Vertebral Osteomyelitis: Clinical Features and Diagnosis.
Clin Microbiol Infect. 2014 Apr 28;
Authors: Gök SE, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, Dokuzoğuz B
OBJECTIVE: we aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment.
METHODS: This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed from six months to three years.
RESULTS: In total 214 patients were included to the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) were brucella vertebral osteomyelitis (BVO), 63 (29%) were tuberculous vertebral osteomyelitis (TVO), and 55 (26%) were pyogenic vertebral osteomyelitis (PVO). Mean days between onset of symptoms and establishment of diagnosis were longer with the patients TVO (266 days) than BVO (115 days) or PVO (151 days) (p<0.001). In blood cultures, Brucella spp was isolated among 35 out of 96 BVO patients (35%). Among 55 PVO patients, etiologic agent was isolated in 11 (20%) patients. For tuberculin skin test (TST) >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and ROC area was 0.8.
CONCLUSION: Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of VO, consumption of fresh cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, lumbar involvement in MRI were found to be predictors of BVO, thoracic involvement in MRI and TST> 15 mm were found to be predictors of TVO, and history of spinal surgery and leukocytosis were found to be predictors of PVO. This article is protected by copyright. All rights reserved.
PMID: 24766063 [PubMed - as supplied by publisher]