Invasive pulmonary aspergillosis with Aspergillus vertebral osteomyelitis in an HIV-infected adult: a case report

Senosain-Leon, Valeria; Hidalgo-Benites, Aida; Arriola-Montenegro, José; D'Angelo-Piaggio, Lorenzo; Beas, Renato

doi:10.1177/0956462419865403

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…Most patients suffer from impaired immune function or chronic diseases (due to AIDS, organ transplantation, chemotherapy or immunosuppressive therapy, etc.] [2,10]; however, patients with normal immune function but predisposing factors (pulmonary aspergillosis, tuberculosis, discectomy, diabetes, chronic obstructive pulmonary disease, fungal heart disease, endometritis, etc.) may also be affected [11,12].…”

Section: Discussionmentioning

confidence: 99%

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Aspergillus spondylitis: case series and literature review

Dai

Wang

Yin

et al. 2020

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

“…Aspergillus is a saprophytic fungus that mainly inhabits soil and plants [1]. Aspergillosis is an opportunistic infection that mainly affects the respiratory tract and can be spread through blood contact [2]. Severe neutropenia, glucocorticoid use, transplantation and other immunosuppressive conditions may lead to invasive infections [3].…”

Section: Introductionmentioning

confidence: 99%

Aspergillus spondylitis: case series and literature review

Dai

Wang

Yin

et al. 2020

BMC Musculoskelet Disord

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“…35 This important association should be emphasized because of the increased number of immunocompromised patients during the last decades. 37,38 Moreover, considering that Aspergillus is the most common infection in solid organ transplant recipients, [39][40][41] it is important to highlight that any new back pain should raise suspicion of vertebral infection in this population. Our review yielded a relatively higher rate of postoperative complications in the 18 patients who received surgical intervention (33.6%; n 5 6) and a mortality rate of 17.5% (n 5 7).…”

Section: Lessonsmentioning

confidence: 99%

Primary spinal infections in patients with solid organ transplant: a systematic literature review and illustrative case

Hatter¹,

Beyer²,

Camino-Willhuber³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Primary spinal infections (PSIs) are a group of uncommon but serious infectious diseases considered more prevalent and aggressive among patients with chronic immunocompromised states. Association of PSI and solid organ transplant has not been systematically analyzed. The authors performed a systematic review analyzing clinical presentation and mortality of patients with PSI in the setting of solid organ transplant. OBSERVATIONS PSIs in patients with immunosuppressive therapy, such as those with solid organ transplant, may behave differently in terms of epidemiology, clinical presentation, and outcomes compared with nonimmunosuppressed patients. Overall PSI in solid organ transplant patients is associated with a high rate of neurological compromise, postoperative complications, and mortality. LESSONS Accurate diagnosis and appropriate treatment of PSI require a multidisciplinary effort. Localized pain is the most frequently reported symptom associated with PSI. As opposed to PSI in patients without transplant, inflammatory and infectious markers such as white blood cells and C-reactive protein are often not elevated. Furthermore, the causative microorganism profile varies significantly when compared to pyogenic spinal infection in patients without transplant. Aspergillus species was responsible for spondylodiscitis in transplant patients in more than 50% of cases, and the incidence of Aspergillus infection is projected to rise in the coming years.

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“…Ежегодно в мире регистрируется до 200 тыс. случаев инвазивного аспергиллеза, при этом на долю поражений позвоночника приходится не более 0,5-1,6 % [7].…”

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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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Invasive pulmonary aspergillosis with Aspergillus vertebral osteomyelitis in an HIV-infected adult: a case report

Cited by 11 publications

References 11 publications

Aspergillus spondylitis: case series and literature review

Aspergillus spondylitis: case series and literature review

Primary spinal infections in patients with solid organ transplant: a systematic literature review and illustrative case

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

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