681. Differentiation between Tuberculous and Bacterial Vertebral Osteomyelitis Using Diagnostic Scoring System
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Incidence of tuberculous vertebral osteomyelitis (TVO) has been increasing. Since the main symptoms of TVO and bacterial vertebral osteomyelitis (BVO) such as back pain or fever are similar, differentiation between them are still challenging until the culture results come back. However, early diagnosis is essential for adequate treatment and better prognosis.

Methods: We retrospectively reviewed the medical records of 10 patients (pts) with TVO and 52 pts with BVO at St. Luke’s Intl. Hosp. during a 17 year period (Jan 93-Dec 2009) and investigated the clinical characteristics.

Results: The median age was 65 (50-81) and 60% (6/10) were male in TVO and 66 (50-81), 62% (32/52) in BVO, respectively. The duration from onset to admission, history of Tb, Tmax, WBC, CRP and ESR in TVO and BVO was 108 days vs 10.4 days (p<0.05), 60% (6/10) vs 7.7% (4/52) (p<0.05), 37.6℃ vs 38.5℃ (p<0.05), 6,800 /mm3 vs 11,800 /mm3 (p<0.05), 7.6 mg/dl vs 13.2 mg/dl (p=0.05), 84 mm/hr vs 70 mm/hr (p=0.08), respectively. We scored them as following: duration less than 7 days: 0, 8-14 days: 1, 15-30 days: 2, more than 31 days: 3, history of Tb: 1, Tmax more than 39℃: 0, 38-38.9℃: 1, 37-37.9℃: 2, less than 36.9℃: 3, WBC more than 20,001 /mm3: 0, 15,000-20,000 /mm3: 1, 10,001-15,000 /mm3: 2, less than 10,000 /mm3: 3, CRP more than 20.1 mg/dl: 0, 15.1-20 mg/dl: 1, 10.1-15 mg/dl: 2, less than 10 mg/dl: 3, and ESR less than 100 mm/hr: 0, 101-200 mm/hr: 1, more than 201 mm/hr: 2, respectively. Defining more than 10 scores in total as positive, the sensitivity, specificity, PPV and NPV of diagnosing TVO turned out to be 90%, 94.2%, 75%, and 98%, respectively.

Conclusion: The diagnostic scoring system with cutoff of 10 might be quite useful to differentiate TVO from BVO.


Subject Category: J. Clinical practice issues

Nobuyoshi Mori, M.D., Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan and Keiichi Furukawa, MD, Infectious Diseases, St Luke's International Hospital, Tokyo, Japan

Disclosures:

N. Mori, None

K. Furukawa, None

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