Aspergillus spondylitis: case series and literature review

Abstract

Background: Spinal fungal infections, especially spinal Aspergillus infections, are rare in the clinic. Here, we introduce the clinical features, diagnosis, treatment, and prognoses of 6 cases of Aspergillus spondylitis. Methods: We retrospectively analysed the complete clinical data of patients with Aspergillus spondylitis treated in our hospital from January 2013 to January 2020. Results: Aspergillus fumigatus was isolated in 4 cases, and Aspergillus spp. and Aspergillus niger were isolated in 1 case each. All six patients reported varying degrees of focal spinal pain; one patient reported radiating pain, one patient experienced bowel dysfunction and numbness in both lower limbs, and three patients had fever symptoms. One case involved the thoracic spine, one case involved the thoracolumbar junction, and 4 cases involved the lumbar spine. Three patients were already in an immunosuppressed state, and three patients entered an immunosuppressed state after spinal surgery. All six patients were successfully cured, and five required surgery. Of the 5 patients who underwent surgical treatment, 2 had spinal cord compression symptoms, and 3 had spinal instability. At the end of follow-up, 1 patient reported left back pain and 1 patient reported left limb numbness. Conclusion: The clinical manifestations of Aspergillus spondylitis are non-specific, and the diagnosis depends on typical imaging findings and microbiological and histopathological examination results. When there is no spinal instability, spinal nerve compression symptoms, or progressive deterioration, antifungal therapy alone may be considered. If spinal instability, spinal nerve compression, or epidural abscess formation is present, surgery combined with antifungal therapy is recommended.

A Rare Case of Aspergillus Spondylodiscitis In B-Cell Acute Lymphoid Leukemia

“…Histopathological investigation and bacterial culture are the most reliable diagnosis procedures for Aspergillus spondylitis. Diagnostic imaging, such as CT and/or MRI, is necessary for disease staging and guiding orthopaedic and/or neurosurgical intervention [2,4,7]. In our case, the patient is known ALL, and radiological findings suggested infective spondylodiscitis at L4-L5.…”

“…Although Aspergillus spondylodiscitis is an uncommon opportunistic fungal infectious illness, it has recently overtaken Candida spondylitis in terms of occurrence. It most commonly arises in an immunocompromised host as a result of AIDS, organ transplantation, chemotherapy, or immunosuppressive medication, among other factors [2,7]. The patient in this case was immunocompromised, and the predominant focus of Aspergillus appeared to be pulmonary.…”

“…Invasive aspergillosis can migrate from the lungs to the brain, kidneys, heart, and bones, with the spine being a main target. It is frequently misdiagnosed at first presentation because to its potentially delayed start and non-specific clinical symptoms [2]. Medical therapy alone or surgery with medical therapy is the mainstay of treatment [3,4].…”

Fungal infections of spine: Case series during the COVID times

“…The incidence of spondylodiscitis varies from 1 per 100,000/year to 1 per 250,000/year [ 3 ]. These infections reported are common in males involving the lumbar spine commonly [ 1 , 3 , 4 ]. Likewise, all the three cases in this scenario were males, lumbar spine being involved.…”

An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary)

“…Most cases with Candida spondylitis have been reported in adults [ 75 , 76 ], with the lower thoracic and lumbar spine representing the most commonly affected regions (⁓95%); involvement of the cervical spine seems to be uncommon [ 72 – 74 ]. Similar to Candida spondylitis, vertebral osteomyelitis due to Aspergillus species occurs predominantly in the thoracic and lumbar regions; the disease scarcely affects the cervical spine [ 72 , 74 , 77 , 78 ]. Both candidiasis and aspergillosis can cause vertebral body destruction and collapse with subsequent kyphosis formation [ 62 ]; and therefore, they cannot be completely rejected as diagnostic options in S0603 .…”