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  #51  
Old 10-01-2009, 09:32 PM
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Exclamation Bumping this up...

For newbies and others, this is a long topic. This post and Steve's tonight talks about staph, which may be introduced in a surgical procedure, injection, or even a dental procedure (which we've also talked about and is now a FAQ).

I hope this helps patients consider the following:

- how some pre-operative conditions contribute to post-op problems, but are not diagnosed or identified;
- how incredibly sophisticated microbes are in terms of chronic disease: evading the immune systems of the body, staying out of blood and finding tissue to hide in, forming biofilms and so more;
- how prevalent nosomomial infections are in the US (et al) and may cause problems with spine (et al) patients (120,000 deaths, 1.5M infections annually);
-how US spine patients are at a informational disadvantage, compared to international patients. E.g., see the stats here on infection for hip/knee patients Orthosupersite. Note: these stats report only what is identified & tracked. Think about it -- no spine patients tracked here!

I have much to share in the coming months...but is this making sense yet?
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  #52  
Old 10-29-2009, 07:17 PM
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Exclamation Cysts and bacterial biofilm composition

When Abbe posted recently about the cysts noted by her surgeon, it made me think about the many times here in this community that this cyst issue has been reported (sorry).

I’ve attended conferences that involve the discussions of bacterial biofilms. There’s been a lot of research over the years regarding biofilms, specifically how they sequester and protect many different species of pathogens, ranging from mycobacteria to yeast to viruses to protozoa. These complex fortresses that protect these naughty guys are called polymicrobial biofilms. This phenomenon has been known for decades, but IMHO has been woefully neglected by the medical establishment.

Check these out:
Surg Infect (Larchmt). 2009 Oct 7.
Chronic Surgical Site Infection Due to Suture-Associated Polymicrobial Biofilm.
http://www.ncbi.nlm.nih.gov/pubmed/19811056

Antimicrob Agents Chemother. 2009 Sep;53(9):3914-22. Epub 2009 Jun 29.
Candida albicans and Staphylococcus aureus form polymicrobial biofilms: effects on antimicrobial resistance.
http://www.ncbi.nlm.nih.gov/pubmed/19564370
So, how does all this interrelate? Bacterial biofilms are said to be composed of calcium (et al) stuff, which make them tough – and resistant to both the immune system and antibiotics.

In the future, perhaps scientists will find that this calcium “stealing” or "leaching" is related to osteoporosis and other conditions. This is one of many topics I’ve been researching and will share much more in the spring. In the meantime, see below.

PS: I do wonder how "unusual" this cyst is in terms of its composition. I think what is very unusual is the level of diagnostics performed on any excised tissue from a patient that is diseased. Presumably, all patients with DDD have a localized disease of some sort with an undiagnosed etiology.
_____________________________________

Unusual facet cyst containing struvite and hydroxyapatite
Journal: Skeletal Radiology M. Grantham and B. Richmond
Department of Musculoskeletal Radiology, A21, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH44195, USA, US

This case report describes a patient with severe back pain and radiculopathy. She was found to have a facet cyst within the lumbar spine that appeared to contain calcium on MRI and CT. Upon aspiration the cyst was found to contain calcium ammonium phosphate (struvite) and calcium phosphate (hydroxyapatite). Ammonia production in the presence of urease-producing bacteria is responsible for the production of struvite in the human body. We postulate that there was a prior infection of the facet with urease-producing bacteria, thus accounting for the production of the struvite within the facet cyst.

http://www.springerlink.com/content/bejywlqmg9fmvcpu/fulltext.pdf?page=1
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  #53  
Old 12-16-2009, 10:00 PM
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Default Cervical Myelopathy with Osteomyelitis or Something Else?

Please see attached case study, courtesy of Spine Universe. If you are new to this topic, please read the whole multi-page topic, there's a lot of information (links, docs, etc.) concerning pathogenic causes of degenerative disc disease(s).
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  #54  
Old 01-04-2010, 11:03 PM
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Default Septic Arthritis, Mycoplasma Felis, H1N1

Recently, I spoke with a friendly neighbor who is a pet owner and a vet. We were talking about how pets have been diagnosed with various flus, including H1N1 and various co-infections like Mycoplasma felis. She also noted how Mycoplasma felis is zoonotic and how in rare cases it causes arthritis in humans. See this article for more:

Mycoplasma felis in Septic Arthritis in a Patient with Hypergammaglobulinemia

It’s interesting that both human and feline patients who were diagnosed with these particular mycobacteria were treated with doxycycline sufficiently so that symptoms abated; it remains to be seen if these treatments were effective in the long term in eradicating arthritic problems. For more:

H1N1 Virus Still Infecting Pets, Domestic Animals

I hope this is interesting and helpful to both patients and spine researchers. It appears that mycobacteria continue to be an elusive, insidious and curious culprit for many diseases; those involving joints and other parts of our precious bodies!
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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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  #55  
Old 01-06-2010, 01:28 PM
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Default mycobacteria vs mycoplasma

Harrison: FYI: Mycoplasma and mycobacteria are two different critters. Mycobacteria cause tuberculosis, leprosy, some other bacterial diseases. Mycoplasma are also bacteria, but completely different genus, completely different diseases. Just didn't want you to get them confused.

Susan/ ERvet
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hx of r-sided radicular pain (2003)
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2006 L4-5-S1 hemi, no relief
2007-RF @L5-S123, 2mo relief
2008-disco pos @L5-S1, +/-L4-5
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Don't even ask about the other ortho sx!
New onset left-sided pain Nov 08
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  #56  
Old 01-06-2010, 06:02 PM
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Default

Sue,

You’re absolutely right, I should have been clearer when referring to the entire topic (not just that post). I admit I am still learning a lot about bugs, especially when trying to understand how mycobacteria are “not really” gram negative or gram positive critters! My point was that both mycoplasmas and mycobacteria are implicated in arthritides and even in device infections.

I’ve been a bit tight lipped about the on-camera interviews I’ve conducted in the last six months, so let me broach these recent developments. As you know, some of my research interests are focused on pre and post-operative infections caused by all different kinds of microbes. I’ve interviewed top scientists at NIH, orthopedic and microbiology researchers at several universities, with more scheduled in the coming months. I’ll probably set up another web site to share some of these videos, but I’ve not decided yet because of time & resources.

Back to your point: here are some definitions I found quickly below. I think there are better ones elsewhere (more current), but for now…
_____________________________

Mycoplasma: The mycoplasma are a very large group of bacteria. There are more than 70 types. Mycoplasma hominis and Mycoplasma pneumoniae are among the dozen types of mycoplasma that occur in humans. Mycoplasma hominis is a common inhabitant of the vagina and can cause infections of the female and male genital tracts.

Mycoplasma pneumoniae can infect the upper respiratory tract and the lungs. It is a major cause of respiratory infection in children of school age and young adults. It is also a common cause of pneumonia in persons with HIV. Certain antibiotics including tetracycline and erythromycin are frequently used to treat infection with Mycoplasma hominis or Mycoplasma pneumoniae. Mycoplasma are very simple one-celled organisms without an outer membrane. They penetrate and infect individual cells.

Mycobacterium: A large family of bacteria that have unusually waxy cell walls that are resistant to digestion.

The mycobacteria includes:

Mycobacterium avium -- which causes tuberculosis in birds and immunodeficient people;

Mycobacterium leprae -- which causes leprosy;

Mycobacterium marinum -- which causes swimming pool granuloma;

Mycobacterium tuberculosis -- which causes most cases of tuberculosis;

Mycobacterium ulcerans -- which causes Buruli ulcer.

The mycobacteria are acid-fast rod-shaped bacteria. They are usually slow-growing. Many are intracellular parasites.
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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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  #57  
Old 01-06-2010, 07:51 PM
CP7959 CP7959 is offline
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Default

Some questions:

Is the potential for infection issues more prevalent with ADR's as opposed to other spine hardware such as plates and cages? Has there been any statistics gathered on "other" spine hardware and infection? If so what is the course of action?

If there is infection such as Steve had, is ADR removal the only solution? Or is early detection and treatment beneficial?

Which if early detection is advantageous, what is the best test / follow up? Periodic Xray's to identify subsidence of the ADR? Or would a blood test be appropriate?
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  #58  
Old 01-06-2010, 08:44 PM
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There’s no question that some materials (because of their surface charge and structure) are “not great” at resisting microbes and subsequent biofilm formations. Once a biofilm community (monomicrobial, or worse, polymicrobial) is set up, it becomes almost impossible to eradicate the infection on the device or in tissue. Diagnostics for most preliminary infections (gram-positive likely suspects) are not widely available yet.

My interview with Dr. Tom Webster at Brown University was almost entirely about your questions, so I’ll do my best to make some of this information available next month (but no promises). It was a 50 minute on-camera interview, covering these subjects:

1. Prosthetic designs and device failures
2. Orthopedic device infections
3. Types of bacterial infections
4. Bone turnover & osteoporosis
5. Osteoporosis medications & efficacy
6. Bacterial biofilms on orthopedic devices
7. Biofilms defined
8. Biofilms and antibiotic resistance
9. Challenges in biofilm eradication
10. Deploying nanotechnology: antibacterial design
11. Enzymes and electromagnetic fields for biofilm eradication
12. Beating biofilms

Sorry I can’t work more quickly to make this information available; but I’ve been working on these issues for the past year. I need resources, people, money or miracles. Any of these will do nicely, thank you.

Any way, a small excerpt from this informative video interview:

Dr. Tom Webster -- Brown University:

“…biofilms are extremely detrimental, even the presence of some bacteria on an implant surface is detrimental, because that keeps bone from growing next to the implant. If you have something I the way like bacteria that will keep the bone or the appropriate tissue from growing. What bacteria will try to do is, try to stick to that foreign object if that environment is appropriate, and proliferate much faster than any bone cell could ever proliferate, until it reaches a state of biofilm formation, until multi-layers are formed and it kind of, a good way to think about it, it sequesters that area of the implant from the rest of the body.

So you really have an impenetrable area that has formed next to the implant and this is why pharmaceutical agents no longer matter once you reach that point is because that agent or drug cannot penetrate the biofilm to expose themselves to then kill bacteria, so there is really a so called sweet spot in which you can begin to kill bacteria once you pass, once the bacteria pass that, you cannot kill them through conventional means. The other things that happen underneath a biofilm, if it has formed on something like this titanium, is you get a very aggressive degradation of the metal, or a polymer, or if it was a polymer and because of the environment inside of a biofilm, you will have a lot of corrosive events, which would occur, which would just lead you down this cascade of failure of this negative release of metal ions, to even promote more bacteria to grow, or promote more inflammatory cells to come to the implant surface, etc…”

CP: Please add a signature to your profile. CP, see the User CP link?! Made just for you!
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Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #59  
Old 02-01-2010, 05:38 PM
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Default MRSA as a Cause of Lumbar Facet Joint Septic Arthritis

Methicillin-Resistant Staphylococcus aureus as a Cause of Lumbar Facet Joint Septic Arthritis
The Journal of Bone and Joint Surgery (American). 2010;92:465-468.
doi:10.2106/JBJS.H.01888 2010

A Report of Two Cases
Venkatesh Krishnan, DNB(Orth)1, R. Amritanand, MS(Orth)1 and G.D. Sundararaj, MCh, MS(Orth)
Spinal Disorders Services, Department of Orthopaedics Unit 1, Christian Medical College, Vellore, Tamil Nadu-632004, India.

Introduction
Hematogenous septic arthritis of the lumbar facet is a well-recognized although rare1-5 primary infectious entity of the spine. Traditionally, the most commonly implicated organism has been Staphylococcus aureus1,2,6. Although there have been reports of methicillin-resistant Staphylococcus aureus (MRSA) spondylodiscitis7, methicillin-resistant Staphylococcus aureus as a cause of hematogenous facet joint septic arthritis has not been described, to our knowledge. We report our experience with the treatment of two cases of facet joint septic arthritis due to methicillin-resistant Staphylococcus aureus. The patients were informed that data concerning these cases would be submitted for publication, and they consented.

Case Reports
CASE 1. A fifty-three-year-old man presented with an eighteen-day history of severe back pain radiating to the left lower limb. He was unable to walk because of the intensity of pain. He had retention of urine, for which he required catheterization. Apart from being a chronic smoker, he had no medical . . .

[Full Text of this Article] [Subscription required for full text]
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  #60  
Old 02-28-2010, 09:00 PM
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Clin Orthop Relat Res. 2005 Aug;(437):25-30.

Is aseptic loosening truly aseptic?

Nelson CL, McLaren AC, McLaren SG, Johnson JW, Smeltzer MS.
Department of Orthopaedic Surgery, University of Arkansas Medical Sciences, Little Rock, 72205, USA.

Surgeons who treat osteomyelitis or infected implants think that microorganisms can live on and around implanted biomaterials and necrotic bone without clinical manifestations of infection. Gristina and Costerton, in their seminal work, suggested that such bacteria persist within biofilms and that they are often overlooked when diagnosis is based on standard microbiologic culture techniques. Subsequent studies using specialized techniques including sonication to remove adherent bacteria and direct detection using various forms of microscopy have confirmed that bacteria are present in many culture-negative cases.

This led to the suggestion that at least some cases of failed orthopaedic implants that were considered aseptic loosening based on the absence of clinical signs of infection and the failure to isolate bacteria may actually have an infectious etiology. In addition to biofilms, potentially important concepts that also may contribute to false negative culture results include the failure to recognize small colony variants induced during growth in vivo and the presence of bacteria inside host cells including osteoblasts. Importantly, bacteria persisting as small colony variants within biofilms and/or inside osteoblasts also may be an explanation for the recurrent nature of musculoskeletal infection.

PMID: 16056022 [PubMed - indexed for MEDLINE]
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ankylosing spondylitis, bacteremia, bacterial biofilm, biofilm, biofilm formation, biofilms, borrelia, calcium, cyst, ddd, degenerative disc disease, h1n1, hematogenous osteomyelitis, infectious spondylitis, lyme disease, mycobacteria, mycobacterium, mycoplasma felis, osteomyelitis, periodontal disease, reactive arthritis, septic arthritis, septic discitis, seronegative spondyloarthropathy, spondylodiscitis

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