Vertebral osteomiyelit tanısında serolojik ve tüberküloz testlerinin rolü ile paravertebral tutulumun medikal tedavisi

Öz

Amaç: Vertebral osteomiyelit (VOM), sık tanınmayan ancak bel/sırt ağrısı olan hastalarda mutlaka akılda tutulması gereken bir kemik doku enfeksiyonudur. En sık ağrı şikâyeti ile başvuran bu hasta grubunda, bazen hiçbir yakınma olmayabilir ve tanı muayene sırasında tesadüfen konulabilir. Nadirdir ancak sıklıkla gözden kaçabilen önemli bir hastalık grubudur. VOM hematolojik yolla, komşuluk yoluyla ya da invaziv girişimler sonrası gelişebilir. Etkenler sıklıkla piyojenik bakteriler (çoğunlukla Gram-pozitif ajanlar) ve Mycobacterium tuberculosis’tir. Nadir olmakla birlikte fungal etkenlere bağlı olarak da VOM gelişebilir. Yöntem: Bu çalışmada son 5 yıl içerisinde VOM tanısı almış ve tedavisi başarı ile sonuçlanmış 127 hasta incelendi. Hastaların demografik özellikleri, tanı yöntemleri, tutulan vertebra seviyesi, etken mikroorganizma, başlangıç klinik bulguları, ağrı düzeyleri (NRS–Numerik Derecelendirme Skalası), laboratuvar değerleri, uygulanan tedaviler, tedavi değişim zamanları ve tedavi yanıtları kaydedildi. Bulgular: Çalışmamızda tüm VOM olguları arasında en sık etken piyojenik bakteriler olarak saptandı. Granülomatöz VOM olgularında ise M. tuberculosis ilk sırada yer aldı. Tüberküloz(TB) VOM olgularında C-reaktif protein düzeyleri anlamlı derecede yüksek bulunurken, piyojenik VOM’da sedimentasyon değerleri anlamlı derecede yüksek saptandı. Beyaz küre sayısı (WBC) ve prokalsitonin düzeylerinin tanısal değeri düşük bulundu. Tedavi sürecinde kontrastlı MRG ile aylık takip yapılmasının, tedavi revizyon ihtiyacının belirlenmesinde faydalı olabileceği düşünüldü. Paravertebral yumuşak doku tutulumu, bruselloz ve TB VOM olgularında istatistiksel olarak daha sık görüldü. Sonuç: VOM hastalarında etken mikroorganizmanın belirlenmesi her zaman mümkün değildir ve bu hastalar çoğunlukla ampirik olarak tedavi edilmektedir. Çalışmamızdan elde edilen verilerin, VOM hastalarının tanı ve tedavi süreçlerine katkı sağlayacağı düşünülmektedir

Anahtar Kelimeler

• Vertebra osteomyelit
• medikal tedavi
• seroloji

The Role of Serological and Tuberculosis Tests in the Diagnosis of Vertebral Osteomyelitis and the Medical Management of Paravertebral Involvement

Öz

ABSTRACT Objective: Vertebral osteomyelitis (VOM) is a bone tissue infection that is not often recognized but should be considered in cases of low back pain/back pain. This group of patients, who most commonly present with pain complaints, may sometimes have no complaints and may be diagnosed by chance during the examination. This is a rare but important disease group that is often missed. VOM may develop by hematogenous route, through neighborhood or after invasive procedures. Causative agents are often pyogenic bacteria (often gram-positive agents) and Mycobacterium tuberculosis. Although rare, VOM may develop due to fungal agents. Method: This study focused on 127 patients who were diagnosed with VOM in the last 5 years and whose treatment was completed with cure. In addition to the patients' demographics, diagnostic methods, involved joint, causative microorganism, initial clinical findings, pain levels (NRS-Numeric rating Scale), laboratory values, treatments received, treatment switch times, and treatment responses were recorded. Results: In our study, pyogenic bacteria group was found to be the most common agent among all VOM patients. In granulomatous VOMs, M. tuberculosis ranked first. In VOM caused by M. tuberculosis, C-reactive protein was found to be significantly higher and in VOM caused by pyogenic bacteria, sedimentation values were significantly higher. White blood cell count (WBC) and procalcitonin levels had low diagnostic value. Monthly follow-up of patients with contrast-enhanced MRI during the treatment period may be helpful in identifying the need for treatment revision. Paravertebral soft tissue involvement in patients with vertebral osteomyelitis was statistically more common in patients with brucellosis and tuberculous VOM. Conclusion: In patients with VOM, identification of the causative agent is not always possible. These patients are mostly treated empirically. Our study data will contribute to the diagnosis and treatment of VOM patients.

Anahtar Kelimeler

• **Vertebral osteomyelitis
• medical treatment**
• serology

Kaynakça

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