Actinomycosis of Bone With Special Reference to Infection of the Vertebral Column

Cope, V. Zachary

doi:10.1302/0301-620x.33b2.205

Cited by 51 publications

(22 citation statements)

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“…The present case is the 15th. These cases are listed in Table 1 (3,6,7,9,12,13,17,19,23,24,25,26,27). In summary, they show that 9/15 (60%) were caused by A. israelii, the average age of the patients was 42.2 years, 12/14 (85.7%) cases occurred in males, and at least 8/12 (66.7%) cases were associated with thoracic involvement or other pulmonary symptoms.…”

Section: Discussionmentioning

confidence: 92%

“…are insidious organisms and infections with these organisms may show only nonspecific clinical manifestations (e.g., low-grade fever or other constitutional symptoms) (22,24). Even in a patient with thoracic vertebral actinomycosis, the clinical appearance does not differ remarkably from that resulting from other diseases causing spinal cord compression, such as malignancy or an epidural abscess (6,22,24).…”

Section: Discussionmentioning

confidence: 99%

“…(6). Likewise, it is unlikely to be the result of vertebral osteomyelitis and epidural abscesses due to common bacterial pathogens.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

et al. 2008

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Actinomyces spp. are considered rare pathogens in today's medicine, especially with thoracic vertebral involvement. Classic actinomycosis (50%) presents as an oral-cervicofacial ("lumpy jaw") infection. This report describes a case of spinal cord compression caused by Actinomyces israelii with the coisolation of Fusobacterium nucleatum. There are limited numbers of similar cases. CASE REPORTThe case described here involves a 43-year-old Filipino man who presented to a medical center emergency department with a chief complaint of acute lower back pain and urinary incontinence. He had been in his usual state of health until approximately 3 days prior to admission, when he first noticed a gradual onset of bilateral lower-extremity weakness, followed by difficulty with walking and, finally, the inability to arise from bed. In addition, the patient stated that he had been experiencing low-grade fevers and progressive weight loss over the past several months. His medical history was unremarkable and did not include any recent trauma. The patient had emigrated from the Philippines to Hawaii about 20 years earlier. However, he denied any history of exposure to tuberculosis or any recent travel back to the Philippines or Southeast Asia.In the emergency room, the patient appeared to be disoriented, although he was able to follow simple commands. His vital signs included a temperature of 97.8°F, blood pressure of 121/75 mm Hg, a heart rate of 116 beats/min, and mild tachypnea, with an O 2 saturation of 99% on room air. On physical examination, he was noted to have poor dentition and evidence of multiple previous dental extractions. A neurological examination revealed significant bilateral lower-extremity weakness (two of five) with brisk deep-tendon reflexes, positive ankle clonus, and a positive Babinski sign, as well as diminished rectal tone. The remainder of the physical examination was unremarkable. Laboratory blood findings were significant for leukocytosis (22.0 ϫ 10 9 /liter) with 87% segmented neutrophils, an elevated platelet count of 722 ϫ 10 6 /liter, and an erythrocyte sedimentation rate of 84 mm/h. A screen for human immunodeficiency virus type 1 and 2 antibodies was negative. The remaining laboratory findings were noncontributory.A chest X ray showed a left-lower-lobe infiltrate with minimal pleural effusion.Because of the possibility of spinal cord compression and injury, the patient was admitted to the medical intensive care unit for further workup and management. This included magnetic resonance imaging of the spine, which showed an abnormal signal intensity involving the thoracic vertebrae from T5 through T8 and an abnormal soft tissue mass enhancement consistent with an apparent abscess that involved the left posterior chest wall and ribs and that extended to the thoracic vertebral column and into the epidural space, with apparent spinal cord compression. A computed tomography scan of the chest revealed similar abnormal findings involving the left posterior chest wall and ribs as well as a collapsed lef...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

et al. 2008

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“…The patho-anatomical findings in actinomycosis of the spine have been described in detail by numerous authors (Parker 1923, Simpson & McIntosh 1927, Beitzke 1934, Meyer & Gale 1935, Cope 1951.…”

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confidence: 95%

Actinomycosis of the Spine: Report of Two Cases

Ernst¹,

Ratjen²

1971

Acta Orthopaedica Scandinavica

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“…2,5 Involvement of the spine and the central nervous system may result from direct spread of infection along connective tissue planes, through foramina at the base of the cranium, or by way of the intervertebral foramina. The spinal dura consists of a tight barrier preferring epidural abscess 3,6 and granulation tissue 3,5 formation rather than intrathecal empyema, which is a very rare clinical presentation. Such a fulminant lesion can remain localized for many years without causing any systemic effects as was seen in this patient who had the discharging sinuses for 7 years.…”

mentioning

confidence: 99%

Actinomycosis of the neck causing cervical epidural cord compression. ‘A case report and review of literature’

2007

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Objective and importance: Involvement of cervical spinal cord by Actinomycosis and consequent cord compression is a rare presentation. As the organism is located in nose and throat, the face and jaw area is commonly affected. Involvement of cervical cord has been rarely recorded. We are reporting this case because of the rarity of area of the involvement and have reviewed literature. Clinical presentation: A 30-year-old male with multiple discharging sinuses on the nape of neck and upper back for 7 years which resulted in cervical cord compression and spastic paraperesis. Tissue biopsy from the site of discharging sinuses revealed Actinomycosis. Patient responded to the medical therapy with penicillin and power in lower limbs was improved. The local lesion was also reduced. Intervention: Medical therapy with penicillin and surgical decompression forms the mainstay of treatment. Conclusion: A high degree of suspicion and demonstration of organism by biopsy or culture is essential for treatment. Penicillin is highly effective and should be given for long duration for optimal results.

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Actinomycosis of Bone With Special Reference to Infection of the Vertebral Column

Cited by 51 publications

References 0 publications

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

Thoracic Vertebral Actinomycosis:Actinomyces israeliiandFusobacterium nucleatum

Actinomycosis of the Spine: Report of Two Cases

Actinomycosis of the neck causing cervical epidural cord compression. ‘A case report and review of literature’

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