Question 12#

Diabetics, intravenous (IV) drug abusers, and dialysis patients have an increased risk of contracting the CNS infection:

A. Pyogenic vertebral osteomyelitis
B. Subdural empyema
C. Discitis
D. Epidural abscess

Correct Answer is A


Pyogenic vertebral osteomyelitis is a destructive bacterial infection of the vertebrae, usually of the vertebral body. Vertebral osteomyelitis frequently results from hematogenous spread of distant disease, but may occur as an extension of adjacent disease, such as psoas abscess or perinephric abscess. Staphylococcus aureus and Enterobacter spp. are the most frequent etiologic organisms. Patients usually present with fever and back pain. Diabetics, IV drug abusers, and dialysis patients have increased incidence of vertebral osteomyelitis. Epidural extension may lead to compression of the spinal cord or nerve roots with resultant neurologic deficit. Osteomyelitis presents a lytic picture on imaging and must be distinguished from neoplastic disease. Adjacent intervertebral disc involvement occurs frequently with pyogenic osteomyelitis, but rarely with neoplasia. Plain films and computed tomography (CT) help assess the extent of bony destruction or deformity such as kyphosis. Magnetic resonance imaging (MRI) shows adjacent soft tissue or epidural disease. Most cases can be treated successfully with antibiotics alone, although the organism must be isolated to steer antibiotic choice. Blood cultures may be positive. Surgical intervention may be required for debridement when antibiotics alone fail, or for stabilization and fusion in the setting of instability and deformity.