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Background: In tuberculosis (TB) endemic areas, other pyogenic causes of spine involvement may be missed. The study aimed to describe TB and non-TB causes of spine involvement and identify features that can help in differentiating them. Methods: A retrospective cohort study was conducted to screen the clinical records of all admitted patients (Kasturba Hospital, Manipal) in 2018--20 for a diagnosis of spondylitis and/or sacroiliitis. The clinical features, radiological findings, laboratory parameters, treatment details, and outcomes were compared among those diagnosed with confirmed TB, confirmed brucellosis, or confirmed pyogenic infection. A scoring system was also developed to differentiate spondylodiscitis due to tuberculous and pyogenic causes. The qualitative variables were compared using the Chi-square test, while quantitative variables were compared using the one-way analysis of variance test. Results: Of 120 patients with spine infections, a total of 85 patients were confirmed with the microbiological diagnosis of interest. Involvement of the thoracic spine, longer duration of illness, and caseous granulomatous reaction on histopathology was more common in TB patients. Male gender, involvement of lumbar vertebra, and neutrophilic infiltrate on histopathology were more common in brucellosis patients. Male gender, diabetes mellitus, involvement of lumbar vertebra, neutrophilic infiltrate on histopathology, leukocytosis, and increased C-reactive protein were more commonly seen in patients with pyogenic infection. The scoring system had a sensitivity and specificity of 75% and 91%, respectively, when used to differentiate TB from pyogenic infection. Conclusions: In resource-limited settings, suggestive findings can be used to decide empiric therapy. [ABSTRACT FROM AUTHOR]

Introduction: Patients with melioidosis can present with a combination of fever, respiratory distress and focal involvement. Focal involvement of bone and joint is, however, rare in patients with melioidosis. This study aimed to characterize patients with osteoarticular melioidosis., Patients and Methods: This was a retrospective review of records of all adult patients diagnosed with culture-positive osteoarticular melioidosis over three years. The clinical, laboratory and treatment details were recorded in a predefined case-record form and analyzed., Results: Of the 11 patients with osteoarticular melioidosis, 55% (n=6) had concurrent pulmonary involvement. The patients were classified as isolated osteomyelitis (n=3), isolated arthritis (n=3), and both osteomyelitis and septic arthritis (n=5). Of eight patients with joint involvement, 87.5% had monoarthritis. A single bone was involved in 75% of the patients with bone involvement (n=8). Concomitant myositis was seen in 36.4% (n=4) of the cases. Local debridement of the involved bone or joint was done in 54.5% (n=6) of the cases. Combination therapy with ceftazidime/meropenem and cotrimoxazole was predominantly used as intensive therapy for a mean of 3+1.3 weeks. Monotherapy with cotrimoxazole was used as eradication therapy for a mean of 4.6+2 months. Except for one patient with recurrent disease and one death, all patients were declared cured at the end of therapy., Conclusion: Osteoarticular melioidosis should be suspected in high-risk individuals from endemic areas with single bone or joint involvement and surrounding myositis. Early diagnosis and prompt initiation of therapy is key to a favourable response., Competing Interests: Conflicts of interest None., (Copyright © 2016 - 2021 InfezMed.)