Cat Scratch Disease With Cervical Vertebral Osteomyelitis and Spinal Epidural Abscess

Tasher, Diana; Armarnik, Erez; Mizrahi, Avram; Liat, Ben Sira; Constantini, Shlomi; Grisaru‐Soen, Galia

doi:10.1097/inf.0b013e3181a3242e

Cited by 33 publications

(29 citation statements)

References 21 publications

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“…1,10 Duration of intravenous antibiotic therapy should be a minimum of 4 to 6 weeks. 6 The length of therapy is dependent on the level of immunocompetence, clinical improvement, and response to treatment demonstrated by subsequent ESR and MRI. 8 The typical treatment of SEA is surgical decompression and drainage in combination with several weeks of antibiotics, 4,13,26 although no consensus on management has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…SEAs are potentially increasing in incidence due to a rise in risk factors (spine trauma, previous skin infections, intravenous drug use, and immunodeficiency) and enhancement of imaging studies allowing increased detection. [1][2][3] Treatment has traditionally been surgical decompression and drainage in combination with antibiotics [4][5][6] ; recent reports suggest that antibiotic therapy alone can be successful in select patient populations. 1,3,[7][8][9][10] We present an institutional review revealing successful outcomes in patients who historically have had significant morbidity and mortality.…”

mentioning

confidence: 99%

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Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature

Hawkins

Bolton

2013

Pediatrics

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Spinal epidural abscess (SEA) is a rare condition that requires prompt diagnosis and initiation of treatment for optimal outcome. Treatment generally consists of surgical intervention and systemic antibiotics. We present 1 of the largest cohorts of nontuberculous pediatric SEA in the English literature, emphasizing the outcomes of conservative (ie, nonoperative) management. We retrospectively identified 9 pediatric patients (≤18 years of age) with SEAs at Our Lady of the Lake Children’s Hospital from 2002 to 2011. Cases were reviewed for demographic, clinical, diagnostic, and treatment characteristics and outcomes. The diagnosis of SEA was made by MRI in all cases, and methicillin-resistant Staphylococcus aureus (MRSA) was the only identified pathogen, isolated via blood culture in 6 of 9 patients. Although every patient received systemic antibiotics, only 2 had neurosurgical intervention. Four of the 7 patients treated conservatively received computed tomography-guided needle drainage. All patients recovered without significant sequelae. SEA is a potentially fatal illness that necessitates a heightened clinical awareness for diagnosis and treatment. Although official recommendations regarding management in pediatrics are lacking, treatment has generally been surgical decompression and drainage in combination with antibiotics; recent reports have suggested that antibiotic therapy alone may be successful in select patient populations. Although the adult literature has suggested that such management can be trialed in specific situations, only a handful of cases in the pediatric literature have reported this nonoperative approach. We present one of the largest reviews in support of successfully treating SEA with nonsurgical therapy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature

Hawkins

Bolton

2013

Pediatrics

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“…The association of this pathogen with an epidural abscess has been described in only 4 prior cases, 1,6,7,11 only 2 of which were proven with a surgical biopsy or aspiration of the affected vertebral body or abscess (Table 1). 7,11 Often, cat scratch disease may resolve spontaneously or with medical management; however, the association with a compressive epidural abscess may necessitate surgical intervention. Spinal epidural abscesses have historically been associated with high rates of morbidity and mortality, especially in the pediatric population due to delayed diagnosis and nonspecific symptoms at disease onset.…”

Section: Discussionmentioning

confidence: 99%

“…Tasher et al reported a case of a 5-yearold boy diagnosed with a cervical epidural abscess, treated initially with cloxacillin, gentamicin, and ceftriaxone. 11 However, due to worsening torticollis and evidence of spinal cord compression on follow-up imaging, the patient required surgical decompression. Intraoperative fluid PCR analysis revealed B. henselae.…”

Section: Discussionmentioning

confidence: 99%

Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report

Dornbos¹,

Morin

Watson

et al. 2016

PED

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Osteomyelitis of the spine with associated spinal epidural abscess represents an uncommon entity in the pediatric population, requiring prompt evaluation and diagnosis to prevent neurological compromise. Cat scratch disease, caused by the pathogen Bartonella henselae, encompasses a wide spectrum of clinical presentations; however, an association with osteomyelitis and epidural abscess has been reported in only 4 other instances in the literature. The authors report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome.

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“…Rare causes include Clostridium difficile [36] and Cat scratch disease. [37] Inflammation of the intervertebral disk is an uncommon entity. Noniatrogenic cases of diskitis are seen almost exclusively in children and the etiology remains controversial.…”

Section: Pyogenic Vertebral Osteomyelitis and Diskitismentioning

confidence: 99%

Pediatric spinal infections

Kumar

Arora

2017

IJNS

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The infections of the spinal axis in children are rare when compared with adults. They encompass a large spectrum of diseases ranging from relatively benign diskitis to spinal osteomyleitis and to the rapidly progressive, rare, and potentially devastating spinal epidural, subdural, and intramedullary spinal cord infections. We present a comprehensive review of the literature pertaining to these uncommon entities, in light of our experience from northern India. The most prevalent pediatric spinal infection in Indian scenario is tuberculosis, where an extradural involvement is more common than intradural. The craniovertebral junction is not an uncommon site of involvement in children of our milieu. The majority of pyogenic infections of pediatric spine are associated with congenital neuro-ectodermal defects such as congenital dermal sinus. The clinico-radiological findings of various spinal infections commonly overlap. Hence the endemicity of certain pathogens should be given due consideration, while considering the differential diagnosis. However, early suspicion, rapid diagnosis, and prompt treatment are the key factors in avoiding neurological morbidity and deformity in a growing child.

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Cat Scratch Disease With Cervical Vertebral Osteomyelitis and Spinal Epidural Abscess

Cited by 33 publications

References 21 publications

Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature

Pediatric Spinal Epidural Abscess: A 9-Year Institutional Review and Review of the Literature

Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report

Pediatric spinal infections

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