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Infective endocarditis associated with spondylodiscitis and frequent secondary epidural abscess

Lawrence A Cone1, Joel Hirschberg, Carlos Lopez

  • 1Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA. laconemedico@aol.com

Surgical Neurology
|August 28, 2007
PubMed
Abstract

Insights

Infective endocarditis (IE) rarely causes back infections. However, certain bacteria like Staphylococcus aureus, Streptococcus bovis, and Enterococcus faecalis increase the risk of spondylodiscitis and epidural abscess.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Neurosurgery

Background:

  • Joint, muscle, and back pain are common in infective endocarditis (IE), but spinal infections are rare, affecting less than 4% of patients with endocarditis and back pain.
  • This study investigates the relationship between the causative organism in IE and the development of spondylodiscitis and epidural abscess.

Observation:

  • Four cases of IE with spondylodiscitis were identified, caused by Staphylococcus aureus, Streptococcus bovis, Streptococcus mitis, and Enterococcus faecalis.
  • A literature review identified 36 additional patients with IE and spondylodiscitis.
  • While Streptococcus viridans typically causes over 50% of IE cases, only 25% of IE-related spondylodiscitis cases in the review were attributed to this organism.

Findings:

  • Organisms with higher pyogenic potential, such as staphylococci and enterococci, were more frequently implicated in IE-associated spondylodiscitis and epidural abscess compared to Streptococcus viridans.
  • The incidence of Streptococcus viridans in IE cases has decreased to approximately 40% in recent studies.

Implications:

  • Patients with infective endocarditis and back pain may have a higher risk of developing spondylodiscitis and epidural abscess if infected by bacteria with significant pyogenic capabilities.
  • Understanding the specific microbial etiology of IE is crucial for predicting and managing spinal complications.

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