PDF(Pubmed)
Abstract：
Pyogenic spinal infections (PSI) have an incidence of 0.5-2.2 cases per 100,000 population, though diagnosis can be delayed by up to three months. The incidence of Fusobacterium nucleatum bacteremia is rare, occurring in 0.22-0.34 cases per 100,000 population, whilst its implication in spinal infections is rarer still. A man in his 60s with a background of chronic lower back pain presented to the emergency department with a two-week history of worsening back pain associated with fever and difficulty voiding. He was initially managed as pyelonephritis due to the recent history of urinary tract infection (UTI) with fever and flank pain. However, there were radiculopathy and bilateral pain on hip flexion with reduced power on the right side. The light-touch sensation was reduced over the right hallux and distal L4 dermatome. These neurological deficits associated with deranged infective markers made a diagnosis of discitis plausible. Discitis and native vertebral osteomyelitis (NVO) should be suspected in patients reporting a fever and back pain of recent onset or increasing in severity. Once discitis was confirmed, the patient was subsequently tested for tuberculosis (TB) using a T-SPOT, human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus, with no positive findings, but in the days following, blood cultures yielded F. nucleatum. Guided by knowing the natural reservoirs in the body, establishing the source of F. nucleatum could be achieved through head and neck imaging and investigating the gastrointestinal tract for malignant or inflammatory processes.
摘要：
化脓性脊柱感染（PSI）的发生率为每100,000人口0.5-2.2例，尽管诊断可能会延迟长达三个月。有核梭杆菌菌血症的发病率很少见，每10万人发生0.22-0.34例，虽然它在脊柱感染中的影响仍然很少。一名60多岁的患有慢性下背部疼痛的男子被送往急诊科，他有两周的背部疼痛恶化史，伴有发烧和排尿困难。由于最近的尿路感染（UTI）病史，发烧和腰痛，他最初被治疗为肾盂肾炎。然而,右侧有神经根病和双侧髋关节屈曲疼痛，功率降低。右侧和远端L4皮刀的轻触感觉降低。这些与感染标记物紊乱相关的神经功能缺损使椎间盘炎的诊断变得合理。在报告近期发作或严重程度增加的发烧和背痛的患者中，应怀疑有关节炎和天然椎体骨髓炎（NVO）。一旦确认了门徒，随后使用T-SPOT对患者进行了结核病（TB）测试，人类免疫缺陷病毒（HIV），乙型肝炎病毒，和丙型肝炎病毒，没有积极的发现，但在接下来的日子里,血液培养产生F.核仁。通过了解体内的天然水库，建立F.核仁的来源可以通过头颈部成像和检查胃肠道的恶性或炎症过程来实现。
