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

Abstract

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.

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References

  1. Almekinders LC, Greene WB (1991) Vertebral Candida infections. A case report and review of the literature. Clin Orthop 267:174–178

    PubMed  Google Scholar 

  2. Andermahr J, Isenberg J, Prokop A, Rehm KE (1998) Candida spondylitis. Case report and review of literature [article in German]. Unfallchirurg 101:955–959

    PubMed  Article  CAS  Google Scholar 

  3. Burns J, Hemker T, Dahmen G (1986) Fungal spondylitis. Acta Orthop Scand 57:563–565

    Article  Google Scholar 

  4. Conner CL (1928) Monilia from osteomyelitis. J Infect Dis 43:108–116

    Google Scholar 

  5. Curran MP, Lenke LG (1996) Torpulosis glabrata spinal osteomyelitis involving two contiguous vertebrae: a case report. Spine 21:866–870

    PubMed  Article  CAS  Google Scholar 

  6. Dietze DD Jr, Fressier RG, Jacob RP (1997) Primary reconstruction for spinal infections. J Neurosurg 86:981–989

    PubMed  Article  Google Scholar 

  7. Edwards JE, Turkel SB, Elder HA, Rand RW, Guze LB (1975) Haematogenous Candida osteomyelitis: report of three cases and review of literature. Am J Med 59:89–94

    PubMed  Article  CAS  Google Scholar 

  8. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA (1983) Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg [Am] 65:19–29

    CAS  Google Scholar 

  9. El-Zaatari MM, Hulten K, Fares Y et al (2002) Successful treatment of Candida albicans osteomyelitis of the spine with fluconazole and surgical debridement: case report. J Chemother 14:603–606

    Google Scholar 

  10. Garbino J, Schnyder I, Lew D et al (2003) An unusual cause of vertebral osteomyelitis: Candida species. Scand J Infect Dis 35:288–291

    PubMed  Article  Google Scholar 

  11. Gathe JC, Harris RL, Garland B, Bradshaw MW, Williams TW (1987) Candida osteomyelitis: report of five cases and review of literature. Am J Med 82:927–937

    PubMed  Article  Google Scholar 

  12. Hassan MG (2003) Anterior plating for lower cervical spine tuberculosis. Int Orthop 27:73–77

    PubMed  Article  CAS  Google Scholar 

  13. Hirschmann JV, Everett ED (1976) Candida vertebral osteomyelitis: case report and review of literature. J Bone Joint Surg [Am] 58:573–575

    CAS  Google Scholar 

  14. Keating PM (1932) Fungus infection of bone and joint. South Med J 25:1072–1076

    Google Scholar 

  15. Korovessis P, Pestsinis G, Koureas G, Zacharatos S (2005) Posterior transcanal lumbar interbody fusion for septic vertebral fracture pseudarthrosis and sitting imbalance. Spine 30:E255–E258

    PubMed  Article  Google Scholar 

  16. Owen PG, Willis BK, Benzel EC (1992) Torulopsis glabrata vertebral osteomyelitis. J Spinal Disord 5:370–373

    PubMed  CAS  Article  Google Scholar 

  17. Ozgen S, Naderi S, Ozek MM, Pamir MN (2004) A retrospective review of cervical corpectomy: indications, complications and outcome. Acta Neurochir (Wien) 146:1099–1105

    Article  CAS  Google Scholar 

  18. Parry MF, Grant B, Yukuna M et al (2001) Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 32:352–357

    PubMed  Article  CAS  Google Scholar 

  19. Pohjola-Sintonen S, Ruutu P, Tallroth K (1984) Hematogenous Candida spondylitis—a case report. Acta Med Scand 215:85–87

    PubMed  CAS  Article  Google Scholar 

  20. Przybylski GJ, Sharan AD (2001) Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg 94(1 Suppl):1–7

    PubMed  CAS  Google Scholar 

  21. Rodriguez D, Pigrau C, Almirante B et al (2003) Vertebral osteomyelitis due to Candida spp [article in Spanish]. Enferm Infecc Microbiol Clin 21:568–570

    PubMed  Article  Google Scholar 

  22. Waldvogel FA, Medoff G, Swartz MN (1970) Osteomyelitis: a review of clinical features, therapeutic consideration, and unusual aspects. N Engl J Med 282:198–206

    PubMed  CAS  Article  Google Scholar 

  23. Wang YC, Lee ST (2001) Candida vertebral osteomyelitis: a case report and review of the literature. Chang Gung Med J 24:810–815

    PubMed  CAS  Google Scholar 

  24. Williams RL, Fukui MB, Meltzer CC et al (1999) Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. AJNR Am J Neuroradiol 20:381–385

    PubMed  CAS  Google Scholar 

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Correspondence to Rabi M Khazim.

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Khazim, R.M., Debnath, U.K. & Fares, Y. Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases. Eur Spine J 15, 1404–1410 (2006). https://doi.org/10.1007/s00586-005-0038-z

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  • DOI: https://doi.org/10.1007/s00586-005-0038-z

Keywords

  • Spinal osteomyelitis
  • Vertebral osteomyelitis
  • Candida albicans
  • Fungal infection