Responsiveness of routine diagnostic tests for vertebral osteomyelitis may be influenced by the infecting organism

Ghassibi, Michael; Yen, Tzu Chuan; Harris, Shelby M.; Si, Zhengye; Leary, Emily; Choma, Theodore J.

doi:10.1016/j.spinee.2021.04.001

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…For comparison of these indicators between the two groups of patients, a nonparametric test was used, because the data for ESR and CRP did not conform to a normal distribution; in contrast, an independent-sample t test was used to analyze the differences in WBC between the two groups. As another challenge to differential diagnosis of spinal tuberculosis, septic and brucellosis infections are infectious diseases like tuberculosis, so these diseases also lead to increases in serum infection indicators ( Ghassibi et al., 2021 ). Tumors can also sometimes cause the release of inflammatory substances, leading to increases in serum inflammatory marker levels in patients ( Allin and Nordestgaard, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

“…The results of tests with low specificity can mislead physicians, causing them to use antituberculosis therapies for patients without tuberculosis. This has led to the treatment of misdiagnosed patients with unnecessary antituberculosis drugs with considerable adverse effects, including hepatotoxicity, optic nerve damage, and hearing loss ( Yew et al., 2018 ; Ghassibi et al., 2021 ). In addition, incorrect antituberculosis treatment may lead to the emergence of drug-resistant bacteria ( Nagel et al., 2017 ).…”

Section: Discussionmentioning

confidence: 99%

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Analysis of the diagnostic efficacy of the QuantiFERON-TB Gold In-Tube assay for preoperative differential diagnosis of spinal tuberculosis

Zhang

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundDifferential diagnosis of spinal tuberculosis is important for the clinical management of patients, especially in populations with spinal bone destruction. There are few effective tools for preoperative differential diagnosis in these populations. The QuantiFERON-TB Gold In-Tube (QFT-GIT) test has good sensitivity and specificity for the diagnosis of tuberculosis, but its efficacy in preoperative diagnosis of spinal tuberculosis has rarely been investigated.MethodA total of 123 consecutive patients with suspected spinal tuberculosis hospitalized from March 20, 2020, to April 10, 2022, were included, and the QFT-GIT test was performed on each patient. We retrospectively collected clinical data from these patients. A receiver operating characteristic (ROC) curve was plotted with the TB Ag-Nil values. The cutoff point was calculated from the ROC curve of 61 patients in the study cohort, and the diagnostic validity of the cutoff point was verified in a new cohort of 62 patients. The correlations between TB Ag-Nil values and other clinical characteristics of the patients were analyzed.ResultsOf the 123 patients included in the study, 51 had confirmed tuberculosis, and 72 had non-tuberculosis disease (AUC=0.866, 95% CI: 0.798-0.933, P<0.0001). In patients with spinal tuberculosis, the QFT-GIT test sensitivity was 92.16% (95% CI: 80.25%-97.46%), and the specificity was 67.14% (95% CI: 54.77%-77.62%). The accuracy of diagnostic tests in the validation cohort increased from 77.42% to 80.65% when a new cutoff point was selected (1.58 IU/mL) from the ROC curve of the study cohort. The TB Ag-Nil values in tuberculosis patients were correlated with the duration of the patients’ disease (r=0.4148, P=0.0025).ConclusionThe QFT-GIT test is an important test for preoperative differential diagnosis of spinal tuberculosis with high sensitivity but low specificity. The diagnostic efficacy of the QFT-GIT test can be significantly improved via application of a new threshold (1.58 IU/mL), and the intensity of the QFT-GIT test findings in spinal tuberculosis may be related to the duration of a patient’s disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of the diagnostic efficacy of the QuantiFERON-TB Gold In-Tube assay for preoperative differential diagnosis of spinal tuberculosis

Zhang

et al. 2022

Front. Cell. Infect. Microbiol.

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“…However, serum inflammatory markers have been shown to vary based on the responsible infecting organism. A more robust elevation is seen with Staphylococcus aureus and antibiotic-resistant organisms as compared to the minimal elevation seen with blood culture- and biopsy culture-negative cases [ 7 ]. Given this, the variation in inflammatory marker elevation may have a correlation to the positive versus negative cultures.…”

Section: Discussionmentioning

confidence: 99%

An Isolated Radiographic Finding of Spontaneous Vertebral Osteomyelitis

Tacy¹,

Patel²,

Pérez³

2022

Cureus

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Vertebral osteomyelitis (VO) is an infection of the vertebral body, most often arising secondary to hematogenous spread or contiguous spread from local soft tissue infection. Establishing a diagnosis of VO requires a high index of suspicion as patients often present with nonspecific symptoms such as pain of the affected vertebral segments along with leukocytosis and elevated inflammatory markers. Magnetic resonance imaging (MRI) has high sensitivity and specificity for detecting VO, even in the early phases of infection. Diagnosis is generally confirmed with blood cultures or vertebral biopsy demonstrating a culprit organism and treatment is tailored to the identified organism. However, some patients may have culture-negative VO that still necessitates antimicrobial treatment. Imaging alone may be an acceptable form of diagnosis that can allow for prompt empiric antibiotic therapy, reducing the need for invasive diagnostic measures. We present a case of a 46-year-old male with a past medical history of type 2 diabetes mellitus, hyperlipidemia, and prior transient ischemic attack (TIA). The patient presented with signs and symptoms of another TIA as well as new-onset neck and upper back pain. MRI in the neurologic workup demonstrated findings consistent with osteomyelitis of the C5 and C6 cervical vertebrae. Previous imaging showed no evidence of vertebral dysfunction. This patient presented with new-onset VO in the absence of systemic symptoms or elevation of inflammatory markers and no identified source of infection. Based on imaging and clinical presentation, empiric antibiotic treatment was initiated resulting in clinical improvement and resolution of VO on imaging. This case demonstrates an atypical presentation of VO and describes the benefit of MRI in recognizing infection in the absence of concurrent typical findings, which allowed for the initiation of empiric therapy.

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Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults

et al. 2022

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IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools.

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Responsiveness of routine diagnostic tests for vertebral osteomyelitis may be influenced by the infecting organism

Cited by 5 publications

References 14 publications

Analysis of the diagnostic efficacy of the QuantiFERON-TB Gold In-Tube assay for preoperative differential diagnosis of spinal tuberculosis

Analysis of the diagnostic efficacy of the QuantiFERON-TB Gold In-Tube assay for preoperative differential diagnosis of spinal tuberculosis

An Isolated Radiographic Finding of Spontaneous Vertebral Osteomyelitis

Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults

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