Principi Nicola, Esposito Susanna
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Int J Mol Sci. 2016 Apr 9;17(4):539. doi: 10.3390/ijms17040539.
In children, infectious discitis (D) and infectious spondylodiscitis (SD) are rare diseases that can cause significant clinical problems, including spinal deformities and segmental instabilities. Moreover, when the infection spreads into the spinal channel, D and SD can cause devastating neurologic complications. Early diagnosis and treatment may reduce these risks. The main aim of this paper is to discuss recent concepts regarding the epidemiology, microbiology, clinical presentation, diagnosis, and treatment of pediatric D and SD. It is highlighted that particular attention must be paid to the identification of the causative infectious agent and its sensitivity to antibiotics, remembering that traditional culture frequently leads to negative results and modern molecular methods can significantly increase the detection rate. Several different bacterial pathogens can cause D and SD, and, in some cases, particularly those due to Staphylococcus aureus, Kingella kingae, Mycobacterium tuberculosis, Brucella spp., the appropriate choice of drug is critical to achieve cure.
在儿童中,感染性椎间盘炎(D)和感染性脊椎椎间盘炎(SD)是罕见疾病,可引发严重的临床问题,包括脊柱畸形和节段性不稳定。此外,当感染蔓延至椎管时,D和SD可导致毁灭性的神经并发症。早期诊断和治疗可能会降低这些风险。本文的主要目的是讨论有关儿童D和SD的流行病学、微生物学、临床表现、诊断和治疗的最新概念。需要强调的是,必须特别关注致病感染因子的鉴定及其对抗生素的敏感性,要记住传统培养常常导致阴性结果,而现代分子方法可显著提高检出率。几种不同的细菌病原体可引起D和SD,在某些情况下,尤其是由金黄色葡萄球菌、金氏金杆菌、结核分枝杆菌、布鲁氏菌属引起的病例,药物的恰当选择对于实现治愈至关重要。