Diagnosis
Î IDSA advises against performing an image-guided aspiration biopsy
in patients with suspected subacute NVO (high endemic setting) and
strongly positive brucella serology (S/L).
Î In patients with neurologic compromise with or without impending sepsis
or hemodynamic instability, IDSA recommends immediate surgical
intervention and initiation of empiric antimicrobial therapy (S/L).
Î IDSA suggests the addition of fungal, mycobacterial, or brucella cultures
on image-guided biopsy and aspiration specimens in patients with
suspected NVO if epidemiologic, host risk factors, or characteristic
radiologic clues are present (W/L).
Î IDSA suggests the addition of fungal and mycobacterial cultures, and
bacterial nucleic acid amplification test (NAAT) to appropriately stored
specimens if aerobic and anaerobic bacterial cultures reveal no growth in
patients with suspected NVO (W/L).
Î If adequate tissue can be safely obtained, pathology specimens should be
sent from all patients to help confirm a diagnosis of NVO and guide further
diagnostic testing, especially in the setting of negative cultures (S/L).
Î In the absence of concomitant bloodstream infection, IDSA recommends
obtaining a second aspiration biopsy in patients with suspected NVO in
whom the original image-guided aspiration biopsy specimen grew a skin
contaminant [coagulase-negative staphylococci (except S. lugdunensis),
Propionibacterium sp. or diphtheroids] (S/L).
Î In patients with a non-diagnostic first image-guided aspiration biopsy and
suspected NVO, further testing should be done to exclude difficult-to-grow
organisms (e.g., anaerobes, fungi, Brucella sp. or mycobacteria) (S/L).
Î In patients with suspected NVO and a non-diagnostic image-guided
aspiration biopsy and laboratory work-up, IDSA suggests either repeating
a second image-guided aspiration biopsy, a percutaneous endoscopic
discectomy and drainage (PEDD), or proceeding with an open excisional
biopsy (W/L).
