Abstract
Background: Anaerobic organisms have been known to have an association with dental infections, bacteremia, endocarditis and soft tissue infections. However, anaerobic isolation from bone and joint infections are relatively rare. Sparse literature has been found on reports of anaerobic osteomyelitis. There is no literature reported on anaerobic osteomyelitis complicating Tuberculosis of spine. Case Report: We report two cases of tuberculosis of spine complicated by aerobic and anerobic infections. The first is a case of a young female who presented with chronic lower backache and fever. Examination revealed a lumbar scoliosis with paraspinal tenderness. Magnetic resonance imaging (MRI) of the spine showed lumbar spondylodiscitis with multiple abscesses. There were air-fluid levels noted in the abscesses. The pus sent for CBNAAT (cartridge based nucleic acid amplification test) was positive. Further the cultures also grew Escherichia coli (aerobic) Bacteroids fragilis and Peptoniphilus asachrolyticus (anaerobic) organisms. She improved with a course of intravenous antibiotics and decompression surgery. The second case is a middle aged man who presented with chronic neck pain and fever. Examination revealed kyphosis of the neck with spasm of the neck muscles and midline tenderness. MRI showed C4-5 cervical spondylodiscitis with parapharyngeal collections showing air-fluid levels. The pus culture showed Streptococcus constellatus (aerobic) and Prevotella sps. (anaerobic). The CBNAAT report was positive for Mycobacterium tuberculosis. The patient was treated with intravenous antibiotics and cervical decompression. Conclusion: Though tubercular vertebral osteomyelitis (TVO) is usually a diagnosis in itself, it should not hinder us from considering secondary infections (both aerobic and anaerobic) complicating the osteomyelitis. Further, the presence of air-fluid levels on imaging studies and the presence of foul smell during operative exploration of the spine must arouse the suspicion of an anaerobic co-infection. Isolation and treatment of these organisms are crucial as they may hamper the clinical outcome of the primary TVO.
Highlights
Anaerobic organisms have been known to have an association with dental infections, bacteremia, endocarditis and soft tissue infections.[1]
There is no literature reported on anaerobic osteomyelitis complicating Tuberculosis of spine/Tubercular vertebral osteomyelitis (Pott’s spine)
Our cases highlight the rare isolation of gram-negative anaerobes (Prevotella, Bacteroides, Peptoniphilus) from Tubercular vertebral osteomyelitis (TVO) in immunocompetent adults diagnosed with tuberculosis of spine
Summary
Anaerobic organisms have been known to have an association with dental infections, bacteremia, endocarditis and soft tissue infections.[1]. Case report Case 1 A 22-year-old poorly built (body mass index: 16 kg/m2) lady from rural South India who was pursuing her undergraduate degree, presented with complaints of low back ache of one-month duration It was insidious in onset and gradually radiated to the right gluteal region. Multiple collections in parapharyngeal space communicating with the pre-vertebral space were seen along with air-fluid levels (Figure 2c and d) By this time the blood culture grew Streptococcus constellatus and he was started on Injection ceftriaxone (2gm q24h) as per sensitivity report. Histopathology confirmed granulation tissue with epitheloid cells and Langhans giant cells suggestive of tubercular osteomyelitis He was started on Antitubercular therapy and Injection Metronidazole (500 mg q8h for two weeks) in addition to Injection Ceftriaxone (two weeks). Written informed consent for publication of their clinical details and/or clinical images was obtained from the patients
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