Salmonella spondylodiscitis in the immunocompetent: our experience with eleven patients.

Abstract

Retrospective case series. To report the clinical features, diagnostic dilemmas and management options of 11 immunologically normal patients with salmonella spondylodiscitis. Majority of existing data on salmonella spondylodiscitis in the immunologically normal patient is from anecdotal case report. From 1995 to 2008, 11 patients with salmonella spondylodiscitis proven by positive culture, biopsy, and Widal test were included. One patient died, and the average follow-up of the remaining 10 patients was 36 months (12-122 months). Five (50%) patients had a documented history of typhoid fever. Intravenous antibiotics for 2 weeks and oral antibiotics for at least 10 weeks were given to all patients. Indications for surgical intervention were unrelenting pain and osseous instability. Clinical outcome was evaluated according to Macnab criteria. Salmonella typhi was cultured in 4 and S. Paratyphi in 5 patients. No organism was identified in 2 patients, on whom the diagnosis was performed by a characteristic history, high Widal titers, and a positive biopsy. Widal titers were positive for all patients (Average + 1360). Five patients were managed with antibiotics only, 1 with surgical debridement and uninstrumented fusion and 4 with single-stage debridement, anterior fusion, and posterior instrumentation. Healing of disease with a good to excellent outcome was seen in all patients. Salmonella and tuberculous spondylitis must be differentiated as they both have similar epidemiological and clinicoradiologic presentations. Prodromal gastrointestinal symptoms are usually not present. The diagnosis rests largely on the recovery of the organism by appropriate culture techniques. However, when this is not apparent the Widal test, in the setting of a suggestive history and radiograph, may be used as a diagnosis tool. Though antibiotics are the mainstay of treatment, surgical debridement with the use of instrumentation may be indicated in selected patients.