title: Hematogenous spinal infection in central Greece.
abstract: METHODS
  We retrospectively analyzed spinal infection (SpI), in a teaching Hospital, in Central Greece.
  
  
  OBJECTIVE
  To study presentation, etiology, and outcome of SpI in Central Greece.
  
  
  BACKGROUND
  SpI most frequently involves the intervertebral disc and adjacent vertebral bodies and can cause neurologic impairment.
  
  
  METHODS
  Thirty three patients (23 men; age [mean +/- standard deviation], 60.6 +/- 11.3 years; disease duration, 44.5 [+/-54.7] days) hospitalized with SpI between January 2000 and December 2007 were included in the study. All patients had magnetic resonance imaging of the spine.
  
  
  RESULTS
  Nineteen patients had pyogenic SpI (57.6%) and 14 patients had granulomatous SpI, 11 due to Brucella spp (34.4%), 3 due to Mycobacterium tuberculosis (9.4%). Staphylococcus aureus was the most frequent cause of pyogenic SpI, and spondylodiscitis (SpD) was the most frequent localization. Epidural entension was found in 8 of 17 pyogenic SpD and in 2 of 11 brucellar SpD patients. Subdural extension was detected in 3 patients with pyogenic SpD. Blood cultures were positive in 17 of 19 patients with pyogenic SpI. Two patients had concomitant endocarditis (staphylococcal 1, enterococcal 1). The most common associated disease was diabetes mellitus. All but 2 patients received medical treatment alone. Two patients died of uncontrollable sepsis.
  
  
  CONCLUSIONS
  Back pain in presence of fever, constitutional symptoms, and/or high inflammation markers should alert physicians for spinal infection. In endemic areas, Brucella is a frequent cause of SpI.
authors: From the Departments of Internal Medicine/Rheumatology, Thessaly University School of Medicine, Larisa, Greece. lsakkas@med.uth.gr
authors: Lazaros I
authors: LI
authors: Sakkas
authors: Evangelos M
authors: EM
authors: Davas
authors: Efie
authors: E
authors: Kapsalaki
authors: Maria
authors: M
authors: Boulbou
authors: Konstantinos
authors: K
authors: Makaritsis
authors: Ioannis
authors: I
authors: Alexiou
authors: Thomas
authors: T
authors: Tsikrikas
authors: Nikolaos
authors: N
authors: Stathakis
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001416:Back Pain / Q000382:microbiology; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D015415:Biomarkers; D002006:Brucellosis / Q000453:epidemiology; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000382:microbiology; D004824:Epidural Space / Q000382:microbiology / Q000473:pathology; D005260:Female; D005334:Fever / Q000382:microbiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007403:Intervertebral Disc / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013131:Spine / Q000382:microbiology* / Q000473:pathology* / Q000503:physiopathology; D013166:Spondylitis / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D013203:Staphylococcal Infections / Q000453:epidemiology; D013355:Subdural Space / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers