       Document 0190
 DOCN  M9640190
 TI    Spinal infections in the immunocompromised host.
 DT    9604
 AU    Broner FA; Garland DE; Zigler JE; Department of Surgery, Rancho Los
       Amigos Medical Center, Downey,; California, USA.
 SO    Orthop Clin North Am. 1996 Jan;27(1):37-46. Unique Identifier : AIDSLINE
       MED/96133769
 AB    There is an increasing population of immunocompromised patients with
       HIV, IV drug abuse, organ transplantation, and long-term steroid
       treatment developing spinal infections. Delayed diagnosis because of
       blunted host immune response and lack of outward signs and symptoms
       places the treating physician at a disadvantage in the treatment of this
       type of disease, which presents at a later stage of development.
       Immunocompromised patients are infected by a different group of
       pathogens than their healthier cohorts (e.g., Pseudomonas, gram-negative
       bacteria and fungal infections) because their host defenses are
       diminished. Osteomyelitis with or with out pyomyositis and epidural
       abscess may occur. The overriding symptom is back pain. Radiculopathy,
       myelopathy, and sensory loss may accompany local pain and tenderness.
       Plain film radiography, CT scan, MR image, and bone scan is invaluable
       in the diagnosis of these infections. The cornerstone of treatment is
       identification of the responsible pathogen, appropriate medical therapy,
       immobilization of the affected segment of the spine, and physical
       therapy to combat physical deconditioning. Psoas abscesses may require
       surgical debridement if they cannot be adequately drained by CT-guided
       percutaneous catheterization. Epidural abscesses with neurologic
       compromise require surgical drainage. Impingement of the spinal cord or
       cauda equina by collapsed osteomyelitic vertebral bodies requires
       surgical debridement by anterior vertebrectomy, with an autologous
       tricortical iliac crest strut and immobilization of the spine using
       external bracing or posterior instrumentation as dictated by the
       disease.
 DE    Abscess/IMMUNOLOGY  Case Report  Diabetes Mellitus,
       Insulin-Dependent/COMPLICATIONS  Female  Forearm  Human
       *Immunocompromised Host  Infection/DIAGNOSIS/*IMMUNOLOGY/THERAPY  Middle
       Age  Osteomyelitis/IMMUNOLOGY  Psoas Abscess/IMMUNOLOGY  Spinal
       Diseases/DIAGNOSIS/*IMMUNOLOGY/THERAPY  Substance Abuse,
       Intravenous/COMPLICATIONS  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

