Hematogenous candida vertebral osteomyelitis treated with ketoconazole
- 31 Downloads
- 18 Citations
Summary
Candida vertebral osteomyelitis was diagnosed in a patient with systemic lupus erythematodes following X-ray evidence of osteomyelitis and the repeated culturing ofCandida albicans from material obtained by needle biopsies from the third lumbar vertebra. The patient had been on glucocorticosteroids and parenteral nutrition six months previously. At that time, a yeast was cultured from the blood and the tip of the subclavian catheter which had been removed. After candida vertebral osteomyelitis was diagnosed, she was treated with ketoconazole for seven months. Recovery was impressive, as judged by the clinical and radiographic findings. At the time of writing this paper — 12 months after the withdrawal of ketoconazole — the patient showed no signs of recurrence.
Keywords
Candida Osteomyelitis Ketoconazole Candida Species HistoplasmosisBehandlung einer hämatogenen Candida-Wirbelosteomyelitis mit Ketoconazol
Zusammenfassung
Bei einer Patientin mit systemischem Lupus erythematodes wurde röntgenologisch eine Wirbelosteomyelitis diagnostiziert. In Material, das durch Punktur des dritten Lendenwirbelkörpers gewonnen wurde, ließ sich kulturell wiederholtCandida albicans nachweisen. Sechs Monate vorher war die Patientin mit Kortikosteroiden behandelt und parenteral ernährt worden. Zu dieser Zeit wurden aus dem Blut und von der Spitze des entfernten Subclavia-Katheters Hefen kultiviert. Nachdem eine Wirbelosteomyelitis durchCandida diagnostiziert worden war, wurde die Patientin sieben Monate lang mit Ketoconazol behandelt. Entsprechend den klinischen und röntgenologischen Befunden kam es zu einem eindrucksvollen Heilungsverlauf. Zwölf Monate nach Beendigung der Ketoconazolbehandlung — zum Zeitpunkt der Manuskripterstellung — waren bei der Patientin keine Zeichen für einen Rückfall festzustellen.
Preview
Unable to display preview. Download preview PDF.
Literature
- 1.Levine, H. B. Ketoconazole in the management of fungal disease. ADIS press, Balgowlah, Australia, 1982.Google Scholar
- 2.Levine, H. B., Cobb, J. M. Ketoconazole in early and late murine coccidiomycosis. Rev. Infect. Dis. 2 (1980) 546–550.CrossRefPubMedGoogle Scholar
- 3.Williams, D. M., Graybill, J. R., Drutz, D. J., Levine, H. B. Suppression of cryptococcosis and histoplasmosis by ketoconazole in athymic nude mice. J. Infect. Dis. 141 (1980) 76–80.CrossRefPubMedGoogle Scholar
- 4.Dixon, D., Shadomy, S., Shadomy, H. J., Espinel-Ingroff, A., Kerkering, Th. M. Comparison of thein vitro antifungal activities of miconazole and a new imidazole R41400. J. Infect. Dis. 138 (1978) 245–248.CrossRefPubMedGoogle Scholar
- 5.Heeres, J., Backx, L. J. J., Mostmans, J. H., van Cutsem, J. M. Antimycotic imidazoles. Part 4. Synthesis and antifungal activity of ketoconazole, a new potent orally active broad-spectrum antifungal agent. J. Med. Chem. 22 (1979) 1003–1005.CrossRefPubMedGoogle Scholar
- 6.Symoens, J., Moens, M., Dom, J., Scheijgrond, H., Dony, J., Schuermans, V., Legendre, R., Finestine, N. An evaluation of two years of clinical experience with ketoconazole. Rev. Infect. Dis. 2 (1980) 674–687.CrossRefPubMedGoogle Scholar
- 7.Van Cutsem, J. M., Thienpont, D. Miconazole, a broad-spectrum antimycotic agent with antibacterial activity. Chemotherapy 17 (1972) 392–404.CrossRefPubMedGoogle Scholar
- 8.Van Cutsem, J. M., Borgers, M., de Brabander, M. The activity of ketoconazole on clinical isolates ofCandida albicans cultured in mycelium promoting medium. Mykosen 24 (1981) 596–602.CrossRefPubMedGoogle Scholar
- 9.Van Cutsem, J. M., van Gerven, F., Zaman, R., van der Flaes, M.: New method for determiningin vitro activity of R41400. Janssen Pharmaceutica Preclinical Research Report R41400, 13 December 1977.Google Scholar
- 10.Simpson, M. B. Jr., Merz, W. G., Kurlinski, J. P., Solomon, M. H.: Opportunistic mycotic osteomyelitis: bone infections due to aspergillus and candida species. Medicine (1977) 475–482.Google Scholar
- 11.Hirschmann, J. V., Dale Everett, E. Candida vertebral osteomyelitis. J. Bone Joint Surg. 58A (1976) 573–575.PubMedGoogle Scholar
- 12.Edwards, J. E. Jr., Turkel, S. B., Elder, H. A., Rand, R. W., Guze, L. B. Hematogenous candida osteomyelitis: report of three cases and review of the literature. Am. J. Med. 59 (1975) 89–94.CrossRefPubMedGoogle Scholar
- 13.Holzman, R. S., Bishko, F. Osteomyelitis in heroin addicts. Ann. Intern. Med. 75 (1971) 693–696.CrossRefPubMedGoogle Scholar
- 14.O'Connell, C. J., Cherry, A. V., Zoll, J. G. Osteomyelitis of cervical spine:Candida guilliermondii. Ann. Intern. Med. 70 (1973) 748.CrossRefGoogle Scholar
- 15.Yvin, M. Un cas de mycose vertébrale. Rév. Orthop. 21 (1934) 42–49.Google Scholar
- 16.Shaikh, B. H., Appelbaum, P. C., Aber, R. C. Vertebral disc space infection and osteomyelitis due toCandida albicans in a patient with acute myelomonocytic leukemia. Cancer 45 (1980) 1025–1028.CrossRefPubMedGoogle Scholar
- 17.Edwards, J. E. Jr. Severe candidal infections. Ann. Intern. Med. 89 (1978) 91–106.CrossRefPubMedGoogle Scholar
- 18.Young, R. C., Bennett, J. E., Geelhoed, G. W., Levine, A. S. Fungemia with compromised host resistance. A study of 70 cases. Ann. Intern. Med. 80 (1974) 605–612.CrossRefPubMedGoogle Scholar
- 19.Editorial: Treating fungal infections. Br. Med. J. 1 (1980) 668–669.Google Scholar
- 20.Bennet, J. E., Remington, J. S. Miconazole in cryptococcosis and systemic candidiasis: a word of caution. Ann. Intern. Med. 94 (1981) 708–709.CrossRefGoogle Scholar
- 21.Van der Meer, J. W. M., Keuning, J. J., Scheygrond, H. W., Heykants, J., van Cutsem, J., Brugmans, J. The influence of gastric acidity on the bio-availability of ketoconazole. J. Antimicrob. Chemother. 6 (1980) 552–554.CrossRefGoogle Scholar