Spontaneous infective spondylitis and mycotic aneurysm: incidence, risk factors, outcome and management experience.
Infective spondylitis occurring concomitantly with mycotic aneurysm is rare. A retrospective record review was conducted in all cases of mycotic aneurysm from January 1995 to December 2004, occurring in a primary care and tertiary referral center. Spontaneous infective spondylitis and mycotic aneurysm were found in six cases (10.3% of 58 mycotic aneurysm patients). Neurological deficit (50% vs. 0; P < 0.001) is the significant clinical manifestation in patients with spontaneous infective spondylitis and mycotic aneurysm. The presence of psoas abscess on computed tomography (83.3% vs. 0; P < 0.001) and endplate destruction on radiography (50% vs. 0; P < 0.001) are predominated in patients with spontaneous infective spondylitis and mycotic aneurysm. Of these six patients, four with Salmonella infection received surgical intervention and all survived. Another two patients (one with Streptococcus pyogenes, another with Staphylococcus aureus) received conservative therapy and subsequently died from rupture of aneurysm or septic shock. Paravertebral soft tissue swelling, presence of psoas abscess and/or unclear soft tissue plane between the aorta and vertebral body in relation to mycotic aneurysm may indicate a concomitant infection in the spine. In contrast, if prevertebral mass is found in the survey of spine infection, coexisting mycotic aneurysm should be considered.
Chen
Shih-Hao
SH
Department of Orthopaedics, Chang-Gung Memorial Hospital, Kasohsiung, Taiwan.|Chang Gung University of Medicine, Kasohsiung, Taiwan.
Lin
Wei-Che
WC
Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Kasohsiung, Taiwan.|Chang Gung University of Medicine, Kasohsiung, Taiwan.
Lee
Chen-Hsiang
CH
Department of Internal Medicine, Chang-Gung Memorial Hospital, No. 123, Ta Pei Road, Niao Sung Hsiang, Kasohsiung Hsien, 833, Taiwan. lee900@adm.cgmh.org.tw.|Chang Gung University of Medicine, Kasohsiung, Taiwan. lee900@adm.cgmh.org.tw.
Chou
Wen-Yi
WY
Department of Orthopaedics, Chang-Gung Memorial Hospital, Kasohsiung, Taiwan.|Chang Gung University of Medicine, Kasohsiung, Taiwan.
D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001011:Aorta / Q000382:microbiology / Q000473:pathology; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D003646:Debridement; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D013166:Spondylitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D054854:Vertebroplasty