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MRI and clinical features of acute fungal discitis/osteomyelitis
F Joseph Simeone1, Jad S Husseini1, Kaitlyn J Yeh1
1Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street - YAW 6046 -, Boston, MA, 02114, USA.
Objectives:
To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies.
Methods:
Our study was IRB-approved and HIPAA-compliant. A group of 11 fungal DO (FG) with MRI within 7 days of the biopsy and a control group (CG) of 19 Staphylococcus aureus DO were evaluated. Imaging findings (focal vs diffuse paravertebral soft tissue abnormality, partial vs complete involvement of the disc/endplate), biopsy location, pathology, duration of back pain, immune status, history of intravenous drug, history of prior infection, current antibiotic treatment, and history of invasive intervention. Differences were assessed using the Fisher exact test and Kruskal-Wallis test. Naïve Bayes predictive modeling was performed.
Results:
The most common fungal organisms were Candida species (9/11, 82%). The FG was more likely to have focal soft tissue abnormality (p = 0.040) and partial disc/endplate involvement (p = 0.053). The clinical predictors for fungal DO, in order of importance, back pain for 10 or more weeks, current antibiotic use for 1 week or more, and current intravenous drug use. History of invasive instrumentation within 1 year was more predictive of Staphylococcus aureus DO.
Conclusion:
MRI features (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.
Key Points:
• MRI features of discitis-osteomyelitis (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.
Insights
Imaging and clinical factors can help identify fungal discitis-osteomyelitis (DO). Focal abnormalities on MRI and longer back pain duration suggest fungal infection over Staphylococcus aureus DO.
Area of Science:
- Infectious Diseases
- Radiology
- Orthopedic Surgery
Background:
- Discitis-osteomyelitis (DO) is a serious spinal infection.
- Distinguishing between fungal and bacterial etiologies, particularly Staphylococcus aureus, is crucial for effective treatment.
- CT-guided biopsies are often used for diagnosis.
Purpose of the Study:
- To compare the imaging and clinical characteristics of fungal DO versus Staphylococcus aureus DO.
- To identify predictors that differentiate fungal from bacterial DO in patients undergoing CT-guided biopsy.
Main Methods:
- Retrospective analysis of 11 patients with fungal DO and 19 with Staphylococcus aureus DO.
- Evaluation of MRI findings including soft tissue abnormality and disc/endplate involvement.
- Assessment of clinical factors such as pain duration, immune status, and history of drug use or instrumentation.
Main Results:
- Fungal DO cases more frequently showed focal paravertebral soft tissue abnormality and partial disc/endplate involvement on MRI.
- Clinical predictors for fungal DO included back pain >10 weeks, antibiotic use >1 week, and IV drug use.
- History of invasive instrumentation within a year was more indicative of Staphylococcus aureus DO.
Conclusions:
- MRI features like focal partial soft tissue abnormality and partial disc/endplate involvement are suggestive of fungal DO.
- Combining specific MRI findings with clinical data can aid in predicting fungal species as the causative organism for DO.
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