Aspergillus Spondylodiscitis in an Immunocompetent Patient following Spinal Anesthesia

Shashidhar, Nandeesh; Trıpathy, Sujit Kumar; Balasubramanian, Sakthivel; Dhanakodi, Naresh; Venkataramaiah, Sathyanarayana

doi:10.1111/os.12091

Cited by 8 publications

(4 citation statements)

References 14 publications

(31 reference statements)

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“…The initial MRIs in our case, however, showed no signal changes in the adjacent disc, consistent with the MR findings of fungal spondylodiscitis in previous studies (Williams et al, 1999;Shashidhar et al, 2014;Storm et al, 2014). This explains why our case was at first misdiagnosed as a vertebral tumor.…”

Section: Discussionsupporting

confidence: 75%

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Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis

Feng

Wang

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:To report a rare case of fungal spondylodiscitis in a patient recovered from H7N9 virus infection and perform a literature review of the different characteristics of Candida and Aspergillus spondylodiscitis, we reviewed cases of spondylodiscitis caused by Candida and Aspergillus species. Data, including patients' information, pathogenic species, treatment strategy, outcomes, and relapses, were collected and summarized. The characteristics of Candida and Aspergillus spondylodiscitis were compared to see if any differences in clinical features, management, or consequences could be detected. The subject of the case study was first misdiagnosed as having a vertebral tumor, and then, following open biopsy, was diagnosed as having fungal spondylodiscitis. The patient made a good recovery following radical debridement. Seventy-seven additional cases of Candida spondylodiscitis and 94 cases of Aspergillus spondylodiscitis were identified in the literature. Patients with Candida spondylodiscitis tended to have a better outcome than patients with Aspergillus spondylodiscitis (cure rate 92.3% vs. 70.2%). Candida was found more frequently (47.8%) than Aspergillus (26.7%) in blood cultures, while neurological deficits were observed more often in patients with Aspergillus spondylodiscitis (43.6% vs. 25.6%). Candida spinal infections were more often treated by radical debridement (60.5% vs. 39.6%). Patients with Candida spondylodiscitis have better outcomes, which may be associated with prompt recognition, radical surgical debridement, and azoles therapy. A good outcome can be expected in fungal spondylodiscitis with appropriate operations and anti-fungal drugs.

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Section: Discussionsupporting

confidence: 75%

“…Biopsy or open surgery should be performed immediately when anti-bacterial or anti-TB treatments fail to control the symptoms. However, biopsy sometimes cannot provide an accurate answer (Palmisano et al, 2011;Shashidhar et al, 2014). A non-diagnostic aspirate should prompt an open biopsy for pathogen cultures and pathological examinations.…”

Section: Discussionmentioning

confidence: 99%

Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis

Feng

Wang

et al. 2016

J. Zhejiang Univ. Sci. B

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“…В структуре сопутствующей патологии, регистрируемой у пациентов с аспергиллезом позвоночника, превалируют иммунодефицитные состояния как на фоне иммуносупрессивной терапии после трансплантации органов (3 наблюдения), так и при первичных онкогематологических заболеваниях (5 наблюдений) [10,15,19,26,27,29,30,32].…”

Section: результаты и их обсуждениеunclassified

Spinal aspergillosis: a rare clinical case and review of the literature

et al. 2023

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Objective. To analyze long-term results of treatment of a patient with recurrent lumbar aspergillosis and to systematize the literature data.Material and Methods. Long-term follow-up results of treatment of recurrent Aspergillus spondylitis in a 48-year-old patient who underwent primary surgery for reconstruction of the anterior spinal column through the anterior approach were studied. Literature data on the treatment of spinal aspergillosis from 2000 to 2022 were systematized.Results. The key method for the etiological verification of spinal aspergillosis is percutaneous bone biopsy from the lesion, followed by histological and bacteriological examination of the material. Isolated anterior spinal column reconstruction through the anterior approach ensures the achievement of local control of the infection process, but a short course of antimycotic chemotherapy after surgery is a factor of disease recurrence. The optimal duration of antimycotic chemotherapy in the postoperative period is at least 3 months, with voriconazole being the drug of choice.Conclusion. Spondylitis caused by Aspergillus spp. is a special form of inflammatory spine disease requiring obligatory percutaneous bone biopsy for etiological verification. A multidisciplinary therapeutic approach including a course of conservative antimycotic therapy for at least 3 months, surgical debridement and reconstruction of the affected spinal motion segments provide the best clinical results.

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“…After reviewing all English language reports of fungal osteomyelitis involving the spine since 2010, a minimum of 40 related cases were identified (Table2). Among them, infections included 19 (47.5%) cases of Candida[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], 10 (25.0%) of Aspergillus[21,22,29,[38][39][40][41][42][43][44], 6 (15%) of Cryptococcus[45][46][47][48][49][50], 2 (5%) cases of Blastomyces[51,52], and 4 (10.0%) cases involving other microorganisms[22,[53][54][55]. M. restricta, an opportunistic fungal pathogen, is implicated in various human skin disorders including tinea versicolor, seborrheic dermatitis/dandruff, atopic dermatitis, folliculitis, and psoriasis…”

mentioning

confidence: 99%

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

Peng,

Lin,

Zou

et al. 2024

BMC Infect Dis

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Background Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports. Case presentation A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up. Conclusions M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

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Aspergillus Spondylodiscitis in an Immunocompetent Patient following Spinal Anesthesia

Cited by 8 publications

References 14 publications

Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis

Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis

Spinal aspergillosis: a rare clinical case and review of the literature

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

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