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HIV status does not affect microbiologic spectrum or neurologic outcome in spinal infections
R F Heary1, C D Hunt, A J Krieger
1Section of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark.
Abstract:
The impact of human immunodeficiency virus (HIV) on the clinical presentations, causative organisms, and neurologic outcomes of patients with spinal infections is reviewed. Thirty-two patients with spinal epidural abscesses, vertebral osteomyelitis, or both were treated at an urban hospital over a 42-month period. Thirteen of these patients were confirmed by serologic analysis to be HIV seropositive. The diagnoses were confirmed by 30 open surgical procedures (14 anterior, 16 posterior) and seven percutaneous biopsies. Twenty-seven intraoperative cultures were positive and the remaining three patients had positive blood cultures prior to the surgical procedure. In both the HIV (+) and HIV (-) groups, Staphylococcus aureus predominated as the causative organism (overall rate: 72%). Mycobacterium tuberculosis was the second most common organism. The clinical presentations in both groups were similar with pain as the most frequent symptom and objective neurologic abnormalities on physical examination in 29 of the 32 patients (91%). The results of this analysis show that the clinical presentations and organisms cultured do not differ depending upon a concurrent HIV infection. Furthermore, the ultimate neurologic outcome of patients with spinal infections depends on their neurologic status at the time of treatment and not on their HIV status.
Insights
Human immunodeficiency virus (HIV) does not alter spinal infection presentation or causative organisms. Neurologic outcomes in patients with spinal infections depend on initial status, not HIV status.
Area of Science:
- Infectious Diseases
- Neurology
- Spinal Surgery
Background:
- Spinal infections, including epidural abscesses and vertebral osteomyelitis, pose significant clinical challenges.
- The role of human immunodeficiency virus (HIV) in modifying the presentation and outcomes of spinal infections requires further elucidation.
Purpose of the Study:
- To investigate the impact of HIV on the clinical features, microbial etiology, and neurologic outcomes of patients with spinal infections.
- To compare spinal infection characteristics and patient outcomes between HIV-positive and HIV-negative individuals.
Main Methods:
- Retrospective review of 32 patients with spinal infections treated over 42 months.
- Diagnosis confirmed via surgical procedures and percutaneous biopsies.
- Microbial identification through intraoperative and blood cultures.
Main Results:
- Staphylococcus aureus was the predominant organism in both HIV-positive (13 patients) and HIV-negative groups.
- Clinical presentations (pain, neurologic abnormalities) and causative organisms were similar across both groups.
- Neurologic outcomes were primarily determined by the patient's neurologic status at the time of treatment.
Conclusions:
- Concurrent HIV infection does not significantly alter the clinical presentation or microbial profile of spinal infections.
- Neurologic recovery in spinal infection patients is independent of HIV status, emphasizing the importance of baseline neurologic condition.