{"id":401,"date":"2023-09-16T22:08:16","date_gmt":"2023-09-16T21:08:16","guid":{"rendered":"https:\/\/microregistrar.com\/?p=401"},"modified":"2023-09-16T22:08:16","modified_gmt":"2023-09-16T21:08:16","slug":"diagnosis-of-vertebral-osteomyelitis-vo","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=401","title":{"rendered":"Diagnosis of vertebral osteomyelitis (VO)"},"content":{"rendered":"\n

Reference: JBJI review<\/a> published on 27\/1\/2022<\/strong>. Read the full paper here \u2013 Maamari, J., Tande, A. J., Diehn, F., Tai, D. B. G., and Berbari, E. F.: Diagnosis of vertebral osteomyelitis, J. Bone Joint Infect., 7, 23\u201332, https:\/\/doi.org\/10.5194\/jbji-7-23-2022, 2022.<\/a><\/p>\n\n\n\n

Biomarkers<\/h4>\n\n\n\n
    \n
  • CRP and ES<\/strong>R have the highest sensitivity (94\u2009%\u2013100\u2009%), especially when used together.<\/li>\n\n\n\n
  • White cell count<\/strong> has low sensitivity and specificity.<\/li>\n\n\n\n
  • >90% of patients with VO have an ESR of >50. ESR is usually more elevated in bacterial VO compared to TB VO.<\/li>\n\n\n\n
  • If fever and MRI findings, the predictive value may increase further.<\/li>\n<\/ul>\n\n\n\n

    Imaging<\/h4>\n\n\n\n
      \n
    • MRI (preferably<\/strong> with intravenous gadolinium contrast) is the preferred mode of imaging with high sensitivity (97%), specificity (92%), and accuracy (94%). MRI can identify marrow oedema as early as 48 hrs. However, MRI can be repeated in 2-4 weeks if the early imaging is inconclusive. Routine repeat MRI to test response may not help as the radiological response lags behind the clinical response.<\/li>\n\n\n\n
    • X-ray<\/strong> \u2013 low sensitivity at the early stage of the disease (abnormalities appear 2 to 8 weeks after the onset of symptoms), but can be used as the initial test to rule out other pathologies and spinal enumeration. Comparison with old X-rays may help to identify subtle signs.<\/li>\n\n\n\n
    • CT scan \u2013 CT could be superior to MRI in some cases -Modic type endplate changes and if clinical findings do not strongly suggest infection.<\/li>\n\n\n\n
    • Nuclear imaging<\/strong> \u2013
      \u2013 Scintigraphy with single-photon emission computed tomography (SPECT) using Technetium-99m (99mTc) and Gallium-67 (67Ga) tracers can be used when MRI is contraindicated.
      \u2013 Positron emission tomography\u2013computed tomography (PET\/CT) also can be used and may have similar efficacy to MRI.<\/li>\n<\/ul>\n\n\n\n

      Biopsy and Microbiology<\/h4>\n\n\n\n
        \n
      • Blood culture<\/strong>: positive in 58% of cases (range 30-70%). Two sets of blood cultures are recommended. Previous antibiotic therapy may affect the blood culture positivity. If a typical organism is identified (St aureus, St lugdunensis, Brucella) \u2013 further investigation is not necessary.<\/li>\n\n\n\n
      • Biopsy <\/strong>\u2013 when blood or other cultures does not give a conclusive result, image-guided (typically CT or fluoroscopy) percutaneous biopsy or open biopsy is necessary. Open biopsy has higher yield (76%) compared to percutaneous (48-52%). Biopsy specimens should be sent for culture and histopathology.<\/li>\n\n\n\n
      • Factors which increase the yield are<\/strong> \u2013 an elevated CRP, a lower-gauge needle, an increased number of specimens and aspiration of a fluid collection.<\/li>\n\n\n\n
      • Repeat biopsy<\/strong>: if the initial needle biopsy is not diagnostic, a repeat needle biopsy can be undertaken after 3 days, or an open biopsy can be done.<\/li>\n<\/ul>\n\n\n\n

        Serology<\/h4>\n\n\n\n
          \n
        • Fungal serology can be considered, if risk factor present, endemic situation or clinically suspected.<\/li>\n\n\n\n
        • Brucella serology: if Brucella is suspected \u2013 Blood culture and serology should be used for diagnosis. A cutoff of ><\/em>\u20091\u2009:\u2009160 for Brucella<\/em> antibodies or ><\/em>\u20091\u2009:\u2009320 for the Coombs test is considered positive.<\/li>\n\n\n\n
        • TB: a purified protein derivative test or an interferon-\u03b3<\/em> release assay could be used for their high negative predictive value.<\/li>\n<\/ul>\n\n\n\n

          Novel modalities<\/h4>\n\n\n\n
            \n
          • Low-tesla open-magnet MRI scanners \u2013 86\u2009% sensitivity with a 100\u2009% specificity for MRI-guided biopsies.<\/li>\n\n\n\n
          • 16S ribosomal RNA (rRNA) PCR and TB PCR to support microbiological diagnosis.<\/li>\n\n\n\n
          • Metagenomic modalities \u2013 Metagenomic next-generation sequencing (mNGS) \u2013 is complementary to culture-based methods.<\/li>\n<\/ul>\n\n\n\n

            Flow chart as shown in the above article<\/strong><\/p>\n\n\n\n

            \"\"<\/figure>\n\n\n\n

            <\/p>\n","protected":false},"excerpt":{"rendered":"

            Reference: JBJI review published on 27\/1\/2022. Read the full paper here \u2013 Maamari, J., Tande, A. J., Diehn, F., Tai, D. B. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[107],"tags":[116],"class_list":["post-401","post","type-post","status-publish","format-standard","hentry","category-infection","tag-vertebral-osteomyelitis"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=401"}],"version-history":[{"count":4,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/401\/revisions"}],"predecessor-version":[{"id":633,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/401\/revisions\/633"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=401"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=401"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}