Infectious Diseases and Clinical Microbiology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Clin Microbiol Infect. 2014 Oct;20(10):1055-60. doi: 10.1111/1469-0691.12653. Epub 2014 Jun 14.
We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.
我们旨在描述椎体骨髓炎的临床和诊断特征，以便进行鉴别诊断和治疗。这是一项在土耳其安卡拉努姆努恩教育与研究医院于 2002 年至 2012 年间进行的前瞻性观察性研究。所有椎体骨髓炎患者的随访时间为 6 个月至 3 年。共有 214 例患者纳入本研究，其中 113 例（53%）为女性。214 例患者中，96 例（45%）为布鲁氏菌性椎体骨髓炎（BVO），63 例（29%）为结核性椎体骨髓炎（TVO），55 例（26%）为化脓性椎体骨髓炎（PVO）。TVO 患者（266 天）从症状发作到确诊的平均天数长于 BVO（115 天）或 PVO（151 天，p<0.001）。在血培养中，从 96 例 BVO 患者中分离出布鲁氏菌属（35%）。55 例 PVO 患者中，11 例（20%）患者分离出病因。对于结核菌素皮肤试验>15mm，其敏感性为 0.66，特异性为 0.97，阳性预测值为 0.89，阴性预测值为 0.88，受试者工作特征曲线面积为 0.8。结核性和布鲁氏菌性椎体骨髓炎仍然是导致椎体骨髓炎诊断延迟的主要原因。在椎体骨髓炎的鉴别诊断中，食用未巴氏消毒的奶酪、从事畜牧业、出汗、关节痛、肝肿大、丙氨酸转氨酶升高和磁共振成像显示腰椎受累被认为是 BVO 的预测因素，磁共振成像显示胸椎受累和结核菌素皮肤试验>15mm 被认为是 TVO 的预测因素，而脊柱手术史和白细胞增多被认为是 PVO 的预测因素。
