Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases

Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3-6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. Al...

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Bibliographic Details
Published in:European spine journal 2006-09, Vol.15 (9), p.1404-1410
Main Authors: Khazim, Rabi M, Debnath, Ujjwal K, Fares, Youssef
Format: Article
Language:English
Subjects:
Adult
Aged
Antifungal Agents - therapeutic use
Back Pain - microbiology
Back Pain - physiopathology
Back Pain - surgery
Candida albicans - physiology
Cervical Vertebrae - microbiology
Cervical Vertebrae - pathology
Cervical Vertebrae - surgery
Debridement
Disease Progression
Female
Fluconazole - therapeutic use
Humans
Lumbar Vertebrae - microbiology
Lumbar Vertebrae - pathology
Lumbar Vertebrae - surgery
Male
Mycoses - diagnosis
Mycoses - microbiology
Mycoses - surgery
Neck Pain - microbiology
Neck Pain - physiopathology
Neck Pain - surgery
Neurosurgical Procedures
Original
Osteomyelitis - diagnosis
Osteomyelitis - microbiology
Osteomyelitis - surgery
Reconstructive Surgical Procedures
Spinal Cord Compression - microbiology
Spinal Cord Compression - physiopathology
Spinal Cord Compression - surgery
Spinal Diseases - diagnosis
Spinal Diseases - microbiology
Spinal Diseases - surgery
Thoracic Vertebrae - microbiology
Thoracic Vertebrae - pathology
Thoracic Vertebrae - surgery
Treatment Outcome
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Description
Summary:Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3-6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5-6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-005-0038-z