AB0594 Infectious spondylodiscitis in elderly patients: a report of 22 cases
Authors: I. Cherif, O. saidane, I. Mahmoud, R. tekaya, H. sahli, L. abdelmoula, R. Zouari
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Infectious Spondylodiscitis is rare among elderly people. Besides being life-threatening it has variable clinical presentations and insidious onset, leading to a delay in diagnosis and a difficulty in treating <h3>Objectives</h3> To analyse the characteristics of spondylodiscitis in the elderly patients focusing upon epidemiology, diagnosis, and treatment outcome. <h3>Methods</h3> A retrospective monocentric study was performed. All patients with spondylodiscitis admitted between 1999 and 2013 at the rheumatology department of the Charles Nicolles Hospital, and aged more than sixty-five years were included. Demographic characteristics, underlying diseases, imaging studies, isolated microorganisms, different treatments, complications, and outcome were recorded. <h3>Results</h3> Twenty two patients among seventy seven cases of spinal spondylodiscitis were more than sixty-five years old. Ten patients were male. Duration of symptoms before the diagnosis was 6.3 months (20 days-24 months). The presence of diabetes mellitus was found in five patients, underlying chronic comorbidities in three cases, high-dose ofcorticotherapy in one case and renal failure in one case. Inflammatory back pain was reported in 19 cases, stiffness in 14 cases, fever in only 5 cases with an average of 38.3°, impaired general condition in 16 cases and night sweat in 9 cases. Neurological involvement was found in 3 cases. The vertebral level involved was lumbar in 15 patients, thoracic in 5 patients, in the thoracolumbar junction in 2 patients, sacral in one patient and cervical in one other. Multifocal spondylodiscitis was found in 6 cases. Radiographies have shown anomalies in all patients. MRI has shown epiduritis in 9 cases, abscess of psoas in 8 patients, paravertebral abscess in 5 cases and medullar compression in 2 cases. Hyperleucocytose and leucopenia were noted in 4 cases each, whether increased erythrocyte sedimentation rate (ESR) were observed in all patients with a mean value of 96mm. The mean CRP was 70mg/l. In our study, we found 8 cases of pyogenic spondylodiscitis and 14 cases of specific spondylodiscitis. Among pyogenic spondylodiscitis patients', blood cultures identified the microorganism in three cases: Serratia Marcescens in one case, Lactococcus cremoris in one case and association of Staphylococcus and Enterobacter cloacae in the last case. In the other 5 casesdiagnosis was madeonclinical features and the results of the punction biopsy of the intervertebral disc (PBID). Among specific spondylodiscitis, positive Wright serology yielded the diagnosis of brucellar spondylodiscitis in 3 cases, whether 11 cases of tuberculosis spondylodiscitis were confirmed by positive tuberculin skin test and specific lesions in the PBID. During treatment, 5 patients experienced different complications: renal failure in one case, medullar compression in another case, relapse in two cases, and death in one case. <h3>Conclusions</h3> Spondylodiscitis in elderly patients is characterized by a delayed diagnosis. A large spectrum of microorganism may be involved. In a significant number of cases, neurological impairment, relapse or fatal outcome may occur. <h3>Disclosure of Interest</h3> None Declared