Letter to the Editor
Spondylodiscitis Without Endocarditis Caused by Streptoccocus mitis
Espondilodiscitis sin endocarditis causada por Streptococcus mitis
Águeda Prior-Español
, Lourdes Mateo, Melania Martínez-Morillo, Anne Riveros-Frutos
Corresponding author
Servicio de Reumatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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Its incidence is on the rise in recent years. The causative microorganism in most adult patients is <span class="elsevierStyleItalic">Staphylococcus aureus</span>. To date, <span class="elsevierStyleItalic">Streptococcus</span> species have had little relevance as causative agents of vertebral osteomyelitis. However, the number of cases caused by these microorganisms has increased in recent years.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> We report the case of a patient with spondylodiscitis caused by <span class="elsevierStyleItalic">Streptococcus mitis</span>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 49-year-old man, an ex-smoker, with nothing else remarkable in his clinical history. He presented with a 4-week history of low back pain with inflammatory features and pain that radiated down his left leg. He did not have associated fever or metabolic syndrome. There was no evidence of skin lesions, either, and he did not consume farmhouse dairy products. He had not undergone any dental procedures in the preceding 2 years. Notable findings in the results of laboratory tests were the absence of leukocytosis in the complete blood count and a normal differential leucocyte count, but elevation of acute-phase reactants was detected (erythrocyte sedimentation rate [ESR], 80<span class="elsevierStyleHsp" style=""></span>mm; C-reactive protein [CRP], 42<span class="elsevierStyleHsp" style=""></span>mg/L). Serological tests for human immunodeficiency virus and <span class="elsevierStyleItalic">Brucella</span> were negative, as was the tuberculin skin test. A radiograph of the lumbar spine revealed a slight irregularity in the vertebral endplate below L5. Magnetic resonance imaging of the lumbosacral spine disclosed signs compatible with spondylodiscitis involving L5–S1. Blood cultures were negative. A transthoracic echocardiogram showed no evidence of endocarditis. Finally, a biopsy and fine-needle aspiration cytology were performed, both under computed tomography (CT) guidance. Bacterial culture yielded colonies of <span class="elsevierStyleItalic">S. mitis</span> that were sensitive to all the different classes of antibiotics except penicillin. Four hours after the vertebral biopsy, a blood sample was again obtained for culture, in which <span class="elsevierStyleItalic">S. mitis</span> was also isolated. Treatment consisted of intravenous ceftriaxone for 3 weeks, followed by another 3 weeks with oral levofloxacin. The patient responded well to the treatment, with resolution of the clinical signs and normalization of the acute-phase reactants.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To date, 7 cases of spondylodiscitis caused by <span class="elsevierStyleItalic">S. mitis</span> have been reported in the English-language literature<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–3</span></a> (PubMed: Spondylodiscitis and <span class="elsevierStyleItalic">S. mitis</span> 1969–2015). <span class="elsevierStyleItalic">S. mitis</span>, which belongs to the group of viridans streptococcal species, forms part of the commensal flora of the mouth and nasal sinuses and is a rare cause of spondylodiscitis. Spondylodiscitis is uncommon in adults. The predisposing factors are diabetes mellitus, malnutrition, intravenous drug use, immunodeficiency, neoplasms, prolonged glucocorticoid therapy, chronic kidney disease and cirrhosis. It usually presents with inflammatory back pain, which can be accompanied by fever and clinical signs of a systemic disorder.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> In contrast to spondylodiscitis caused by <span class="elsevierStyleItalic">S. aureus</span> and by streptococci from a group other than viridans, that attributed to viridans streptococci has a more subacute course, with less systemic involvement. For this reason, the diagnostic delay is usually longer. The majority of the patients with infection caused by this microorganism present with infective endocarditis, as well. Thus, performance of echocardiography is indispensable in these patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–5</span></a> Laboratory tests reveal leukocytosis and neutrophilia, as well as elevated acute-phase reactants (ESR, CRP). Blood cultures are essential for the microbiological diagnosis and avoid the need for more invasive procedures. Imaging studies (plain radiography, CT or nuclear magnetic resonance) are performed to exclude other diseases and to identify signs suggestive of spondylodiscitis, as well as to rule out its complications. The definitive diagnosis requires the isolation of the causative pathogen, either in blood cultures or a biopsy. The latter can be percutaneous, and is generally CT-guided or open.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Blood cultures performed during the first few hours after the biopsy have been reported to be more sensitive and, thus, are worthwhile as they can confirm that the infection was caused by the microorganism isolated in the biopsy specimen and is not the result of contamination.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Prior-Español Á, Mateo L, Martínez-Morillo M, Riveros-Frutos A. Espondilodiscitis sin endocarditis causada por <span class="elsevierStyleItalic">Streptococcus mitis</span>. Reumatol Clin. 2016;12:362–363.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Streptococcal vertebral osteomyelitis: multiple faces of the same disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Murillo" 1 => "A. Roset" 2 => "B. Sobrino" 3 => "J. Lora-Tamayo" 4 => "R. Verdaguer" 5 => "E. 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Maillefert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2003" "volumen" => "42" "paginaInicial" => "913" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300764/v1_201611050033/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000006/v1_201611050033/S2173574316300764/v1_201611050033/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300764?idApp=UINPBA00004M" ]
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| 2024 February | 61 | 22 | 83 |
| 2024 January | 56 | 20 | 76 |
| 2023 December | 58 | 26 | 84 |
| 2023 November | 51 | 37 | 88 |
| 2023 October | 64 | 30 | 94 |
| 2023 September | 63 | 31 | 94 |
| 2023 August | 49 | 11 | 60 |
| 2023 July | 65 | 30 | 95 |
| 2023 June | 59 | 16 | 75 |
| 2023 May | 62 | 21 | 83 |
| 2023 April | 41 | 13 | 54 |
| 2023 March | 78 | 23 | 101 |
| 2023 February | 57 | 29 | 86 |
| 2023 January | 75 | 12 | 87 |
| 2022 December | 91 | 42 | 133 |
| 2022 November | 83 | 28 | 111 |
| 2022 October | 106 | 27 | 133 |
| 2022 September | 58 | 29 | 87 |
| 2022 August | 56 | 35 | 91 |
| 2022 July | 65 | 35 | 100 |
| 2022 June | 41 | 28 | 69 |
| 2022 May | 37 | 33 | 70 |
| 2022 April | 50 | 36 | 86 |
| 2022 March | 49 | 42 | 91 |
| 2022 February | 51 | 30 | 81 |
| 2022 January | 43 | 36 | 79 |
| 2021 December | 35 | 41 | 76 |
| 2021 November | 43 | 43 | 86 |
| 2021 October | 46 | 54 | 100 |
| 2021 September | 34 | 40 | 74 |
| 2021 August | 31 | 38 | 69 |
| 2021 July | 23 | 26 | 49 |
| 2021 June | 31 | 22 | 53 |
| 2021 May | 46 | 43 | 89 |
| 2021 April | 117 | 98 | 215 |
| 2021 March | 65 | 37 | 102 |
| 2021 February | 49 | 27 | 76 |
| 2021 January | 33 | 23 | 56 |
| 2020 December | 31 | 24 | 55 |
| 2020 November | 24 | 22 | 46 |
| 2020 October | 21 | 17 | 38 |
| 2020 September | 28 | 26 | 54 |
| 2020 August | 24 | 18 | 42 |
| 2020 July | 14 | 20 | 34 |
| 2020 June | 30 | 26 | 56 |
| 2020 May | 20 | 27 | 47 |
| 2020 April | 17 | 23 | 40 |
| 2020 March | 9 | 7 | 16 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 3 | 2 | 5 |
| 2018 April | 27 | 4 | 31 |
| 2018 March | 39 | 11 | 50 |
| 2018 February | 15 | 6 | 21 |
| 2018 January | 17 | 5 | 22 |
| 2017 December | 27 | 14 | 41 |
| 2017 November | 21 | 12 | 33 |
| 2017 October | 11 | 13 | 24 |
| 2017 September | 24 | 10 | 34 |
| 2017 August | 22 | 9 | 31 |
| 2017 July | 31 | 14 | 45 |
| 2017 June | 36 | 24 | 60 |
| 2017 May | 35 | 18 | 53 |
| 2017 April | 35 | 16 | 51 |
| 2017 March | 28 | 17 | 45 |
| 2017 February | 23 | 10 | 33 |
| 2017 January | 43 | 26 | 69 |
| 2016 December | 59 | 37 | 96 |
| 2016 November | 41 | 37 | 78 |
| 2016 October | 9 | 19 | 28 |
| 2016 September | 15 | 5 | 20 |
| 2016 August | 8 | 3 | 11 |
Show all
