Introduction
A rare cause of back pain is infectious spondylitis. Individuals with severe back pain who wake at night, fever, or pain that does not improve with rest are suspected of infectious spondylitis. Infectious spondylitis is identified once the illness has lasted for a while and it requires complicated treatment.
What Is Infectious Spondylitis?
Infectious spondylitis is a rare but severe spinal infection caused by bacteria or other germs. It is also called vertebral osteomyelitis. The condition accounts for 5 percent of all skeletal infections and is potentially life-threatening.
Infectious spondylitis often has diagnostic challenges and requires expensive testing for disease diagnosis. Accurate diagnosis is essential as the condition causes irreversible neurological damage and requires longer to treat infection.
What Causes Infectious Spondylitis?
Infectious spondylitis causes inflammation within the spine. The infection within the spine develops when the pathogen enters the spine and produces inflammation. The agents responsible for developing infections are:
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Pyogenic: Bacterial infections commonly cause pyogenic spondylitis. Bacteria like Staphylococcus aureus and Escherichia coli are primarily responsible for causing infection in humans. The infection from these bacteria can spread from other body parts to the spine or through blood. It can involve the vertebrae, intervertebral disk, paraspinal soft tissue, and epidural space. Pyogenic spondylitis can be associated with vertebral osteomyelitis, spondylodiscitis, and epidural abscess.
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Tubercular: Tubercular spondylitis is also called Pott’s disease. Tuberculosis infection spreads to the spine via blood. The condition can persist for several years before being diagnosed.
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Fungal: Candida or other fungal species cause spinal infection in rare instances.
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Parasitic: Rarely, parasitic infections like toxoplasmosis can affect the central nervous system, leading to spinal infection.
What Is the Incidence of Infectious Spondylitis?
Infection spondylitis is twice more common in men than women. It could be because of higher risk factors in men. Although the infection occurs at any age, the infection rate is higher for adults. Among them, pyogenic spondylitis occurs frequently in the old age groups and tubercular spondylitis in younger adults.
Underlying medical conditions can increase an individual's susceptibility to developing infectious spondylitis. Diabetes is a common medical condition that causes spondylitis. Other medical conditions causing infectious spondylitis are HIV (human immunodeficiency virus), cancer, sepsis, malnourishment, chronic renal failure, cirrhosis, and a weak immune system. The incidence of developing infection spondylitis increases in individuals taking immunosuppressants and corticosteroids for a long time.
In recent years, the incidence of infectious spondylitis has been increasing because of increasing spinal procedures and intravenous drug use.
What Is the Mechanism of Developing Infectious Spondylitis?
The infectious agent gains abscess to the spine through the following mechanism:
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Hematological spread of the infectious agent from remote focal infection.
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The infection can directly spread to the spine from a nearby infectious source. Examples include infection spreading from septic arthritis or discitis-osteomyelitis.
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Iatrogenic inoculation of infection while administering spinal or epidural anesthetics, steroid injections, or surgery. The infections can develop due to medical procedures or inoculation of infection from other body parts. Other causes include epidural administration, dental procedures, intravenous drug use, or the use of vascular devices like catheters.
What Are the Symptoms of Infectious Spondylitis?
All infectious spondylitis types present with clinical symptoms of pain. The pain can be present at the back or from the neck to the abdomen, groin, and lower limbs. The pain can be so severe that the affected individual stays awake during the night. Pyogenic spondylitis presents symptoms earlier than tuberculous spondylitis.
Other symptoms depend on the type of infection the individual has. The most commonly noticed symptoms are fever, chills, night sweats, localized swelling, and tenderness. Neurological symptoms can develop in infectious spondylitis because of nerve root or cord compression. Neurological deficits are severe manifestations of the disease occurring in one-third of affected individuals. In individuals with surgery, if an infection develops at the incision site, redness and fluid drainage occur at the affected area of the skin.
How Is Infectious Spondylitis Diagnosed?
Along with clinical features, infectious spondylitis can be diagnosed with an imaging test of the spine. MRI (magnetic resonance imaging) is the most common imaging test. Some doctors may take a vertebral biopsy with the help of a CT (computed tomography) scan. The imaging studies are inconclusive during the early course of the disease. The destructive changes become evident in imaging studies after several weeks. The changes of two adjacent vertebral bodies and intervening discs appear as loss of height in vertebral bodies and narrowed disc space in imaging.
Other laboratory tests, including blood tests, help analyze the cause of infection. It helps determine if the individual suffers from an autoimmune condition. The Mycobacterium causing tuberculous spondylitis is determined by polymerase chain reaction. The condition may take several weeks or months to be diagnosed, as symptoms like back pain are non-specific.
How Is Infectious Spondylitis Treated?
Infectious spondylitis cannot be cured without hospitalization. The doctors administer intravenous medications like antibiotics, antitubercular drugs, or antifungals to treat the infections. In addition to medications, a conservative approach, such as strict immobilization, is followed.
Depending on the infection severity, antimicrobial treatment can last for six to eight weeks. Pyogenic infectious spondylitis requires long-term antibiotic treatment. However, the cause of infection remains undiagnosed in some patients, necessitating empirical treatment. The commonly used antibiotic for empiric treatment is cephalosporins or other broad-spectrum antibiotics. The use of empiric treatment increases the risk of developing antibiotic resistance.
Rarely do individuals suffering from infectious spondylitis require surgery to treat complications of spinal infections such as bone damage or sepsis.
What Is the Prognosis for Infectious Spondylitis?
Infectious spondylitis can result in mortality in 20 percent of cases. The risk of dying from the infection is higher in immunocompromised individuals. Treatment can prevent other complications of infectious spondylitis, such as sepsis, irreversible spine damage, or neurological complications.
When Should a Doctor Be Consulted for Infectious Spondylitis?
An individual must consult a doctor if they have back pain and associated symptoms of:
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Pain not responding to over-the-counter medications.
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Severe pain lasting 12 weeks or longer.
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Pain with flu-like symptoms.
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Concerning symptoms developing after surgery.
Conclusion
Infectious spondylitis is an uncommon but severe infection which has life-threatening complications. The condition affects older and immunocompromised adults. The presenting symptom of the illness is severe back pain. There are diagnostic difficulties in diagnosing the disease. Treatment includes long-term antimicrobial therapy or surgical management.
