Spinal Diseases: Bacterial Causes

[Harrison]

Ann Emerg Med. 2009 Nov;54(5):695-700. Epub 2009 Aug 8.
How common is MRSA in adult septic arthritis?

Frazee BW, Fee C, Lambert L.
Department of Emergency Medicine, Alameda County Medical Center-Highland Campus, Oakland, CA 94602, USA.

STUDY OBJECTIVE:
We determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) in adult septic arthritis patients presenting to the emergency department (ED).

METHODS:
This was a cross-sectional retrospective review in 2 urban academic EDs in northern California, one tertiary care and one public. Subjects included patients who underwent arthrocentesis in the ED from April 2006 through July 2007. We queried the microbiology laboratory databases for synovial fluid cultures sent from the ED. We reviewed synovial fluid culture results and corresponding synovial fluid analyses and then classified positive culture results as true septic arthritis or likely contaminant. For septic arthritis cases, we reviewed medical records and abstracted presenting features. We report our findings with descriptive statistics.

RESULTS:
One hundred nine synovial fluid cultures were sent from the EDs. Twenty-three results (21%; 95% confidence interval [CI] 14% to 30%) were positive, of which 9 were likely contaminants; 1 was from a soft tissue abscess and 1 was from bursitis.

Of 12 septic arthritis cases, 6 cultures (50%; 95% CI 21% to 78%) grew MRSA, 4 (33%; 95% CI 7% to 60%) methicillin-susceptible S aureus, and 1 each (8%; 95% CI 0% to 24%) Streptococcus pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa.

Of the 6 MRSA cases, 4 were in male patients; median age of patients was 47.5 years, 3 patients had previously diseased joints, 2 patients injected drugs, 2 patients were febrile, 3 patients had previously diseased joints, median synovial fluid leukocyte count was 15,184 cells/microL (range 3,400 to 34,075 cells/microL), and 5 patients received appropriate ED antibiotics.

CONCLUSION:
In this 2-ED population from a single geographic region, MRSA was the most common cause of community-onset adult septic arthritis. Synovial fluid cell counts were unexpectedly low in MRSA septic arthritis cases.

[Harrison]

Is a bug the reason for your bad back?
by DIANNE SPENCER, femail.co.uk

Could a common microbe be the cause of your back pain? A chance discovery by researchers in Birmingham suggests that hidden infection by bacteria usually associated with acne could be to blame for up to half of all cases of sciatica.

It's the first time infection has been implicated in the condition, which causes persistent and sometimes excruciating lower back and leg pain. Usually it's blamed on a 'slipped' or herniated spinal disc pressing on the sciatic nerve, but in some cases there is no evidence of abnormal nerve pressure, while many cases of herniated discs are symptom-free.

Researchers stumbled across the finding during trials of a new blood test designed to pick up signs of chronic low-grade infection. Study leader Dr Tom Elliott, professor of microbiology at University Hospital in Birmingham, says his team found evidence of deep-seated infection in a large percentage of sciatica patients, who were being used as a control group during the trials.

'The results surprised us because this group wasn't supposed to show any signs of infection,' says Dr Elliott. 'None of them had had an infection in the past six months.'

Follow-up tests on disc tissue taken from sciatica sufferers revealed the culprit to be Propionibacterium acnes, a slow-growing bacteria commonly associated with acne and routinely found on the skin and in the blood.

'Generally it's considered fairly harmless in healthy people,' says Dr Elliott, 'but it's increasingly being recognised as an agent of infection. We think that minor trauma to the disc, say slight damage as a result of lifting something heavy, provides the bacteria with an ideal resting place.'

Dr Elliott believes the bacteria then colonise the site of the injury causing chronic infection and inflammation, leading to sciatic pain.

The P. acnes bacterium is known to cause infections in artificial hip replacements and catheter wounds, but Dr Elliott says it's likely its role in other infections is often missed simply because it is so slow-growing.

'Lab cultures are traditionally done over 48-72 hours, but P. acnes takes up to seven days to grow - long after most culture plates are destroyed.'

Current treatment for sciatica centres on physiotherapy, exercise, pain management and, in extreme cases, surgery, but the Birmigham team's findings indicate that antibiotics may have a role.

Dr Elliott is already planning the next phase of research, and says the team will examine, among other things, whether antibiotics can clear up disc infections and whether this has any effect on sciatic pain.

Spinal specialist Mr Philip Sell, a consultant orthopaedic surgeon at the University Hospitals of Leicester NHS Trust, says the Birmingham team's findings are very exciting.

'The research needs to be independently verified, of course, but if infection is identified as a cause of sciatica, it would be a finding on par with the discovery of Helicobacter pylori's role in gastric ulcers.'

That discovery, which showed that bacterial infection rather than stress and lifestyle was to blame for most cases of gastric ulcer, has revolutionised ulcer treatment and greatly reduced the need for surgery.

However, Mr Sell said it was too early to say whether bacteria was definitely to blame for those cases of sciatica where infection was present.

'It might be that infection leads to sciatica, as the Birmingham team say, but it could also be the case that sciatica somehow predisposes a disc to infection.

'That said, I hope other units follow up this research. It would be marvellous to find a way to treat extreme sciatica non-operatively.'

According to Back Care, the national charity that funded the study, lower back pain, including sciatica, is currently the number one cause of disability in the UK.

Some 180 million working days are lost each year to the problem, and 13 per cent of unemployed people say back pain is the reason they are not working.

Read more: Is a bug the reason for your bad back? | Mail Online

Also see this long topic of abstracts:

http://www.adrsupport.org/forums/f44...html#post89756

[Harrison]

Stomach Bugs Can Lead to Arthritis, Even in Children

By Linda Fugate PhD
Created 06/04/2012 - 09:16

Food poisoning (infectious gastroenteritis) typically causes nausea, vomiting, and diarrhea. Usually these symptoms clear up in about a week, but some patients develop lifelong problems.

Maryn McKenna reported on a girl named Dana Dziadul who developed arthritis as a toddler.

Dziadul spent two weeks in the hospital with a salmonella infection from cantaloupe when she was three years old. Soon afterward, she developed pain in her knees and ankles that interfered with both sleep and school sports.

Reactive arthritis is the name most commonly used for arthritis following infection. Reiter's syndrome is an older name that is still in use. John M. Townes of the Oregon Health and Science University reported on the problem of reactive arthritis following gastrointestinal infections in the United States. The infection does not spread to the joints, but the inflammation does.

“Clearly, there are inflammatory changes that can occur in joints and other tissues following infection with enteric pathogens,” Townes explained.

The Centers for Disease Control and Prevention (CDC) estimates that 48 million Americans per year get sick with foodborne illnesses. There are 31 known pathogens, including bacteria and viruses.

Salmonella, campylobacter, shigella, yersinia, and chlamydia are the species generally associated with reactive arthritis, according to Townes. The term “postinfectious arthritis” is often used for joint inflammation following other infections.

“ReA [reactive arthritis] is a concept, not a well-defined disease,” Townes wrote. It is not yet clear how many arthritis patients developed their joint problems in reaction to foodborne infection.

Food poisoning is also known as traveler's diarrhea when it occurs in someone away from home. Military personnel are especially susceptible when they are deployed to areas at high risk.

Jennifer A. Curry of the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and colleagues studied active duty U. S. military personnel. They found a significant association between reactive arthritis and infectious gastroenteritis, even though the military population is generally young and physically fit.

“This represents a significant burden on the military healthcare system and may be an important medical condition in returning veterans,” she concluded.

References:

McKenna M, “Food Poisoning's Hidden Legacy”, Scientific American 2012 April. Online version:
http://www.scientificamerican.com/ar...onings-hidden-...

Centers for Disease Control and Prevention. CDC Estimates of Foodborne Illness in the United States. Web. March 31, 2012.
CDC - 2011 Estimates of Foodborne Illness

Townes JM, “Reactive arthritis after enteric infections in the United States: the problem of definition”, Clin Infect Dis. 2010 Jan 15; 50(2): 247-54. Reactive arthritis after enteric infections ... [Clin Infect Dis. 2010] - PubMed - NCBI

Curry JA et al, “The epidemiology of infectious gastroenteritis related reactive arthritis in U. S. military personnel: a case-control study”, BMC Infect Dis. 2010 Sep 13; 10: 266.
The epidemiology of infectious gastroenteriti... [BMC Infect Dis. 2010] - PubMed - NCBI

Reviewed June 4, 2012
by Michele Blacksberg RN
Edited by Jody Smith

[Harrison]

Contrary to a quote in the above article, reactive arthritis is a well-documented condition (not a concept) in the literature. Any way, here's another recent article on the subject.
________________________________

Lab Notes: Drug Versus Bug in Arthritis
By MedPage Today Staff
Published: June 22, 2012

A drug treatment with a novel mechanism and an unusual provenance may help combat spondyloarthritis, a rat study suggested. Also this week: cancer alters nerves to cause pain.

Countering Chlamydia Arthritis

The protease inhibitor nafamostat mesylate effectively blocked the development of reactive arthritis associated with Chlamydia infection in laboratory experiments, minimizing joint swelling and reducing the articular microbial load, researchers reported in Arthritis Research & Therapy.

Infection, particularly with Chlamydia bacterial species, has increasingly been recognized as playing a role in triggering spondyloarthropathies, according to Robert D. Inman, MD, and colleagues at the University of Toronto. Up to 60% of cases of undifferentiated spondyloarthropathy are now thought to be associated with Chlamydia.

In the current animal study, infected control rats had severe joint swelling and rapidly lost weight, while rats given the protease inhibitor had minimal swelling and maintained their body weight.

Nafamostat is currently used in Japan and other Asian nations as a treatment for disseminated intravascular coagulation and pancreatitis, but was not previously known to have antimicrobial properties. The drug may be an "appealing candidate" for the treatment of reactive arthritis, warranting further investigation, Inman and colleagues suggested.

-- Nancy Walsh

Source: http://www.medpagetoday.com/LabNotes/LabNotes/33432

[Harrison]

A few years ago, I met Dr. Steven Fry, a microbiologist who has been helping patients over many years with chronic diseases. Some of the patients' conditions include: various arthritides (including spinal), MS, Lupus, Chronic Fatigue, Fibromyalgia, Lyme Disease, etc. He has developed some rather sophisticated diagnostic techniques to identify and discover new life forms that establish themselves chronically in the human host. In this case, he asserts that a particular microbe (protozoa-like) causes a wide range of medical conditions.

If even half of what he has discovered it true, the ramifications are frightening. From my interviews with various researchers and doctors, this interview makes a lot of sense (almost unfortunately), but I am still having trouble accepting the fact that fats and magnesium "feed" biofilms.

That said, I know that many patients with chronic bacterial infections:

- do in fact feel better (or get better) when they switch to healthier diets, especially ones that are organic and plant-based;

- are low (or very low) in magnesium according to chronic disease doctors;

- vary considerably in terms of their immunopathology and response to different treatments.

Folks, I am still learning, I don't know much. I just wanted to share this for those interested.

[Harrison]

Rheumatoid Arthritis is Caused by Asymptomatic Proteus Urinary Tract Infections

Intro below

Urinary tract infections (UTI) are considered as one of the most common groups of infections in humans and affecting either the upper (kidneys--pyelonephritis) or the lower (bladder--cystitis) part of the urinary tract (Thomson and Armitage, 2010).

The gastrointestinal tract is a reservoir from which uropathogens emerge. Reflecting this, Enterobacteriaceae are the most important cause of UTI in all population groups, accounting for more than 95% of all UTIs. Among these microbes, E. coli is by far the most common invader, causing some 90% of UTIs in outpatients and approximately 50% in hospitalized patients. Whilst, the frequency of P. mirabilis causing outpatient and inpatients UTIs were 3.2% and 12.7% respectively, these value were reversed to 26.6% and 9.3% when all strains of Proteus species were examined (Talkoff-Robin et al, 2008). In a most recent multicentre study involving nine Spanish hospitals, 784 women with uncomplicated cystitis were evaluated for the frequencies of isolated uropathogens and their susceptibility to antibiotics.

Among the 650 pathogens isolated, the first group of the most frequent bacterial agents was Escherichia coli (79.2%) followed by Staphylococcus saprophyticus (4.4%), Proteus mirabilis (4.3%), Enterococcus faecalis (3.3%), and Klebsiella pneumoniae (2.3%) (Palou et al, 2011).

In contrast to E. coli strains, it appears that all strains of P. mirabilis, regardless of isolate origin, are capable of infecting the urinary tract (Sosa et al, 2006). Proteus is particularly significant as a renal pathogen especially in causing upper UTI because of its propensity to promote struvite renal calculi (Ronald and Nicolle, 2007).

Excerpt later in article:

In a preliminary study carried out by a group from Tel Aviv, it has been found that 35 percent of patients with RA and secondary Sjogren’s syndrome had recurrent attacks of UTIs (Tishler et al, 1992). Furthermore, another group from Edinburgh, using a necroscopic examination of kidneys from dead patients with RA, found that approximately 17.6 percent of males and 22.7 percent of female patients showed signs of chronic pyelonephritis (Lawson and Maclean, 1966). A similar result was found in a previous study carried out by a group from Copenhagen, where a considerably high degree of associated non-obstructive pyelonephritis and renal papillary necrosis was detected among the renal autopsy materials from patients with RA (Clausen and Pedersen, 1961). However, this kind of association between RA and UTIs was not always observed (Vandenbroucke et al, 1987). This discrepancy in the results with an apparent lack of the epidemiological link between urinary infections and RA could be due to the occurrence of sub-clinical or occult infections, which are merely characterized by bacteriuria.

Full article: http://cdn.intechopen.com/pdfs/19322...infections.pdf

[JEVE19]

Richard,
I always read the items you post here.
It's always interesting.

I think you missed your calling to be a doctor!

[Harrison]

Thanks Vicki, glad you read this topic and for your kind words. I am happy to be of service in my unusual role I've assumed since 2004.

Quick comment on the above topic. I recently interviewed one of my board members about rheumatoid arthritis for an in-depth interview on all the stuff mentioned in this topic (will share video interview in a few weeks). She reminded me that the above author espouses the notion of "one-bug, one disease," which is old school. In other words, Koch's postulates are 150 years old, and so are the diagnostic tests for patients with chronic bacterial infections that lead to disease states.

Culture based diagnostics only detect up to 6% of all known bugs...no wonder so many infections are NEVER diagnosed and treated. In essence, that's what my documentary on biofilms is all about...

Why Am I Still Sick?

[Harrison]

On the same topic, possible remedies to fix problems associated with a pathogenic (microbial) disease of the spine:

http://www.adrsupport.org/forums/f60...075/#post98833

[Harrison]

Years ago, I got into a nice little debate with a previous member. I was simply making the point that many members who signed up seemed to be coming from the same parts of the country.

Around that time, coincidentally, a bright young student was comparing the geographic locations of Lyme patients with multiple sclerosis patients. The correlation between these maps is stunningly obvious. I've cut and pasted my friend Walter's comment below (thanks Walter).

My question that I can answer eventually if I have the time and money to do the analysis: how many patients with degenerative disc disease are in the regions that are endemic with Lyme disease?!
_______________________

This link is from a friend at PA Dept of Environmental Protection: A very interesting article about M.S. vs Lyme disease.

Esri ArcWatch October 2007 - Spatial Patterns of Disease Inspire New Ideas on Possible Causes

Open the three maps in separate browser windows, superimpose the windows and then switch back and forth to see how closely the Lyme and MS maps coincide with each other and with the control map. The nationwide data set for Lyme mortality in 1998 would be a great research resource if it is still available somewhere.

Note that this poster presentation was published in 2007 by Megan Blewett, at that time an 18-year old science high school student who went on to Harvard majoring in Chemistry. As a Senior at Harvard she was awarded a 2011-12 Hertz Foundation Fellowship (worth $250,000) to help fund her own original research. She is now working on a PhD supported by an NSF Research Fellowship at Scripps Research Institute in California.