoventricular block, one right branch block and one sinus bradicardia. Thus the echocardiogram is an excellent noninvasive method to disclose cardiac disturbances in patients with seronegative spondyloarthropaties.