title: Technetium-99m ciprofloxacin imaging in the diagnosis of postsurgical bony infection and evaluation of the response to antibiotic therapy: A case report.
abstract: The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTC ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTC methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTC ciprofloxacin, indicating a good response. Therefore, 99mTC ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTC methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.
authors.affiliation: Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. pgichandigarh@yahoo.co.in
authors.forename: B
authors.initials: B
authors.lastname: Singh
authors.forename: B R
authors.initials: BR
authors.lastname: Mittal
authors.forename: A
authors.initials: A
authors.lastname: Bhattacharya
authors.forename: A
authors.initials: A
authors.lastname: Aggarwal
authors.forename: O N
authors.initials: ON
authors.lastname: Nagi
authors.forename: A K
authors.initials: AK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001863:Bone Screws / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000031:analogs & derivatives*; D020878:Device Removal; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011856:Radiographic Image Enhancement; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015609:Organotechnetium Compounds; C431804:Technetium Tc 99m ciprofloxacin; D002939:Ciprofloxacin