Candidal Vertebral Osteomyelitis: Report of 6 Patients, and a Review

Hendrickx, Lucas; Wijngaerden, Eric Van; Samson, Ignace; Peetermans, WE

doi:10.1086/318714

Cited by 66 publications

(60 citation statements)

References 44 publications

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“…5 Even though much less common, physicians must take into account the possibility of fungal infections, which typically present as a result of Candidemia with the delayed complication of spondylodiscitis several months later. 16 Rankine and colleagues stressed the importance of attaining fungal cultures in that Candida was isolated in 1 patient after treatment with flucloxacillin. 21 Our study also supports this finding, with 1 of 16 positive samples yielding Candida.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Garg

Kosmas

Young

et al. 2014

FOC

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Object Vertebral osteomyelitis has been reported to occur in approximately 0.2–2 cases per 100,000 annually. Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies. Different imaging modalities, from radiography and CT scanning to nuclear medicine imaging and contrastenhanced MRI, can be employed to evaluate for osteomyelitis. Although MRI has a strong sensitivity and specificity for vertebral osteomyelitis, obtaining histological and microbiological samples remains the gold standard in diagnosis. Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases. However, recent reports have questioned the percentage yield of image-guided percutaneous biopsy even when there is a high clinical suspicion for vertebral osteomyelitis. Methods After obtaining institutional review board approval, the authors performed a chart review of patients who had undergone image-guided percutaneous bone biopsies at University Hospitals Case Medical Center in Cleveland, Ohio. Data were filtered for patients in whom a biopsy sample of a vertebral body/disc was obtained. A total of 213 procedures were performed, of which clinicians indicated a concern for infection in 84, infection or neoplasm in 13, and a noninfectious etiology (the majority being neoplasms) in the remaining 116. Results Histological examination provided positive results in 25 (41.0%) of the 61 samples collected for suspected cases of osteomyelitis. Microbiology samples were less predictive, with only 16 of the 84 samples collected, or 19.0%, yielding a positive result. In 10 patients there were positive blood and/or urine cultures. Of these, 8 samples (80%) demonstrated the same pathogen identified by biopsy (for the remaining 2 positive systemic cultures, no pathogen was identified by the percutaneous intervention). In other words, half of the 16 cases that provided microbiological results from biopsy demonstrated the same results by systemic cultures. However, 89 (76.7%) of the 116 samples collected with the primary concern of neoplasm yielded results. Conclusions Image-guided percutaneous biopsy for vertebral osteomyelitis demonstrates an extremely low probability of identifying specific microbes. Blood or urine cultures concurrently identified culprit pathogens in 50% of positive biopsy cultures. Therefore, in only 8 (9.5%) of 84 biopsies did the biopsy results provide additional information to clinicians as to the pathological microorganism present and how treatment might need to be adjusted.

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Section: Discussionmentioning

confidence: 99%

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Garg

Kosmas

Young

et al. 2014

FOC

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“…Some authors reported that Candida spondylodiscitis could be successfully treated by the only antifungal therapy with amphotericin B and fluconazole 1,4) . To the contrary, in the their review of published literatures, Hendrickx et al 3) advocated surgical debridement soon after diagnosis of Candida spondylodiscitis is established. Half of the patients underwent surgical treatment in the reported cases and 33% of the patients who initially had received only medical treatment subsequently required surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spondylodiscitis Caused by Candida Albicans in Non-Immunocompromised Patient

Moon

Kim

Moon

et al. 2008

J Korean Neurosurg Soc

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“…The type of fungal pathogen most frequently seen in vertebral osteomyelitis is "candida albicans". Less frequently seen strains are Candida tropicalis, Candida glabrata and Candida parapsilosis [8,13]. In vertebral osteomyelitis most affected bones are lumbar vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…In vertebral osteomyelitis most affected bones are lumbar vertebrae. Chronic progressive back pain is the only symptom and fever is absent in most patients [13]. Blood count values are usually normal, however sedimentation rate is high in almost all cases.…”

Section: Discussionmentioning

confidence: 99%

Bone scintigraphy in acute myeloid leukemia patient with fungal vertebral osteomyelitis

Hasbek¹,

Erselcan²,

Turgut³

et al. 2013

CMJ

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The result of the magnetic resonance imaging (MRI) study was reported as "metastasis of primary disease on L2-L3 vertebrae" in a 63-year-old male patient, who developed a back pain after receiving four courses of treatment for AML. The patient, who did not respond to pain medication, was sent to nuclear medicine department for a bone scintigraphy. Diffuse increased osteoblastic activity was reported on L2-L3 vertebrae with a suspicion about infection or fracture, together with a focal osteoblastic activity involvement in the right sacroiliac joint in the bone scintigraphy which was made with Tc99m-MDP. In the mean time, the patient complained about progressive loss of strength on bilateral lower extremities and numbness in legs. Repeated MRI was reported as "irregularities in L2-L3 vertebral disc region concordant with infection, prominent thecal pressure, loss of height in L2-L3 vertebrae associated with osteomyelitis and a mass concordant with paravertebral abscess and granulation tissue". The patient was operated and necrotic tissue was removed by curettage, relieving the compression on L2-L3 and on the disc distance. In culture examination of the sample "candida albicans" was isolated. Antifungal treatment with Amphotericin B was started. Patient's pain was reduced and MRI findings showed some regression in abscess following the treatment. There was improvement in neurological examination. However, relapse in AML was observed in bone marrow aspiration, performed during follow-up and chemotherapy was started again. On the second day of chemotherapy high fever started and cellulitis developed on the right leg. The patient received hemodialysis treatment due to increase in BUN and creatinine levels. Pulmonary edema and associated respiratory insufficiency was developed and the patient died. Fungal infections are one of the most important clinical problems in leukemia patients. However, vertebral osteomyelitis secondary to fungal infection is relatively a rare condition and delay in diagnosis and treatment may led to serious neurological problems. Suspection of a probable fungal infection by clinicians seems vital in such cases. Bone scintigraphy has no place in routine evaluation of leukemia patients. However, we consider that bone scintigraphy should be kept in mind in the first stage of evaluation of such cases, together with other radiological examination, we think that evaluation with consideration of three-phase bone scintigraphy would be beneficial.Keywords: Candida, acute myeloid leukemia, bone scintigraphy, vertebrae osteomyelitis ÖzetAkut miyeloid lösemi (AML) nedeni ile 4 kür tedavi aldıktan sonra, bel ağrısı gelişen 63 yaşındaki erkek hastada yapılan MR incelemesi raporu "L2-L3 vertebrada primer hastalığın metastazı" idi. Ağrı medikasyonlarına yanıt alınamayan hasta, nükleer tıp bölümüne kemik sintigrafisi için gönderildi. Tc-99m MDP ile yapılan kemik sintigrafisinde, enfeksiyon veya kırık şüphesi uyandıran, L2-L3 vertebralarda diffüz osteoblastik aktivite artışları bununla birlikte, sağ sakr...

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Candidal Vertebral Osteomyelitis: Report of 6 Patients, and a Review

Cited by 66 publications

References 44 publications

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Cervical Spondylodiscitis Caused by Candida Albicans in Non-Immunocompromised Patient

Bone scintigraphy in acute myeloid leukemia patient with fungal vertebral osteomyelitis

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