Spondylodiscitis and infectious endocarditis: a round-trip to be considered

Abstract

The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course. A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflamatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the need of a longer antibiotic therapy course, which can range from 6 weeks to 3 months.

Delayed Adjacent Level Spondylodiscitis after Initial Surgery with Instrumented Spinal Fusion: A Report of Three Cases and Review of the Literature

“…Therefore, surgical treatment combined with the administration of vancomycin was appropriate and cured the spondylodiscitis. Similar to the second case, two cases of spondylodiscitis caused by Streptococcus intermedius were reported previously [ 7 , 8 ]. Streptococcus intermedius is a part of the normal oral flora and is known to be a causative organism for endocarditis [ 7 ].…”

Estudo de publicações em periódicos gerais de artigos sobre ortopedia e aparelho locomotor

“…Using the aforementioned strategy, articles were found in the journals: Sao Paulo Méd J 2-12 , Rev Assoc Med Bras 13-16 , Clinics , Rev Esc Enferm USP 65 and Braz J Infect Dis. [66][67][68] Chart 2 presents the number of articles located through the search strategy (Chart 1) and the number of articles selected by the authors for their relationship with the area of interest of orthopedics and study of the locomotor system.…”

Denouement

“…The frequency of spondylodiscitis and pyogenic vertebral osteomylelitis in association with infective endocarditis ranges from 0% to 5% but as high as 15% in some reports. [5][6][7][8] In one study, the reverse association was more significant-of patients with pyogenic vertebral osteomyelitis, 30.8% were found to have definite endocarditis. These diagnoses were established simultaneously in 43% of cases, but 32% of the time, the diagnosis of pyogenic vertebral osteomyelitis preceded the recognition of endocarditis.…”

“…5 Based on these reports, some experts have recommended that all patients with spondylodiscitis undergo evaluation for endocarditis, and conversely, that patients with endocarditis and back pain undergo evaluation for spondylodiscitis. [5][6][7][8] However, back pain is a frequent complaint among those with endocarditis, found up to 43% of the time, and therefore, most patients with endocarditis and back pain will ultimately not be found to have spondylodiscitis. 6 In most cases of spondylodiscitis associated with endocarditis, antimicrobial therapy alone, targeting the causative pathogen, is appropriate; however, spinal surgery may be required in some cases.…”

“…For pyogenic vertebral osteomyelitis alone, 6 weeks to 3 months of therapy has been recommended, though some experts advocate for an initial intravenous phase of 4-6 weeks followed by 3-6 months of oral therapy. 5,8 For endocarditis alone, 4-6 weeks of intravenous therapy is generally recommended, with longer durations indicated for resistant organisms or in the presence of prosthetic materials. 3 When both conditions are present, the duration of treatment reported in the literature has generally reflected the longer course recommended for pyogenic vertebral osteomyelitis.…”