Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970-2011)

Abstract

Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6-12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome.

Candida arthritis in a patient diagnosed with spondyloarthritis

“…Secondary destruction of articular cartilage and progressive bone deformity can occur; therefore, early detection and therapy are essential to prevent signifi cant morbidity. Because there are no specifi c clinical or radiologic fi ndings of Candida arthritis, only an appropriate culture permits diagnosis (7) (8) . Because of the persistency of the arthritis, despite conventional medical and interventional treatment for infl ammatory arthritis, the synovial fl uid is examined closely and repeatedly.…”

Diagnostic Radiology

“…The most common abnormalities include bone destruction, soft tissue extension/ swelling, intervertebral space/joint space narrowing, and epidural abscesses. Hypointense MRI images on T1WI as well as hyperintense images on T2WI were noted [102]. Irregularities of subchondral bone have also been noted [103].…”

Clinical and Laboratory Diagnosis

“…Another study, by Lavery et al, showed that of over 151 patients with lower extremity infections, the ratio was nearly equal, at 52 % male [ 11 ]. However, fungal osteomyelitis has been reported to have a statistically signifi cant male dominance [ 12 ]. Gender should not be considered an independent risk factor and osteomyelitis can affect anyone.…”

“…Other medical conditions resulting in immunosuppression, organ transplants, or any condition that alters neutrophil defense, humoral immunity or cell-mediated immunity, can increase susceptibility to infection and increase the risk of undiagnosed osteomyelitis. Additionally, those with chronic immunosuppression are more likely to be diagnosed with fungal originated osteomyelitis [ 12 ]. Circulation disorders are another risk factor that may decrease host immune response and increase the potential of a deep infection.…”

“…Immunosuppressive medications and medications that can mask symptoms of acute osteomyelitis include corticosteroids, tumor necrosis factor (TNF) inhibitors, antibiotics, chemotherapy agents, and more [ 12 ]. Different environmental settings are associated with a greater prevalence of osteomyelitis in certain patient subsets.…”