1515. A Comparative Study of Tuberculous and Culture-Negative Pyogenic Spondylitis
Session: Poster Abstract Session: Clinical Infectious Diseases: Osteomyelitis
Saturday, October 10, 2015
Room: Poster Hall
Background: Differences in characteristics of culture positive pyogenic spondylitis (CPPS) and tuberculous spondylitis (TS) have been well known. However differences between culture negative pyogenic spondylitis (CNPS) and TS has not been reported, which would be more helpful in clinical practice especially when initial microbiologic examinations of blood and/or biopsy tissues did not reveal the organism in patients with infectious spondylitis. 

Methods: We performed a retrospective review of medical records of patients with CNPS and TS to compare the predisposing factor, clinical, radiographic, and laboratory characteristics. 

Results: We compared the characteristics of 71 patients with CNPS and 94 patients with TS. Patients with CNPS were older (65.9 vs 59.2 yr, p=0.01) and more frequently associated with an epidural procedures within 1 year (26.8% vs 9.6%, p<0.01), higher levels of C-reactive protein (8.6 vs 7.9 mg/dL, p=0.02). Patients with TS were more frequently associated with a previous history of tuberculosis (9.9% vs 22.3%, p=0.03), simultaneous tuberculosis other than spine (0% vs 47.9%, p<0.001), T spine involvement (11.2% vs 42.8%, p=0.03), and positive results of interferon-gamma release assay (26.9% vs 80.9%, p<0.001). Fever (15.5% vs. 31.8%, p=0.02), psoas abscesses (15.5% vs 33.0%, p=0.01), and paravertebral abscesses (49.3% vs. 74.5%, p<0.01) were more prevalent in TS compared with CNPS. 

Conclusion: Differences in characteristics of CNPS and TS were similar to those of CPPS and TS in large part. However the observation that fever, psoas abscesses, and paravertebral abscesses were more prevalent in patients with TS compared with CNPS was different from or contrary to the previous comparisons between CPPS and TS.

 

TS

(N=94)

CNPS (N=71)

P-value

Age

< 40 yr

21 (22%)

4 (6%)

0.09

41-64 yr

24 (26%)

23 (32%)

65-75 yr

25 (27%)

25 (35%)

> 76 yr

24 (26%)

19 (27%)

immunosuppressant

1 (1%)

2 (3%)

0.58

Epidural procedure < 1 yr

9 (10%)

19 (27%)

<0.01

Foreign body in affected vertebrae

3 (3%)

8 (11%)

0.06

Simultaneous pulmonary Tb

30 (32%)

0

<0.01

Simultaneous extrapulmonary Tb

15 (16%)

0

<0.01

Duration of symptom

< 1 month

25 (27%)

32 (45%)

<0.01

1 – 3 month

44 (47%)

32 (45%)

4 month

25 (27%)

7 (10%)

BT 38’C

27 (32%)

11 (16%)

0.02

CRP

<2

40 (43%)

14 (20%)

0.02

2≤ <4

17 (18%)

20 (28%)

4≤ <10

21 (23%)

23 (32%)

≥10

15 (16%)

14 (20%)

Psoas involve

31 (33%)

11 (16%)

0.01

Paravertebral involve

70 (75%)

35 (49%)

<0.01

Chung-Jong Kim, MD1, Kyoung-Ho Song, MD2, Pyoeng Gyun Choe, MD2, Wan Beom Park, MD, PhD2, Ji Whan Bang, MD2, Eu Suk Kim, MD3, Sang-Won Park, MD, PhD2, Hong-Bin Kim, MD4, Myoung-Don Oh, MD, PhD2 and Nam Joong Kim, MD, PhD2, (1)Internal Medicine, Ewha woman's university medical center, Seoul, South Korea, (2)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (3)Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (4)Seoul Natl. Univ. College of Medicine, Seoul, South Korea

Disclosures:

C. J. Kim, None

K. H. Song, None

P. G. Choe, None

W. B. Park, None

J. W. Bang, None

E. S. Kim, None

S. W. Park, None

H. B. Kim, None

M. D. Oh, None

N. J. Kim, None

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