Epidural abscess laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
An epidural abscess is a rare suppurative infection of the central nervous system, a collection of pus localised in the epidural space lying outside the dura mater, which accounts for less than 2% of focal CNS infections. [1] It may occur in two different places: intracranially or in the spinal canal. Because the initial symptoms and clinical characteristics are not always identical, and are similar to the ones in other diseases, along with the fact that they are both rare conditions, the final diagnosis might be delayed in time. This late diagnosis comes at great cost to the patient, since it is usually accompanied by a bad prognosis and severe complications with a potential fatal outcome. The diagnosis of epidural abscess should be first suspected from the clinical findings, being posteriorly supported by laboratory tests and imaging studies, however it can only be confirmed after surgical drainage and proper study of the collected material. The laboratory tests despite helpful, are not diagnostic and should always be used alongside with history taking, clinical examination and imaging studies. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2][3]
Laboratory Findings
Inflammatory markers may be elevated, however this isn't always the case, nor is there a specific marker to confirm the diagnosis. Therefore laboratory results, despite helpful are not diagnostic and should be used alongside clinical findings to help in the diagnosis, nevertheless are still not sufficient, they should then be complemented by imaging studies. [3] Common abnormal markers in this condition are:
- Elevated Erythrocyte Sedimentation Rate
- Elevated C-reactive protein
- Leukocytosis (about 2/3 of patients)
- Bacteremia, detected in about 60% of patients, may be the cause or be originated in the abscess, commonly by Staphylococcus aureus
- Possible thrombocytopenia, particularly in adults [4]
- Thrombocytosis, particullarly in children [4]
Once an abscess has been identified in the imaging studies, it is important to identify the responsible organism, by studying different types of isolated materials, such as blood, material from the abscess and CSF. In the case of material from the abscess, the chance of finding the responsible organism is about 90%, in the blood 62% and in the CSF about 19%. [5]
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.
- ↑ 3.0 3.1 Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ 4.0 4.1 Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
- ↑ Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.