Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- febre
- sensibilidade ou dor na coluna
- fraqueza dos membros
- paralisia
- distúrbios sensitivos
- reflexos anormais
Outros fatores diagnósticos
- disfunção esfincteriana isolada
Fatores de risco
- uso de substâncias por via intravenosa
- cirurgia ou trauma vertebral recente
- cateter espinhal de demora
- infecção local contígua
- imunossupressão
- diabetes mellitus
- doença renal crônica
- bacteremia ou endocardite concomitante
- abuso de álcool
- sexo masculino
- obesidade
- coinfecção não contígua (exceto bacteremia)
- doença hepática crônica
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Hemograma completo
- proteína C-reativa
- velocidade de hemossedimentação
- ressonância nuclear magnética (RNM) da coluna com e sem contraste intravenoso
- hemoculturas
- aspiração direta do abscesso para cultura
Investigações a serem consideradas
- teste de amplificação de ácido nucleico (NAAT) do aspirado
Algoritmo de tratamento
suspeita de abscesso epidural
com infecção por Staphylococcus aureus sensível à meticilina (SASM)
com infecção por MRSA
com infecção por Gram-negativo
com infecção por Mycobacterium tuberculosis
Colaboradores
Autores
Kenneth F. Casey, MD
Associate Adjunct Professor
Clinical Associate Professor of Physical Medicine and Rehabilitation
Wayne State University School of Medicine
Clinical Associate Professor Surgery (Neurosurgery)
Michigan State University
Detroit
MI
Disclosures
KFC has done consultancy work, given lectures on chronic pain and critical care topics, authored several books on face pain, and has received royalties for his contribution.
Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHE
Chair
Department of Medicine
Mercy Hospital-St. Louis
St. Louis
MO
Disclosures
FAM is an author of references cited in this topic.
Peer reviewers
John M. Embil, MD, FRCPC
Consultant
Infectious Diseases
Associate Professor
Section of Infectious Diseases
Department of Medicine
University of Manitoba
Director
Infection Prevention and Control Unit Health Sciences Centre
Winnipeg
Manitoba
Canada
Disclosures
JME declares that he has no competing interests.
Iain Christie, MB BhB, FRCA
Consultant Anaesthetist
Derriford Hospital
Plymouth
UK
Disclosures
IC declares that he has no competing interests.
Wendy Ziai, MD, MPH
Assistant Professor
Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine
The Johns Hopkins University
Baltimore
MD
Disclosures
WZ declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. 2016 Dec 1 [Epub ahead of print].Full text Abstract
Expert Panel on Neurological Imaging., Ortiz AO, Levitt A, et al. ACR Appropriateness Criteria® Suspected spine infection. J Am Coll Radiol. 2021 Nov;18(suppl 11):S488-501.Full text Abstract
Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hematoma epidural
- Esclerose múltipla
- Compressão maligna da medula espinhal
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- ACR appropriateness criteria: suspected spine infection
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer