Vertebral Osteomyelitis in Intravenous Drug Abusers: Report of Three Cases and Review of the Literature

Three cases of vertebral osteomyelitis in intravenous drug abusers are described, and 64 cases in the literature are reviewed. The patients were almost exclusively heroin users from the United States, were predominantly male, and were frequently of black or Hispanic ethnic background. Symptoms were...

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Bibliographic Details
Published in:Reviews of infectious diseases 1980-03, Vol.2 (2), p.196-206
Main Authors: Francisco L. Sapico, Montgomerie, John Z.
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Bones
Drug addiction
Female
Heroin
Heroin - administration & dosage
Heroin - adverse effects
Heroin dependence
Humans
Infections
Injections, Intravenous
Male
Middle Aged
Narcotics
Osteomyelitis
Osteomyelitis - chemically induced
Osteomyelitis - drug therapy
Osteomyelitis - microbiology
Osteomyelitis - surgery
Pseudomonas
Pseudomonas aeruginosa - isolation & purification
Review Articles
Solar X rays
Spine
Substance-Related Disorders
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Summary:Three cases of vertebral osteomyelitis in intravenous drug abusers are described, and 64 cases in the literature are reviewed. The patients were almost exclusively heroin users from the United States, were predominantly male, and were frequently of black or Hispanic ethnic background. Symptoms were present for less than three months in 81% of patients. On admission to the hospital, fever was seen in 42%, transient neurologic deficits in 15%, elevated erythrocyte sedimentation rate in 91%, and leukocytosis in 35%. Twenty-two percent of patients with initially normal X rays had spinal abnormalities detected by tomography and technetium bone scan. A strikingly high incidence (27%) of cervical spine involvement was found. Gram-negative aerobic bacilli accounted for 82% of infections, and Pseudomonas species comprised 66% of the total. Ninety-two percent of the patients responded to parenteral antibiotic therapy administered for four weeks or longer. Patients experiencing relapses responded to a second course of therapy. The prognosis for intravenous drug abusers with vertebral osteomyelitis appeared to be good with appropriate therapy, and no deaths or permanent neurologic sequelae were seen.
ISSN:0162-0886