The diagnostic value of cytokines for the discrimination of vertebral osteomyelitis and degenerative diseases of the spine
Julia BrinkmannEva-Carina ZeißlerJan Simon ScharrenbergJulia SchenkMohamed MajjoutiMax ObersteAyla YagdiranMax J. ScheyererNorma JungJan SieweEsther Mahabir
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Vertebral osteomyelitis (VO) is a primary infection of the endplates of the vertebral bodies with secondary infection of the adjacent intervertebral discs. Diagnosis is often delayed due to unspecific symptoms and a lack of specific infection markers. In this prospective study, we determined the suitability of 27 cytokines for the discrimination of VO and degenerative diseases of the spine and compared its diagnostic potential in relation to the C-reactive protein (CRP), which is widely used as a non-specific inflammation marker in clinical diagnostics. The patients included in this study underwent surgical stabilization of the lumbar and/or thoracic spine with removal of 1 or more affected intervertebral discs, as therapy for VO (n = 16) or for erosive osteochondrosis (EO, control group, n = 20). We evaluated the cytokine and CRP concentrations before (pre-OP = -20-0d where 0 means the day of surgery) and after surgery (post-OP) on days 3-5, 6-11, 40-56, and 63-142. Compared to the control patients pre-OP, a significantly higher elevation of the 4 cytokines IL-6, IL-8, IL-12 (p70), and VEGF as well as CRP were found in the VO patients, showing an area under the curve > 0.80 pre-OP. No significant differences were observed between VO patients with high and low virulent bacteria with respect to all 5 elevated biomarkers. This is the first prospective study in which a broad spectrum of 27 cytokines was analysed via multiplex assay using sera from patients with and without VO. Our results show that, in addition to CRP, 4 different cytokines were significantly altered in VO but not control patients. The results implicate that these candidate cytokines may be used in a multiplex assay for discrimination between VO and degenerative diseases of the spine.Keywords:
Vertebral Osteomyelitis
Intervertebral Disc
Osteochondrosis
Proinflammatory cytokine
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Osteomyelitis is an inflammation of bone caused by a pyogenic organism. Osteomyelitis is one of the most important musculoskeletal infections, commonly occurring in long bones. Vertebral osteomyelitis is fairly rare and is often overlooked. It is usually acquired hematogenously, although there are other ways of infection. Only about half of patients develop fever > 38 °C and symptoms are unspecific. The most common organism is <i>Staphylococcus aureus</i>, with <i>Pseudomonas aeruginosa</i> being an unexpected pathogen accounting for about 6%. We present a case of a 56-year-old Hispanic male that visited emergency room presenting with back pain of 3 weeks of evolution being discharged home. Patient returned 2 days after with no improvement. Blood test returned under normal range. Physical exam showed a focal tenderness at thoracic level. Blood culture recovered <i>Pseudomonas aeruginosa</i> sensitive to levofloxacin. CT/MRI was performed and showed vertebral osteomyelitis. Antibiotic was started for 6 weeks. Therapy was guided with erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP). Patient was evaluated monthly for 6 months and improved. Vertebral osteomyelitis is a challenging diagnosis. The consequences of the disease are dire if not diagnosed on time. Historically, the diagnosis of vertebral osteomyelitis remains in a positive culture of bone biopsy. Nowadays, when handling a suspected hematogenous vertebral osteomyelitis, blood culture has gained importance. Whether a blood culture recovered a pathogen, therapy should be based on sensitivity and can be guided following ESR/CRP levels. This type of management can preclude invasive and expensive methods, such as bone biopsy. J Med Cases. 2017;8(8):246-248 doi: https://doi.org/10.14740/jmc2870w
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This report describes a patient with AIDS who presented with vertebral osteomyelitis secondary to Mycobacterium avium complex (MAC). We briefly discuss the literature regarding MAC osteomyelitis in patients with and without AIDS. This patient's course demonstrates the need for a microbiological diagnosis in order to optimally manage osteomyelitis in patients with AIDS.
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