Research Article
Volume 13 Issue 2 - 2022
Pyogenic Spinal Infection: is Expanded Dengue Syndrome A Risk Factor? – A Series of Ten Cases and Brief Literature Review
Rajsirish BS*
Junior Resident, Department of Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India
*Corresponding Author: Rajsirish BS, Junior Resident, Department of Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
Received: May 21, 2021; Published: January 17, 2022


Background: An acute surge of pyogenic spinal infection was noted during the recent dengue epidemic in Kerala. Review of literature does not show any association between Dengue fever (DF) and pyogenic spinal infections, though immunosuppression is a well-known risk factor. We report ten such cases of spinal infections to create an awareness among the medical fraternity thereby aiding early management.

Methods and Material: A retrospective review of patients with spinal infections and DF during the month of June and July 2017. No statistical analysis was used.

Results: We had ten patients of DF presenting with varying degrees of neurological compromise and a spectrum of spondylitis, spondylodiscitis and epidural abscess. None of them had significant back pain prior to DF. Though various risk factors like diabetes mellitus and intravenous catherization were present, all of them consistently had documented Expanded dengue syndrome (transient leukopenia, neutropenia and culture positive bacteraemia with DF).

Conclusions: We conclude that there appears to be an association between spinal infections and DF with neutropenia. It is highly recommended that it be considered a part of the expanded dengue syndrome for creating awareness among the physicians, thereby preventing any delay in management.


Keywords: Pyogenic Spinal Infection; Dengue Fever; Neutropenia


    1. Camillo X Francis. “Infections of the Spine”. In: Canale ST, Beaty JH, editors. Campbell’s Operative Orthopaedics. Philadelphia: Mosby Elsevier (2008): 2237-2272.
    2. Thein TL., et al. “Severe Neutropenia in Dengue Patients: Prevalence and Significance”. American Journal of Tropical Medicine and Hygiene6 (2014): 984-987.
    3. Davis DP., et al. “Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain”. Journal of Neurosurgery6 (2011): 765-770.
    4. Doutchi M., et al. “Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France”. New Microbes and New Infections 7 (2015): 1-7.
    5. Sendi P., et al. “Spinal epidural abscess in clinical practice”. Quarterly Journal of Medicine1 (2008): 1-12.
    6. Reihsaus E., et al. “Spinal epidural abscess: a meta-analysis of 915 patients”. Neurosurgical Review4 (2000): 175-204.
    7. Darouiche RO. “Spinal epidural abscess”. New England Journal of Medicine19 (2006): 2012-2020.
    8. Pradilla G., et al. “Epidural abscesses of the CNS”. The Lancet Neurology3 (2009): 292-300.
    9. Carragee EJ. “Pyogenic vertebral osteomyelitis”. Journal of Bone and Joint Surgery American 79 (1997): 874-880.
    10. Vakili M., et al. “Spinal Epidural Abscess: A Series of 101 Cases”. The American Journal of Medicine (2017).
    11. Chu A., et al. “Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain”. Case Reports in Neurological Medicine (2015): 103624.
    12. Kumar A., et al. “Spontaneous spinal epidural abscess in a normoglycemic diabetic patient- keep it as a differential”. Journal of Clinical Orthopaedics and Trauma2 (2017): 178-180.
    13. Pigrau C., et al. “Health Care Associated Hematogenous Pyogenic Vertebral Osteomyelitis: A Severe and Potentially Preventable Infectious Disease. Snowden”. Medicine3 (2015): e365.
    14. Ribera A., et al. “Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis”. Infection1 (2016): 29-37.
    15. Stratton A., et al. “Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis”. Journal of Neurosurgery: Spine 26 (2017): 81-89.
    16. Talia AJ., et al. “Safety of instrumentation and fusion at the time of surgical debridement for spinal infection”. Journal of Clinical Neuroscience7 (2015): 1111-1116.
    17. Park KH., et al. “Therapeutic Outcomes of Hematogenous Vertebral Osteomyelitis Treated with Instrumented Surgery”. Clinical Infectious Diseases9 (2015): 1330-1338.
Citation: Rajsirish BS. “Pyogenic Spinal Infection: is Expanded Dengue Syndrome A Risk Factor? – A Series of Ten Cases and Brief Literature Review”. EC Orthopaedics 13.2 (2022): 16-25.

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