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Spinal Meningitis Can Affect the Spine: What to Know

Spinal Meningitis Can Affect the Spine: What to Know

Spinal meningitis does not just affect the brain. Most think of meningitis as a brain disease, but it can also affect the spine. We will discuss learning how to recognize it and find the right treatment to fix it within the spinal cord. Spinal meningitis can be a potentially deadly infection of the meninges. This is the protective tissue that covers the brain and spinal cord.

It can be caused by viruses, bacteria, or fungi that are transmitted from person to person by sneezing, talking, and sharing food. Viruses and pathogens that cause other infections, like the mumps and measles, can also cause meningitis. The lining around the brain and the spine are connected, which means that infection can travel from one area to another, or remain in the brain or the spine.

 

11860 Vista Del Sol, Ste. 128 Spinal Meningitis Can Affect the Spine: What to Know

The Meninges

Meninges are the protective membranes that surround the brain and spinal cord. They are made up of three layers:

  • Dura mater is the thick and tough outer layer
  • Arachnoid mater is the middle layer made up of strands of connective tissue
  • Pia mater is the inner layer of cells

Spinal meningitis can develop when a virus, bacteria, or pathogen invade the meninges layers. This causes the immune system to react trying to remove the invading bacteria etc, which causes inflammation. These organisms usually take up residence in the nose and throat and never cause problems. Most individuals that come into contact with these viruses never get sick.

The reason for this is because the body produces fighting antibodies before the pathogens can invade the meninges. Others, possibly from age or underlying conditions, where they are not able to produce enough or any antibodies, makes them vulnerable to the illness. When the brain and spine’s tissue/s get infected with any one of these pathogens, the tissue swells, which constricts proper blood flow to the brain.

Types of Spinal Meningitis

The most common types of spinal meningitis in the United States include:

Viral meningitis

Viral meningitis is caused by enteroviruses, which are common viruses that enter the body through the mouth and travel to the brain and tissues where multiplication ensues. There are other viruses that can also cause meningitis. These include:

  • Viruses that cause mumps
  • Herpesviruses – like Epstein-Barr, measles, influenza, West Nile
  • Lymphocytic choriomeningitis virus from rodents

Any of these viruses can spread to the meninges, causing spinal meningitis to develop. This is a less severe type than bacterial meningitis.

Bacterial meningitis

This is the type where dangerous bacteria invade the meninges. Individuals are at higher risk as this type can be fatal if not treated. Common types of bacterial meningitis include:

  • Pneumococcal meningitis – is caused by the bacterium Streptococcus pneumonia and is the most common form of bacterial meningitis.
  • Meningococcal meningitis – also known as meningococcal disease, is a less common type. This type is caused by the bacterium Neisseria meningitides. Around 2,600 people in the U.S. are affected yearly.
11860 Vista Del Sol, Ste. 128 Spinal Meningitis Can Affect the Spine: What to Know

Symptoms

Viral or bacterial spinal meningitis can cause a range of symptoms, including:

  • Neck and back stiffness
  • Muscle weakness
  • Headache
  • Drowsiness
  • Fatigue
  • Fever
  • Double vision
  • Sensitivity to light
  • Nausea
  • Vomiting
  • Hearing difficulty
  • Confusion
  • Seizures
  • Rash

Symptoms are often far more pronounced with the bacterial form. This is because it�s associated with more inflammation, compared to the viral type.

Complications

Depending on the type whether viral or bacterial the results can be serious, leading to:

  • Permanent brain damage
  • Permanent organ damage
  • Stroke
  • Loss of hearing
  • Loss of limbs
  • Death

Anyone who experiences symptoms of meningitis should see a doctor immediately for diagnosis and treatment options.

Risk for Spinal Meningitis

Getting spinal meningitis depends on various factors like:

  • Age
  • Immune system status
  • If the individual lives in a group environment
  • Children younger than five
  • Individuals with weakened immune systems from taking medication/s for other conditions
  • Recent organ/bone marrow transplants
  • Babies younger than 1-month-old along with weakened immune systems are more likely to experience severe illness

These are factors that could increase the risk of viral meningitis. Fortunately, most cases are not serious and in children’s cases, most recover in one to two weeks. Meningitis can also occur very rarely after spine surgery where the lining around the dura is torn with an infection happening at the same time.

Diagnosis

Detecting spinal meningitis a doctor will utilize:

  • Blood tests
  • Imaging tests
  • Spinal tap to test the cerebrospinal fluid which surrounds the brain and spinal cord.
  • The fluid is collected and sent to a lab, where it is analyzed for bacteria or viruses.

Treatment

Antiviral medication can help with certain types of viral meningitis with other meds for treating meningitis symptoms. Doctors recommend bed rest, proper fluids, and medication for fever relief and headache relief. This is for viral meningitis.

Antibiotic medications can treat bacterial spinal meningitis. It is commonly treated with intravenous antibiotics in a hospital setting. Unfortunately, around ten percent of children with bacterial meningitis die from it yearly. Even with immediate antibiotic treatment a child’s body can become overwhelmed by the bacteria/organism. The Meningococcus bacteria can create a toxin that invades the blood. This can be fatal for a child or adolescent within hours. This is why it�s highly recommended to prevent bacterial meningitis than to treat it once it’s active.

Contagious

Proper hygiene like hand washing, not sharing food, beverages, utensils, or body care products like lip salve/balm can help stop the spread of bacterial and viral meningitis.

Neck Pain Chiropractic Care

 


Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Discitis Spinal Disc Infection Causing Inflammation

Discitis Spinal Disc Infection Causing Inflammation

Discitis is typically caused by an infection that grows in one of the spine�s vertebral bones and possibly in the intervertebral discs. Discitis is usually a bacterial infection, but it can be viral.

Discitis affects around 1 out of every 100,000 people. This means that it is not a common spinal disease. Discitis can occur in adults and children, however, it is more common in children.

11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation
  • Discitis mostly occurs in the low back region of the spine
  • Followed by the neck region
  • Finally the middle-back region

It accompanies vertebral osteomyelitis. Both types of infections share many of the same symptoms/characteristics. Although these are uncommon conditions, they can produce severe symptoms affecting an individual’s quality of life. This is why early diagnosis and treatment are essential.

Discitis Causes

There are two recognized causes of discitis. The rarest form comes from a prior surgical or diagnostic procedure. This usually happens when a needle or other tool/device transfers the infection. The other is the more common, and it is known as spontaneous discitis. Here the infection develops from a bacterial or viral organism that travels to the disc/s via the blood supply from another part of the body.

When an infection starts somewhere else and then travels to the disc, it is called transient bacteremia, which is bacteria in the bloodstream that has a short life. Ear infections along with skin infections are perfect examples of infections that can lead to transient bacteremia and discitis. �

 

 

After a disc becomes infected, it can be quite difficult for the body to fight the infection. The disc/s are the largest avascular organs in the body, which means they do not have their own blood supply. The discs get their nutrition and blood supply, which includes the white blood cells for fighting infections, from the vertebral endplates. Because the discs lack the resources to fight infections on their own, there is a struggle when trying to protect against infection.

Because discitis is usually caused by an infection that developed in another area of the body, individuals with medical conditions are at a higher risk for developing discitis. These conditions include:

  • Diabetes
  • A.I.D.S
  • Cancer
  • Chronic kidney disease

Symptoms

Intense back pain that starts gradually is the distinctive characteristic symptom of discitis. The pain is usually localized to the area where the infection is located. This means that the pain doesn’t radiate or spread out like other types of back pain conditions. �

 

blog illustration of low back pain

Diagnosis

A doctor, spine specialist, or chiropractor will review medical history and symptoms with the individual. A fever is normally not present once the infection is inside the disc, along with the white blood cell count being normal.

However, the erythrocyte sedimentation rate increases. This is a blood test that examines how fast red blood cells fall to the bottom of a tube. The faster that they fall to the bottom, the more likely there is inflammation somewhere in the body.

Blood tests can be utilized during diagnosis, however, the most accurate diagnostic tool to confirm discitis is magnetic resonance imaging or MRI that shows if an infection is present. �

The Importance of MRI

Treatment

Treatment can be challenging. This is because of the fact that the discs do not have a blood supply, and medications/antibiotics travel through the blood. It is treatable and is usually done within a six to eight-week course of antibiotics intravenously or through an IV.

IV administered antibiotics could require treatment on an outpatient basis. The entire course of antibiotics must be completed in its entirety in order to manage the discitis. A doctor could also prescribe a spinal brace to help stabilize the spine and reduce pain. A brace can limit movement, however, it will help ensure proper healing.

Spinal Infections

Spinal infections can present spontaneously or as secondary conditions, e.g. after a surgical procedure. Spinal infections can affect different structures, like the:

  • Vertebral column or the bones of the spine
  • Intervertebral disc space, which is the cushion-gel structures between the vertebrae
  • Spinal canal
11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation

 

� Here are some facts about the occurrence and prevalence of different infections of the spine:

  • Vertebral osteomyelitis is the most common type of infection. It affects an estimated 27,000 to 66,000 people a year.
  • Epidural abscess is an infection inside the spinal canal that affects up to two cases per 10,000 in hospital admissions around the U.S. It is pretty common in individuals with vertebral osteomyelitis or discitis. Eighteen percent of those individuals can develop this infection. However, it is more common in people fifty and older.
  • Discitis, as aforementioned is a pretty uncommon condition. Although, treatment has advanced, around twenty percent of individuals with this infection do not survive.

Infection Risk Factors

There are certain factors that increase the risk of developing an infection. These factors include:

Symptoms and Diagnosis

Symptoms from a spinal infection can vary. However, continuous back pain with no history of trauma or injury. Usually, there is a delay in the diagnosis for an infection of the spine because of the:

  • Subtle nature of the symptoms
  • Individual’s belief that the pain is not serious
  • Absence of body-wide symptoms like a fever

Lab results can also complicate the diagnostic process, as they can be misleading. There could be normal white blood cell counts, x-rays that show no abnormalities, and a sensitive diagnostic test like a bone scan might not show that an individual is positive until a week later.

An erythrocyte sedimentation rate is a valuable screening test when it comes to spinal infections. The test can measure inflammation and infection in the body. If a spinal infection is suspected, an MRI could be the most reliable tool to confirm early diagnosis.


Health & Immunity Series


Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico

The Factors Of Increased Immunity

The Factors Of Increased Immunity

With everything that is going on in today’s world immunity is especially important. Without a properly functioning immune system, our bodies can become inflamed and more susceptible to viruses. Inflammation can cause a weakened immune system, joint pain, headaches, fatigue and more!

So what can we do to build up our immunity and help give our bodies a fighting chance? First off, washing your hands is highly important. Not just now, but always. Be sure to wash your hands with warm water and scrub everywhere. Second, get plenty of sleep. Rest is how the body recovers. If you do not give your body adequate sleep, the strength you’re cells have to fight off infection lessens. Third, eat healthy food, hydrate, and exercise. Finally, last but not least help kick up your immune system by supplementing the body with all-natural supplements.

There are many supplements that will be beneficial to the body. However, two of the most important are NAC and Glutamine.

 

What Are They?

 

NAC stands for N-acetyl-Cystine. NAC is an amino acid that the body can produce but the body can also greatly benefit from taking additional NAC in supplemental form. NAC plays an important role in helping the liver to detox. In addition to this, NAC helps to replenish the glutathione levels in the lungs and can help to reduce the inflammation. This is highly beneficial in helping to relieve the symptoms of a respiratory infection.

NAC is also greatly beneficial in boosting brain health. NAC helps to regulate glutamate levels and replenish glutathione. However, one of the most important factors of NAC is its ability to boost Glutathione levels.

Glutamine is an amino acid that helps the body perform many functions. Glutamine plays a crucial part in the immune system.

 

The Connection & How It Impacts Immunity

 

However, one of the most important factors of NAC is its ability to booze Glutathione levels. NAC and glutathione can help to boost an individual’s immune health. In research studies shown, NAC has been shown to lessen the effects of a virus and its ability to replicate. When it comes to immunity NAC and Glutamine are powerful molecules. Stoping the replication of a virus can help reduce the spread and the length of the virus in an individual.

Many infections and diseases have been linked to low glutathione levels. When the glutathione levels are low this is typically due to enhanced oxygen radicals. Studies have been done and show that when supplementing NAC to those who have low glutathione levels, it directly boosts their levels and helps with infection.

Especially with everything happening today, we want to increase our immunity and decrease the inflammation in the body.� Essentially, think of the body as a road trip. For this trip we need two main things: the gas for the car, and the car to take you to the end destination.� NAC is the gas that drives the car. We need the gas to get to our end destination. Our end destination is being healthy and giving our body the best chance to fight off infection (increased Glutathione). So by giving our body gas (NAC) we provide it with what it needs to take us to where we want to go (increased Glutathione, leading to increased immunity).

 

How Can I Benefit?

 

Overall, NAC is great to decrease inflammation. Inflammation is an extremely common underlying issue relating to other health conditions individuals suffer from. By providing your body with additional supplements, you can help increase your immunity and decrease your chances of contracting a virus and/or the length of the virus. Always discuss supplements with your primary care doctor before you begin them, but consider adding these into your daily routine!

I always recommend talking to your primary care provider and taking supplements daily. Supplements, in general, are a great way to help provide the body with the essential vitamins and minerals you may be missing. However, now more than ever supplementation is key. By building up and providing the body with the nutrients it needs for proper function, it will help prepare your body to fight off an infection. Supplementation like NAC is great to have already running in your system to help combat an infection if you were to catch one. Remember to be smart, talk to a primary care doctor before beginning supplementation, and keep in mind that not all supplements are created equal.� -Kenna Vaughn, Senior Health Coach��

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�

References:
Dinicola S, De Grazia S, Carlomagno G, Pintucci JP. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review.�Eur Rev Med Pharmacol Sci. 2014;18(19):2942�2948.
Goodson, Amy. �Top 9 Benefits of NAC (N-Acetyl Cysteine).� Healthline, 2018, www.healthline.com/nutrition/nac-benefits#section3.
Wessner B, Strasser EM, Spittler A, Roth E. Effect of single and combined supply of glutamine, glycine, N-acetylcysteine, and R,S-alpha-lipoic acid on glutathione content of myelomonocytic cells.�Clin Nutr. 2003;22(6):515�522. doi:10.1016/s0261-5614(03)00053-0

Diagnosis of Central Nervous System Infections Part 2

Diagnosis of Central Nervous System Infections Part 2

Central nervous system, or CNS, infections can be life-threatening if they are not diagnosed and treated early. Because CNS infections are non-specific, determining an accurate diagnosis can be challenging. The nucleic acid in vitro amplification-based molecular methods are starting to be utilized for routine microbial diagnosis. These molecular methods have improved beyond conventional diagnostic techniques with increased sensitivity and specificity. Moreover, molecular methods utilized on cerebrospinal fluid samples are considered the new standard for diagnosis of CNS infections caused by pathogens. �

 

Molecular methods for the diagnosis of CNS infections offers a variety of monoplex and multiplex PCR assays to diagnose several types of health issues. Pan-omic molecular platforms can also help diagnose CNS infections. Although molecular methods are utilized for the diagnosis of CNS infections, the outcome measures for these diagnostic techniques must be carefully identified by healthcare professionals. The following article discusses conventional diagnostic techniques and molecular methods utilized for the diagnosis of central nervous system infections, their application, and future approaches. �

 

Molecular Methods in the Diagnosis of CNS Infections

 

Because of increased sensitivity and specificity, nucleic acid in vitro amplification-based molecular methods has tremendously improved the ability to diagnose CNS infections in a reasonable and effective time frame. Several PCR-derived techniques have also ultimately increased the flexibility and rigor of currently available diagnostic techniques. �

 

Reverse transcriptase, or RT,-PCR was developed to increase RNA targets. Its utilization plays a fundamental role in the diagnosis of RNA-virus infections as well as managing their reaction to treatment. Timely access to enterovirus RT-PCR outcome measures has demonstrated shorter hospital stays, reduced unnecessary antibiotic utilization, and decreased ancillary laboratory evaluations and tests. Broad-range rRNA PCR techniques, which utilize a single pair of primers targeting conserved regions of genes, have been utilized to diagnose bacterial pathogens and herpes viruses in the CSF. Isothermal amplification-based techniques. including loop-mediated isothermal amplification or LAMP, have been developed to offer a diagnosis within several minutes to hours. Table 2 demonstrates commercial molecular in vitro diagnostic devices, or IVD, which have been cleared by the US Food and Drug Administration, or FDA, for diagnosis of microbial pathogens in CSF. �

 

Monoplex Assays

 

A conventional molecular method involves three phases: sample extraction, target nucleic acid amplification, and amplicon detection. One of the first molecular assays successfully utilized for the diagnosis of CNS infections was utilized for the diagnosis of HSV in cerebrospinal fluid or CSF. PCR became the test of choice when research studies demonstrated that CSF PCR was similar to culture of brain tissue for diagnosis of HSV encephalitis and meningitis. Many PCR based methods for the diagnosis of herpes and enteroviruses have become available with increased sensitivity compared to viral culture. �

 

Real-time PCR with nucleic acid amplification and amplicon detection further improved the transition to molecular methods in clinical laboratories. Unlike conventional PCR, the real-time system is a �closed� system and it overcomes the fundamental problem of carryover contamination. At the time of manuscript preparation, three molecular assays utilized to help diagnose HSV and enteroviruses in CSF have ultimately been approved by the FDA as demonstrated in Table 2 of the previous article. � Real-time PCR-based methods are the main diagnostic technique utilized to help diagnose the Zika virus, which was first reported in Uganda in 1947, and is now a worldwide concern after the virus spread widely in Brazil and Central America. Research studies developed a one-step RT-PCR assay utilized to diagnose the Zika virus in human serum with a limited detection of 7.7pfu/reaction. Along with plasma, the Zika virus RNA can be diagnosed through urine and plasma within the first 2 weeks after symptoms have manifested. In March 2016, the FDA approved a trioplex-PCR assay under emergency use authorization for the simultaneous diagnosis of Zika, Chikungunya, and Dengue viruses in serum, urine, CSF and amniotic fluid. The RT-PCR assay utilizes dual labeled hydrolysis probes with a LOD of 1.54�10 4 GCE/ ml of Zika virus in serum. �

 

Introduction of real-time PCR based diagnostic assays have affected early and effective diagnosis of several bacterial infections. Isothermal amplification-based molecular assays have excellent performance characteristics and they don’t require any specialized equipment. These assays are fundamental for the utilization of on or near point-of-care testing. LAMP-based methods have been utilized to diagnose Neisseria meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b, M. tuberculosis, and JEV in the CSF. The Xpert MTB/RIF assay has tremendously improved regulation of tuberculosis by offering an integrated and automated system which allows quick clinical decision making in a POC or near-care context. Several research studies have utilized the Xpert MTB/RIF to evaluate the diagnosis of M. tuberculosis in CSF from TB meningitis. In a meta-analysis of thirteen research studies, the pooled sensitivity of the Xpert assay was 80.5 percent, or 95 percent CI 59.0 percent to 92.2 percent, against culture and 62.8 percent, or 95 percent CI 47.7 percent to 75.8 percent, against composite standard. Utilizing a large volume of sample, of at least 8�10 ml, is necessary for testing CSF and centrifugation can cause considerable improvements in yield. Despite the lack of standardization for sample processing, WHO has allowed testing CSF with the automated Xpert MTB/RIF assay as the first-line test over conventional microscopy. �

 

Multiplex Assays

 

Simplicity makes multiplex molecular assays fundamental for the diagnosis of a panel of microbial targets. Several multiplex PCR assays have been developed to diagnose bacterial pathogens in CSF targeting the most common causes of meningitis: S. pneumoniae, N. meningitis, H. influenzae, L. monocytogenes, S. agalactiae, S. aureus, E. coli, and M. pneumoniae. A multiplex PCR followed by Luminex suspension array can simultaneously diagnose eight bacterial and viral pathogens in CSF, including N. meningitis, S. pueumoniae, E. coli, S. aureus, L. monocytogenes, S. agalactiae, HSV-1/2, and VZV, among others. �

 

Considering the variety of pathogens involved in CNS infection, application of comprehensive molecular panels with multiple bacterial and viral targets have improved the efficiency of diagnosis. The BioFire FilmArray Meningitis/Encephalitis panel is currently the only FDA cleared multiplex assay utilized for the diagnosis of six bacterial, such as Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitides, Streptococcus agalactiae and Streptococcus pneumoniae, seven viral, such as cytomegalovirus, enterovirus, HSV-1, HSV-2, human herpesvirus 6 or HHV-6, human parechovirus and VZV, as well as a single fungal, such as Cryptococcus neoformans/gattii, target in CSF as demonstrated in Table 2. The integrated FilmArray system takes about an hour, with only 2 minutes of hands-on time. During the preparation of the manuscript, two research studies demonstrated the performance of this assay. Utilizing 48 samples from gram stain negative CSF samples from suspected cases of meningitis, research studies demonstrated that this system diagnosed more viral pathogens, such as EBV. Four cases of WNV and a single case of Histoplasma were not diagnosed by this assay. Among HIV infected patients in Uganda, the test performance demonstrated increased sensitivity and specificity for the diagnosis of Cryptococcus. Although the FilmArray Meningitis/Encephalitis panel offers a quick diagnosis of CNS infections, further research studies are needed to determine its performance for a variety of targets and other high-risk populations. �

 

Co-infections are frequently found among immunocompromised patients and can ultimately be challenging to diagnose for clinicians. The multiplex design allows simultaneous diagnosis of multiple targets on the same sample. One research study utilized a panel of monoplex and multiplex molecular assays to conduct a prospective cohort research study in Uganda to comprehensively evaluate the etiology of meningitis among HIV-infected adults. Among the 314 HIV-infected patients with meningitis, EBV co-infection was diagnosed with Cryptococcus, M. tuberculosis, or other viral pathogens. EBV in CSF in these settings is not completely understood although a single research study associated increased EBV viral load as a marker of poor outcome measures in patients with bacterial meningitis and EBV co-infection/ reactivation, among others. �

 

Pan-Omic Molecular Assays

 

Technological improvements in metagenomic deep sequencing have increased its utilization for clinical diagnosis of CNS infections. Several research studies have demonstrated its ability to solve diagnostic technique problems which challenge the limits of traditional laboratory testing. Due to sterile status and protection by BBB, CSF and brain biopsies are fundamental to further explore the utilization of this technology for pathogen diagnosis. Metagenomics was successfully utilized to establish a diagnosis of neuroleptospirosis in a 14-year-old boy with severe combined immunodeficiency who also suffered from recurrent bouts of fever, headache, and coma. Similarly, high-throughput RNA sequencing performed on brain biopsy from an 18-month-old boy with encephalopathy diagnosed a new Astrovirus as the cause. Despite the utilization of metagenomics for the diagnosis of infectious disease, there are many technological and practical concerns which need to be addressed before this form of diagnostic testing can become mainstream and part of the clinical standard of care. �

 

Other promising advances have occurred in transcriptomics, proteomics and metabolomics. Host and microbial microRNA or miRNA, profiles have been utilized for a variety of inflammatory and infectious diseases. Two miRNAs, miR-155 and miRNA-29b, were reported as potential biomarkers for JEV infection and treatment targets for anti-JEV therapy. Host neural epidermal growth factor, including 2 and apolipoprotein B in CSF, was able to diagnose tuberculous meningitis with 83.3 percent to 89.3 percent sensitivity and 75 percent to 92 percent specificity. CSF metabolite profiling has been reported to be useful in the classification, diagnosis, epidemiology, and treatment assessment of CNS infections in HIV patients. CSF metabolic profile analysis demonstrated bioenergetic adaptation in regulating shifts of HIV-infected patients. �

 

Outcome Measures Associated with Diseases

 

Diagnosis of an etiologic agent in patients with CNS infections needs consideration of the most common causative organisms, the available diagnostic techniques and molecular methods for these agents, and the highest-yield clinical specimens for evaluation and testing. Knowledge of the epidemiology and clinical presentation of specific agents is fundamental in selecting which diagnostic methods are appropriate for patients. Animal or vector exposures, geographic location, recent travel history, season of the year, exposure of ill contacts, and occupational exposures should be considered. �

 

When selecting appropriate pathogen-specific molecular diagnostic methods, the following factors should be considered. CSF is the optimal specimen for PCR testing for patients with meningitis or meningoencephalitis. While indirect evidence can be determined by testing other specimen types, attempts should be made to obtain CSF samples early before treatment can compromise yield. Time of testing from the manifestation of symptoms is fundamental to understand and rule out false-negative results and recommend retesting within a certain time frame. By way of instance, HSV PCR can commonly render false-negative results if CSF sample is obtained very early or late in the process of HSE infection. Host health is also known to affect test performance characteristics. Immunocompromised patients are at risk for infection by a variety of opportunistic pathogens, by way of instance HHV-6, JC virus, Toxoplasma encephalitis in bone marrow transplant recipients and patients with HIV. Often, infection can be more severe, such as WNV, and challenging to diagnose in this population. Table 3 below demonstrates practical recommendations on application and pitfalls of molecular test for the diagnosis of CNS infections. �

 

Table 3 Molecular Methods in Detecting CNS Infections 1 | El Paso, TX Chiropractor Table 3 Molecular Methods in Detecting CNS Infections 2 | El Paso, TX Chiropractor

 

Furthermore, a positive nucleic acid amplification testing results are considered to be complicated by the fact that some viruses survive latently in macrophages or neurologic tissues even if they’re incidentally diagnosed by sensitive molecular techniques without an actual pathogenic role which can potentially lead to overtreatment. Utilization of adjunctive biomarkers which help determine active replication is being explored to overcome this drawback in research studies. �

 

Historically, the diagnosis of microbiologic agents in patients with CNS infections has been hindered by the low yield of CSF culture for viral and fastidious bacterial organisms, delays in CNS production of organism-specific antibodies, and challenges in determining optimum samples for testing. The nucleic acid in vitro amplification-based molecular diagnostic methods and techniques have a wider and better application in clinical microbiology practice. The monoplex assay will likely be the main platform utilized for urgent, random-access, low throughput assays. Multiplex assays have the additional benefit of diagnosing multiple targets and mixed infections. As the volume of CSF sample retrieved is often small, multiplex assays enable comprehensive diagnostic analysis with a low amount of sample, obviating the need for repeated lumbar punctures. The clinical relevance and cost-effectiveness of simultaneous multi-pathogen diagnosis strategies need further research studies. Application of pan-omic techniques in challenging to diagnose CNS infections is the new exciting frontier, the technology is promising but routine implementation is expected to be slow due to various challenges, such as lack of applicable regulatory guidelines and adaptation in the clinical setting, although the outcome measures are promising. �

 

As previously mentioned, central nervous system, or CNS, infections can be life-threatening health issues if they are not accurately diagnosed and properly treated. However, determining a diagnosis of CNS infections can be challenging for many clinicians. Fortunately, a variety of diagnostic techniques and molecular methods can ultimately help determine the source of CNS infections and other health issues. These diagnostic techniques and molecular methods have tremendously improved over the years, as previously mentioned, and more of these evaluations are being utilized in clinical settings to accurately diagnose CNS infections for proper treatment. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

In part 2 of our “Diagnosis of Central Nervous System Infections” article, we discussed the molecular methods and the pan-omic molecular assays which are utilized in the diagnosis of CNS infections as well as how specific testing outcome measures have ultimately been associated with clinical diseases and health issues. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 . �

 

Curated by Dr. Alex Jimenez �

 


 

Additional Topic Discussion: Chronic Pain

 

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance.

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor

Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

 

Formulas for Methylation Support

 

Xymogen Formulas - El Paso, TX

 

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call our office in order for us to assign a doctor consultation for immediate access.

 

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

 

For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

Diagnosis of Central Nervous System Infections Part 1

Diagnosis of Central Nervous System Infections Part 1

The central nervous system, or CNS, plays a fundamental role in the pathogenesis of infection. The CNS is regulated by the blood-brain barrier or BBB, however, it can still be exposed to a microbial invasion from a contiguous focus, hematogenous dissemination, or intraneural passage of organisms. A variety of environmental or commensal bacteria, viruses, fungi, protozoa, or parasites can enter the CNS and cause a variety of infections and health issues. Central nervous system infections can ultimately cause headache, stiff neck, vomiting, fever, photophobia, and focal neurological symptoms. �

 

What are Central Nervous System Infections?

 

CNS infections are characterized according to their affected region. Infection of the brain, spinal cord, and meninges results in meningitis, encephalitis, brain abscess, and myelitis. Infections can affect single or multiple regions of the brain, such as meningoencephalitis and encephalomyelitis. Moreover, CNS infections are characterized as acute, sub-acute, chronic, or recurrent based on their duration. Meningitis can cause headache, neck stiffness, fever, and photophobia over a period of hours to days. Encephalitis can cause brain parenchymal inflammation which can ultimately cause lethargy to coma. Last but not least, Myelitis can cause inflammation of the spinal cord including headache, fever, and paraparesis or paralysis. �

 

Diagram of Central Nervous System and Pathogens.

 

One of the most fatal CNS infections, acute bacterial meningitis, with three to five cases for every 100,000 people in the United States, has a mortality rate of 6 percent to 26 percent. Approximately 4,000 cases of acute bacterial meningitis occur in the U.S. every year with about 500 deaths. The frequent cause of acute bacterial meningitis includes Streptococcus pneumoniae, group B Streptococcus, Neisseria meningitides, Haemophilus influenzae, and Listeria monocytogenes. �

 

CNS infections caused by viruses are more common and are mostly mild and self-limited. However, these can manifest as meningitis and/or encephalitis. CNS infections caused by viruses can vary due to region and season. Non-polio enteroviruses are responsible for the majority of meningitis and/or encephalitis cases from late spring to fall. CNS infections due to herpes simplex viruses, or HSV, are associated with sporadic encephalitis and meningitis with severe sequelae if left untreated. �

 

Diagnosis of CNS Infections

 

Diagnosis of microbial pathogens is fundamental for treatment. Methods and techniques utilized in clinical microbiology laboratories include direct microscopic examination, and culture techniques as well as antigen and antibody detection assays. However, each method and technique has several essential limitations. By way of instance, direct microscopic examination of CSF restricted sensitivity and specificity. The sensitivity of culture for enteroviruses is between 65 percent to 75 percent with average retrieval time of 3.7 to 8.2 days. Moreover, several serotypes of enteroviruses, especially Coxsackievirus A strains, are well-known to be non-cultivable and frequently grow poorly. Because enteroviruses are missing a common antigen found throughout a variety of serotypes, universal antigen and/or antibody diagnosis is impossible. Diagnosis of CNS HSV infections through methods and techniques utilized to determine culture sensitivity from CSF is tremendously poor. The presence of HSV IgG antibodies in CSF can ultimately be utilized to determine a diagnosis, however, the production is delayed until day 10 or day 12 after infection and it is not considered ideal for early diagnosis.

 

Methods and Techniques for Diagnosis of Central Nervous System Infections.

 

Diagnostic techniques, especially PCR based amplification, have developed a variety of mainstay tools to help determine the diagnosis of microbial pathogens in CSF. Molecular methods have demonstrated greater diagnosis rates than other diagnostic techniques. One research study demonstrated that 16S rRNA PCR-based assays were able to diagnose the causative organism in 65 percent of banked CSF samples compared to 35 percent when utilizing culture and microscopy. In another research study, diagnosis based on diagnostic techniques like molecular methods were utilized to optimize antibiotic treatment of patients with infectious meningitis when conventional methods and techniques demonstrated a negative outcome measure. Molecular methods and diagnostic techniques utilized on CSF samples are a fundamental standard when compared to the culture standard in the diagnosis of CNS infections caused by viruses which are challenging to diagnose. �

 

The diagnosis of CNS infections has tremendously changed over the last several years. PCR-based molecular methods have become a fundamental element in the clinical microbiology laboratory, providing tools for an accurate diagnosis. As demonstrated in Table 2, a variety of commercial molecular assays have been cleared by the Food and Drug Administration, or FDA, for the diagnosis of microbial pathogens. The approved assays for pathogen detection in the CNS are shown below. �

 

FDA Assays for Pathogen Detection in the CNS.

 

However, there are still several challenges in molecular diagnostic techniques and methods. Utilizing a combination of conventional diagnostic techniques and molecular methods, research studies demonstrated that in approximately 62 percent of patients with encephalitis, an etiologic organism could not be identified. Researchers have started to focus on developing advanced techniques and methods. In the following series of articles, we will demonstrate an update on the current conventional and molecular platforms utilized for the diagnosis of CNS infections. We will also demonstrate a preview on the potential clinical application of future technologies, including pan-omic assays. The emphasis of the following series of articles is to demonstrate optimal test selection in the clinical scenario for the diagnosis of CNS infection. �

 

Conventional Microbiology Methods and Techniques

 

Microscopic Examination

 

A positive CSF Gram stain confirms the diagnosis of bacterial meningitis. The sensitivity of the Gram stain for the diagnosis of bacterial meningitis is approximately 60 percent to 80 percent in patients not on antimicrobial treatment and approximately 40 percent to 60 percent in patients on antibacterial treatment. In one research study, Gram stain diagnosed as much as 90 percent Streptococcus pneumoniae and 50 percent Listeria monocytogenes in CSF collected from patients with bacterial meningitis confirmed by PCR 26 techniques and methods. Two organisms which are frequently diagnosed by microscopy include Mycobacterium tuberculosis by acid-fast bacillus, or AFB, staining and Cryptococcus neoformans by India ink or Gram stain. However,� the sensitivities of these techniques and methods are poor and culture is generally utilized instead. �

 

Culture

 

Culture of brain tissue can demonstrate a positive diagnosis of CNS infections, however, getting biopsies are tremendously invasive and frequently avoided unless a clinician determines that they are absolutely necessary. CSF sampling is most commonly performed to diagnose CNS infection. CSF viral, bacterial, including mycobacterial, and fungal cultures are fundamental in the diagnosis of infectious meningitis. However, CSF cultures in these cases are extremely low. Another disadvantage of CSF bacterial culture is that it generally requires up to 72 hours to determine a final diagnosis. A recent research study demonstrated that CSF mycobacterial culture had a sensitivity of 22 percent and a specificity of 100 percent in the diagnosis of tuberculosis meningitis. For viruses, utilizing monoclonal antibodies through culture increased the speed and specificity. However, due to time and sensitivity, CSF viral culture is frequently unable to determine a diagnosis. �

 

Rapid Antigen Detection

 

Cryptococcal antigen is the most commonly utilized antigen assay for CNS infections. The test utilizes Cryptococcus capsular polysaccharide antigens in CSF through enzyme immunoassay to determine a diagnosis. In a single research study which evaluated patients less than 35 years of age with CNS cryptococcosis, overall sensitivity and specificity of 93 percent to 100 percent and 93 percent to 98 percent were shown. Cryptococcus is a neurotropic fungus. Polysaccharide serum antigen titers with host immune status are frequently utilized to determine the need for a lumbar puncture to evaluate the patient for CNS health issues. The baseline peak titer of polysaccharide antigen in serum or CSF has demonstrated fundamental prognostic significance with an increased titer, or peak titer less than 1:1024, associated with antifungal therapy failure. �

 

The diagnosis of galactomannan, or GM, antigen and 1,3 ?-D-glucan, or BDG, in CSF, can help in the diagnosis of CNS aspergillosis or other invasive fungal infection such as fusariosis. Increased BDG in serum and CSF is associated with fungal infections. Measuring the levels of BDG is a beneficial biomarker in the evaluation of fungal CNS infection. It was recently demonstrated that patients receiving effective antifungal therapy demonstrated a decrease in CSF BDG concentrations with less than 31pg/ml and for this reason, BDG titers in CSF are a beneficial biomarker when monitoring response to treatment. �

 

For acute bacterial meningitis, a rapid antigen assay can help diagnose for a pneumococcal capsular antigen. Several research studies have demonstrated the utilization of M. tuberculosis-specific antigens in CSF for the diagnosis of tuberculosis meningitis. M. tuberculosis Early Secreted Antigenic Target 6, or ESAT-6, has been utilized for tuberculosis meningitis. �

 

Serology

 

Serological diagnosis of CNS infections is determined by identifying IgM antibodies or by demonstrating an increase in neutralizing antibody titers between acute- and convalescent-phase CSF. Due to a delay in antibody response when symptoms have manifested, a negative antibody test cannot be utilized to rule out infections and retesting may be required. Moreover, in specific populations, such as immunocompromised patients, the tests may not offer optimum sensitivity. In most instances, nucleic acid amplification tests have surpassed antibody-based detection as the test of choice. For several CNS infections, these assays play a fundamental role. CSF IgM is the most commonly utilized test for West Nile virus, or WNV, infections. Antibodies may manifest in as soon as 3 days and may continue for up to 3 months. However, its accuracy is challenged by high cross-reactivity with other flaviviruses and associated vaccines. Antibodies in recombinant WNV E proteins can determine where cross-reacting viruses co-circulate or determine which patients have been immunized. �

 

Fundamental serological assays for CNS infections are utilized for the diagnosis of neurosyphilis. Neurosyphilis is determined by a positive CSF venereal disease research laboratory, or VDRL, test. Diagnosis of varicella-zoster virus, or VZV, IgG in CSF is the most common technique and/or method for the diagnosis of VZV associated with CNS infection. �

 

Central nervous system, or CNS, infections can ultimately be life-threatening health issues if they are not diagnosed and treated early. Determining an accurate diagnosis of CNS infections can be challenging. Fortunately, a variety of diagnostic techniques and molecular methods can help determine the source of CNS infections. These diagnostic techniques and molecular methods have tremendously improved over the years and more and more of these evaluations are being utilized in clinical settings to accurately diagnose CNS infections for early treatment. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

In part 2 of our “Diagnosis of Central Nervous System Infections” article, we will ultimately discuss the molecular methods and the pan-omic molecular assays which are utilized in the diagnosis of CNS infections as well as discuss how specific testing outcome measures are associated with clinical diseases and health issues. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 . �

 

Curated by Dr. Alex Jimenez �

 


 

Additional Topic Discussion: Chronic Pain

 

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance.

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor

Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

 

Formulas for Methylation Support

 

Xymogen Formulas - El Paso, TX

 

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call our office in order for us to assign a doctor consultation for immediate access.

 

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

 

For your convenience and review of the XYMOGEN products please review the following link.*XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

Spinal Infection Diagnostic Imaging Approach | El Paso, TX.

Spinal Infection Diagnostic Imaging Approach | El Paso, TX.

Pyogenic Spinal Infection

  • aka Spondylodiscitis and vertebral osteomyelitis overall are relatively infrequent and may present with bimodal distribution: children and adults >50’s
  • Occasionally considered as two separate entities due to variations in the blood supply of pediatric vs. adult spines
  • Risk factors/causes: distant site of infection in the body (25-35%), e.g., oropharynx, urogenital infections, bacterial endocarditis, indwelling catheters, florid skin infections furunculosis/abscess, etc.
  • Iatrogenic:�operative (e.g., discectomy) interventional or diagnostic/therapeutic procedures
  • Penetrating trauma
  • Immunocompromised patients
  • Diabetics
  • Malnourished patients or patients with low protein
  • IV drug users
  • Chronic disease patients, cancer patients etc.

Potential Pathological Sequence

spinal infection diagnostic imaging el paso, tx.

 

Clinical Presentation

  • Back pain with or w/o high fever and other “septic” signs. Fever may only present in 50% of children
  • Exacerbation of pre-existing back pain in post-surgical cases
  • Neurological complications in advanced cases of vertebral destruction and epidural abscess
  • Meningitis, septicemia etc.
  • Labs: Blood tests are unspecific, may or may not indicate elevated ESR/CRP, WBC
  • Diagnostic imaging is important but
  • If clinical suspicion is strong, prompt I.V. antibiotics are needed to prevent serious complications

Routes of Infection

spinal infection diagnostic imaging el paso, tx.

 

  • Infection routes to the spine are similar to bone in general
  • 3-distinct routes:
  • 1) Hematogenous spread as bacteremia (most common)
  • 2) Adjacent site of infection (e.g., soft tissue abscess)
  • 3)Direct inoculation (e.g., iatrogenic or traumatic)
  • M/C organism Staph. Aureus
  • Mycobacterium TB (tuberculous spinal osteomyelitis) aka Pott’s disease can be presented in cases of re-activated or disseminated pulmonary TB

Mechanisms of Spinal Infection

spinal infection diagnostic imaging el paso, tx.

 

  • May vary depending on the patients’ age
  • In children, the IVD receives direct blood supply and can be infected directly spreading to adjacent bone and causing spondylodiscitis

In Adults

spinal infection diagnostic imaging el paso, tx.

 

  • The disc is avascular
  • Pathogens invade adjacent vertebral end-plates via end-arterial supply of the vertebral body that may facilitate infection due to slow, turbulent flow
  • Organisms may then quickly gain access to disc substance rich in nutrients (discitis) often w/o significant initially visible destruction to the bone
  • Thus, one of the earliest rad. findings of spinal infection or sudden reduction of disc height
  • Later end-plate irregularity/sclerosis may develop, subsequently affecting the entire adjacent vertebral bodies

Diagnostic Imaging

spinal infection diagnostic imaging el paso, tx.

 

  • Initially, in most cases of MSK complaints, radiography is the 1st imaging step
  • Initially, X-radiography is often unrewarding and may appear unremarkable for 7-10 days or presents with some subtle soft tissue changes (e.g., obscuration of Psoas shadows etc.)
  • Some of the earliest x-ray signs of pyogenic spondylodiscitis: sudden reduction of disc height (above arrow) during initial 7-10 days
  • Subsequently (10-20 days) some end-plate irregularity and adjacent sclerosis may be noted
  • In more advanced cases, subsequent vertebral destruction and collapse may occur
  • N.B. Reliable feature to DDx between spinal infection and metastasis is the preservation of disc height in the latter

Discitis

spinal infection diagnostic imaging el paso, tx.

 

  • Discitis needs to be DDx from DDD (spondylosis)
  • An important DDx between discitis and DDD is lack of osteophytes (spondylophytes) and intradiscal gas (vacuum phenomenon) in DDD.
  • Presence of intradiscal gas (vacuum phenomenon) virtually excludes discitis (except if gas-forming pathogens are involved)
  • Note:�sudden disc narrowing with no appreciable spondylosis (above the first image) is suspicious for infection (discitis)
  • MRI +C is required to evaluate suspected infection
  • N.B. 50-60% of pyogenic spondylodiscitis occur in the lumbar region

AP & Lateral Lumbar Radiographs

spinal infection diagnostic imaging el paso, tx.

 

  • Note severe disc narrowing and adjacent vertebral body destruction at L1-L2 in a 68 -y.o.-female with a known Hx of type 2 DM
  • Additional imaging modalities should be used to support the Dx
  • Final Dx: Pyogenic Spondylodiscitis

Sagittal T1 & T2 MRI

spinal infection diagnostic imaging el paso, tx.

 

  • Weighted MRI slices of a patient who had laminectomy at L4
  • MR imaging with gad contrast is the modality of choice for Dx of spinal infection
  • Early septic changes affecting the disc and adjacent vertebral end-plates are readily demonstrated as a low signal on T1 and high T2/STIR d/t edema and inflammation
  • T1 FS +C gad images show avid enhancement of the lesion due to granulation tissue around the phlegmon. Peripheral enhancement is also characteristic of an abscess.
  • Epidural extension/abscess can also be successfully detected my MRI
  • N.B. 50% of epidural abscess cases present with neurological signs

STIR & T1 FS +C Gad Sagittal MRI

spinal infection diagnostic imaging el paso, tx.

 

  • Marked septic collection and edema affecting L4-5 disc and vertebral body with some epidural extension and paraspinal soft tissue edema. Avid contrast enhancement is noted surrounding low signal foci within the bone and disc tissue, some gad. Enhancement is noted in posterior paraspinal muscles and dural spaces
  • Management: Dx of spondylodiscitis requires prompt I.V antibiotics. If instability and neurological complications develop referral to a Neurosurgeon is required

MRI Unavailable or Contraindicated

spinal infection diagnostic imaging el paso, tx.

 

  • Bone scintigraphy is very sensitive but non-specific for spinal infection but overall is of great value d/t higher sensitivity than x-rays and relatively low cost.
  • An area of increased flow with radiopharmaceutical uptake is characteristic but not specific sign of spondylodiscitis
  • If neurological signs are present and MRI is contraindicated than CT myelography may be used

TB Osteomyelitis aka Pott’s Disease

spinal infection diagnostic imaging el paso, tx.

 

  • TB osteomyelitis is increasing d/t HIV and other immunocompromised states. Extrapulmonary TB m/c affects the spine and especially the thoracic spine (60%)
  • Radiographic Pathology:�TB bacillus infects the vertebral body and often spreads subligamentously. “Cold” paraspinal abscess collection may develop and spreads along fascial planes, e.g., Psoas abscess. Disc spaces are preserved until v. late and skip areas are noted helping to DDx TB from pyogenic infection. Severe vertebral destruction aka Gibbus deformity may develop (>60-degree sometimes) and may become permanent. Neurologic and many regional complications may develop
  • Imaging approach:�CXR with spinal x-rays 1st step that may be unrewarding but may potentially reveal VB destruction w/o disc narrowing. CT scanning is more superior than x-rays. MRI with gad C is a modality of choice
  • Management:�isoniazid, rifampin, operative.
  • DDx: Fungal/Brucella infection, neoplasms, Charcot spine

Gibbus Deformity & Pott’s Disease

spinal infection diagnostic imaging el paso, tx.

 

Infection Of The Spine

 

Autoimmune Thyroid Diseases Associated with Infections | Wellness Clinic

Autoimmune Thyroid Diseases Associated with Infections | Wellness Clinic

Autoimmune thyroid diseases, such as Hashimoto’s thyroid disease and Graves’ disease, are several of the most prevalent causes behind thyroid gland dysfunction. Autoimmune thyroid diseases, or AITDs, occur when the human body’s own immune system attacks and damages a healthy thyroid gland. It’s this autoimmune assault on the thyroid which can, over time, lead to the overactive or the underactive function of the buttefly-shaped gland in our neck.

 

What other factors can cause autoimmune thyroid diseases?

 

According to numerous research studies, autoimmune thyroid diseases can be caused due to a variety of factors. Environmental factors like iodine intake and selenium deficiency can alter the balanced metabolism of chemicals in the human body necessary for the proper function of the thyroid gland. Additionally, environmental factors such as exposure to environmental pollutants and toxins have been linked to the interference of efficient thyroid hormone secretion.

 

Autoimmune Thyroid Disease & Infection

 

One autoimmune thyroid disease trigger, however, is often overlooked by healthcare professionals; infection. Researchers today still do not fully understand how�infections trigger autoimmune diseases, however because our immune systems are so complicated and every disease is unique, it’s very likely that there are a number of variables. Recent studies have identified three theories which explain the links between infections and AITDs.

 

Molecular Mimicry

 

Autoimmune thyroid diseases triggered by molecular mimicry are virtually hypothesized to occur when the infection is structurally similar to that of the thyroid gland. Therefore, once the network of defense cells, tissues and organs activates, the immune system proceeds to strike the infection and attacks your thyroid gland.

 

Bystander Activation

 

In this circumstance, the immune system activates when a virus or bacteria invades the thyroid gland and sends cells into your thyroid to destroy the infection. While these cells are currently all attacking the bacteria or virus, it injures the thyroid gland. More cells are signaled by the inflammation to the thyroid gland where they often continue to attack.

 

Cryptic Antigens

 

You can think about this as the “hijacking theory” where an infection (usually due to a virus) hijacks the thyroid cells’ DNA to hide from your immune system. The immune system is intelligent enough to detect the virus anyway, and strikes the virus as well as the thyroid cells it is hiding in.

 

AITDs as a Response to Infection

 

In certain individuals, autoimmunity is the price to be paid for the eradication of an infectious agent. Infections are implicated in the pathogenesis of endocrine, and nonendocrine diseases. Either fungal or viral diseases may represent a risk factor for the evolution of AITDs. Viruses have long been suspected as etiological agents in a variety of health disorders, uncluding autoimmune thyroid disease; furthermore, a trigger of AITDs, infecting the thyroid or immune cells, was demonstrated in an avian model. This potential remains unproven although viruses may be agents in AITDs.

 

An increased frequency of antibodies to the influenza B virus has been observed in a group of patients with thyrotoxicosis. Virus-like particles have been discovered in the thyroid of chickens together with similar particles. Serological evidence of staphylococcal and streptococcal disorders were described in a few patients with AITDs.

 

Some of the strongest evidence linking infectious agents to AITDs’ induction has been the institution of Yersinia enterocolitica disease with thyroid disorder. This Gram-negative coccobacillus commonly causes diarrhea along with a number of abnormalities that indicate disorder, including arthritis, arthralgias, erythema nodosum, carditis, glomerulonephritis, and iritis. Weiss et al. demonstrated that Y. enterocolitica needed a saturable, hormone-specific binding site for its mammalian TSH that resembled the receptor for TSH from the human thyroid gland.

 

An immune response against a viral antigen that shares homology with the TSHR might be the inductive event that ultimately leads to autoimmunity. A substantial association between AITDs and hepatitis C has also been found. Antibody titers are shown to increase in patients with the hepatitis C virus, and these patients were more susceptible to AITDs than were hepatitis B sufferers. These patients must be screened for autoimmune thyroid disease.

 

Infection might induce an autoimmune response by various mechanisms, such as polyclonal T cell activation by microbial superantigens mimicry, and thyroid expression of human leukocyte antigens. Inflammation can alter cell signaling pathways and influence T cell activity and cytokine secretion profiles.

 

In conclusion, research studies have shown that autoimmune thyroid diseases may also be the response of environmental factors such as infections. Infections can lead to AITDs when the human body’s own immune system attacks and damages the thyroid gland cells in addition to those of bacteria and viruses. Ultimately, treating bacterial and viral infections can be an essential way to prevent autoimmune thyroid disease or complications.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

 

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