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  #71  
Old 03-08-2014, 12:14 PM
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Default More Evidence: Microbial Infection Causal Factor

Bugs in the Back: Is Lumbago an Infectious Disease?
Paul G. Auwaerter, MDDisclosures
February 28, 2014

I just had my first consultation with a patient who came to the ID clinic asking whether Propionibacterium acnes was responsible for his chronic back pain. This is a man who has had multiple back surgeries and many previous interventions and treatments for his pain. He recently had been encouraged by family members, who had been trolling the Internet literature, to find out whether a chronic infection could be causing his back pain.

P acnes is often dismissed as a contaminant, but during the past decade or so it has been recognized as an indolent pathogen that can cause problems such as ventriculoatrial shunt infection and perhaps prosthetic joint problems, especially in the shoulder. In addition, a small amount of supportive literature about P acnes infection in the spine has been published. This infection often is not typical; patients have no fever or elevated sedimentation rate. It seems to be fairly rare; however, one review[1] found that 97% of 29 patients with this infection had previously undergone surgery.

Perhaps beginning with a report in the early 2000s in The Lancet, [2] some have speculated that P acnes may explain more mundane lower back pain or sciatica or problems attributed to a herniated disk, for example. A number of studies have supported[3-5] or refuted[6,7] this idea that an infectious cause may be responsible for some back ailments. A few of the studies purport to have used very careful techniques for removing disks and growing this anaerobic organism in cultures.

Recently, a group in Denmark has investigated this more thoroughly and published 2 papers of interest on the subject.[5,8] In the first,[5] they removed disks in 61 patients; P acnes was cultivated from 46% of these herniated disks, and 80% of those had specific MRI findings called Modic 1 (bone edema adjacent to the disk area). There are 3 different kinds of Modic descriptions, named after the physician who described them. Modic 1 means that the disk has caused some adjacent bony trabecular problems with microfractures and resulting serum leaking into the area, which leads to radiographic changes. Thus, perhaps a certain subset of back pain could be attributed to this.

But the proof would have to come, in my mind, from repeated cultures that recover this organism from not just one but multiple areas or perhaps a therapeutic trial. Indeed, the same group has published a therapeutic trial[8] in which patients with Modic 1 MRI findings were randomly assigned to receive either amoxicillin/clavulanate or placebo. Of 162 patients enrolled, 144 completed the trial and were available for follow-up. They all had at least 6 months of chronic low back pain and Modic 1 changes. Patients were randomly assigned to receive amoxicillin/clavulanate or placebo 3 times daily for 100 days.

At 1-year follow-up, there was a statistically significant difference between the antibiotic and placebo groups, with reductions in pain in the active treatment group that seemed to continue even after antibiotic cessation. In addition, the antibiotic group had more resolution of the Modic 1 changes.

These findings are intriguing. This type of antibiotic trial bears repeating in a different setting, and if it holds up, it is highly suggestive that a subset of patients with chronic low back pain may benefit more from antibiotic treatment than injections, neurosurgical interventions, and so on.

I believe this issue deserves close observation and may even be at the point where a trial of amoxicillin/clavulanate could be worthwhile in patients with back pain and Modic 1 changes. I will say that most P acnes isolates are susceptible to amoxicillin alone, which might be a better tolerated regimen, and perhaps the dose could be pushed a bit higher to 1000 mg 3 times daily.

Stay tuned because this particular area of study may change a certain subset of medicine. Whether we can go by MRI findings to make treatment decisions or need some kind of microbiologic confirmation is uncertain. There is biologic plausibility; the spinal column has unique characteristics that make the environment favorable for this particular organism.

Thanks very much for listening.

http://www.medscape.com/viewarticle/820717
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  #72  
Old 08-19-2014, 09:32 PM
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Default

Joint Bone Spine. 2014 Jun 20
Three-decade trends in the distribution of organisms causing septic arthritis in native joints: Single-center study of 374 cases.
Dubost JJ1, Couderc M2, Tatar Z2, Tournadre A2, Lopez J2, Mathieu S2, Soubrier M2.

OBJECTIVE:

A rise in the incidence of septic arthritis due to methicillin-resistant Staphylococcus aureus (MRSA) has been reported in several parts of the world. Here, our objective was to look for changes over the last 30 years in the distribution and antibiotic susceptibility profiles of organisms responsible for septic arthritis.

METHODS:

We conducted a single-center retrospective study of all cases of septic arthritis documented by joint specimens and/or blood cultures between 1979 and 2008. Prosthetic joint infections were excluded.

RESULTS:

We enrolled 374 patients, of whom 127, 136, and 111 were included during each decade, respectively. We detected no significant time trends in the proportions of staphylococci (67%, 65%, and 64%), streptococci (14%, 21%, and 17%), or Gram-negative rods (7%, 10%, and 14%). Tuberculosis was more common during the earliest decade (1979-1988, n=10, 4, 2%; P<0.05). No significant changes occurred in the proportions of methicillin-resistant staphylococci or MRSA (13%, 11%, 15%). Age and prevalence of risk factors for infection increased over time.

CONCLUSION:

The distribution and susceptibility of organisms causing septic arthritis has changed little over time. Our findings do not support the use of broader-spectrum antibiotics when empirical treatment is deemed necessary at our center.
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  #73  
Old 03-25-2017, 08:03 PM
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Default Microbial infections in DDD -- more common that you know

Antibiotics act against back pain - Danish scientist receives German prize

Approximately half of the patients with chronic lower back pain show MR edema in the bone marrow, so-called 'modic changes'. In the first investigations Albert was able to detect bacteria in more than 50% of the patients in the tissue taken after a herniated disc. To a large extent, the tissue was infected with P. acnes. This bacterium, which belongs to the natural oral flora, enters the blood, for example, through small injuries that occur during the brushing process. By newly formed capillaries on the exudated tissue of the disc, the bacteria ultimately reach the inside of the disc, and remain there after a healing of the intervertebral disc disease and cause inflammation, bone edema, and pain.

Thus the idea arose in a pilot study to test whether antibiotics against the bacterial attack and thus also against the back pain of the patients can work. Already this first study showed significant results in the improvement of both the pain symptoms as well as the functional complaints of the patients.

Further randomized, placebo-controlled studies confirm the results. Patients received 1,000 mg amoxicillin 3 times a day over a period of 100 days. First effects were observed after 6 to 8 weeks and continued over a follow-up time of one year, in another study even over two years.

Antibiotics in "modic changes" with bacterial probes

When asked whether all patients with low back pain should be treated with antibiotics, Albert said, "No, but those with modic changes, where bacteria play a role, benefit enormously . "A revolutionary approach to pain medicine that could not only alleviate the suffering of millions of patients, but also save enormous costs due to disability and early retirement. These research efforts have now been awarded the DEUTSCHE SCHMERZPREIS.

"With her breakthrough, Hanne Albert has sustained a change in pain medication and established a new basis for the discussion of chronic back pain," said Dr. Gerhard Müller-Schwefe, President of the German Society of Pain Medicine, in his laudation.

The DEUCHCHE SCHMERZPREIS - Deutscher Förderpreis für Schmerzforschung und Schmerzmedizin - is awarded annually to persons who have earned themselves by scientific work on the diagnosis and therapy of acute and chronic painful conditions, or which, through their work or their public activities, make a decisive contribution to the understanding of the problem of pain and of it Affected patients.
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  #74  
Old 03-26-2017, 12:12 PM
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Default Candida as cause of spinal condition

A reminder on culture-based diagnostics, here: it's a 160 year old method! If it's a difficult or mysterious the condition, the doctor should use better tools. Culture-based methods can detect up to, and only, 5% of all microbes that can cause human health problems.
__________________________________________________ _

Microbiology Case Study: A 73 Year Old Man with Back Pain

Case History

A 73 year old man with a history of multiple back surgeries presented with bilateral lower extremity back pain of over greater than one month duration. Prior surgeries included L4/L5 fusion with pedicel screws and a decompression laminectomy one year prior to presentation. Imaging of his spine showed a fluid collection in his lumbar spine and he underwent several tissue biopsies over the course of a month which consistently showed no growth.

Despite negative cultures he was treated with doxycycline and levoquin for 30 days. He was transferred to University of Vermont Medical Center (UVMMC) for IR drainage and tissue biopsy of this lumbar abscess as he continued to complain of back pain and had begun to develop bilateral lower extremity weakness. Cultures grow the organism below and close inspection revealed the presence of small feet. The organism was confirmed to be Candida albicans.

Discussion

Vertebral osteomyelitis due to Candida is rare, however, a review of the literature reveals that most patients have lower thoracic or lumbar spine involvement and over 80% present with >1 month of lower back pain. An elevated white blood cell count is not as sensitive as an elevated erythrocyte sedimentation rate and of all patients, less than a quarter have neurologic signs.

Candida albicans was responsible for almost 2/3 of cases and the remaining cases were caused by Candia tropicalis or Candida glabrata. Risk factors include IV drug abuse for patients under 25 years old; for elderly patients a central venous catheter, antibiotic use and immunosuppression.

Reference

Miller, D and Mejicano, George. Vertebral Osteomyelitis due to Candida species: Case report and review of the literature. Clinical Infectious Diseases, 2001;33:523-530.

-Agnes Balla, MD is a 3rd year anatomic and clinical pathology resident at the University of Vermont Medical Center.

-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.

Source Link:
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Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #75  
Old 12-09-2017, 07:45 PM
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Post Bartonella surgically excised from femoral head

Culture, PCR, DNA sequencing, and second harmonic generation (SHG) visualization of Bartonella henselae from a surgically excised human femoral head

63-year-old veterinarian was diagnosed at age 8 with Cat Scratch Disease (CSD; acute #Bartonella henselae infection). Over the course of her life, in which she had a lot of exposure to cats, she developed a bull's eye rash twice, cardiac arrhythmias and palpitations, muscle and skeletal pain, uterine (endometrial) cancer, hyperparathyroidism, osteoarthritis in wrist and hip, emergency appendectomy, and hip joint pain.

Galaxy Diagnostic's testing and enriched cultures (BAPGM ePCR) of her blood revealed antibodies and the presence of Bartonella bacteria DNA.

Due to severe, end stage degenerative osteoarthritis, she had hip replacement surgery. After the operation, part of the excised hip joint was examined for infection- it was Bartonella henselae PCR positive. Microscopy revealed that B. henselae was more abundant in the spongy vs. the compact bone. "Assuming that her B. henselae infection persisted between the timing of her blood culture, surgery, and femoral head cultures, she remained infected for at least 108 days."

"B. henselae has been implicated as a cause of osteomyelitis [bone infection] of the hip joint acetabulum in two adult males and localized or generalized osteolytic lesions [areas of bone loss] in children, which are considered atypical or systemic manifestations of CSD." One study found that years following CSD diagnosis, a subset of patients develop arthritis or other musculoskeletal abnormalities.

Authors of this study, including Galaxy employees, suggest that patients with asymmetrical or atypical osteoarthritis should have their history examined for risk factors for Bartonella species (such as cat exposure) and be considered for diagnostic testing.

https://www.ncbi.nlm.nih.gov/pubmed/28028681
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #76  
Old 12-24-2017, 11:58 AM
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Default Lyme disease and knee replacement

A recently published case report entitled, "First case of Lyme arthritis involving a prosthetic knee joint," describes what the authors believe is the "first patient with late Borrelia burgdorferi sensu stricto arthritis-related prosthetic joint infection. They suggest "the case highlights how early, prompt diagnosis and adequate antimicrobial therapy may obviate the need for additional aggressive orthopedic surgical intervention."

http://danielcameronmd.com/successfu...-knee-surgery/
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Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #77  
Old 01-06-2018, 08:33 PM
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Since 2006, I've been advocating for better diagnostics for people afflicted with spinal problems. In this long topic, I've also provided hundreds of references that show how bacteria can create joint problems. Here's yet another very compelling reference below, written by Tom Grier, Lyme disease researcher.
___________________________

This video by Canadian Lyme researcher Dr. Tara Moriarty is amazing.

Borrelia burgdoferi (B-31) is stained with Fluorescent Green stain, and the mouse blood vessel is stained Red.

Borrelia burgdorferi (Lyme spirochetes/ Bb) are injected Live into a mouse. Moments later the "viva scope" captures them flowing threw the tiny vessel.

But look at the ones that don't move. Those are the Bb that are attached to the blood vessel wall. In moments they will create holes in the vessel and leave the blood in favor of the tissues.

Target tissues appear to be joints, heart, brain and skin.

https://www.youtube.com/watch?v=_6kO...yJc4oHDiz4IQY1
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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