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

Abstract

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.

Primary Spinal Infections in Patients With Hematologic Immunocompromising Conditions: A Systematic Literature Review

“…Close monitoring of their condition by their primary oncologists may explain why the diagnosis of PSI in this population was on average faster (29.3 days) compared with the 2 to 6 months’ delay observed by Waheed et al or with the 49.9 days’ delay observed by Pola et al 18 , 19 It is important to highlight that the lag time in diagnosis is correlated with higher rates of mortality and complications. 1 - 3 However, when considering that the extent of infection can be used as a proxy for severity of symptoms and the need for surgical intervention, the immunosuppressed state of this patient population may contribute to the higher number of patients who underwent surgery. In our cohort, 48.3% patients required surgery (14 of 29 patients) while Pola et al 20 reported that 22.75% (47 of 207 patients) of their cohort required surgical treatment.…”

“…Interventions include intravenous or oral antibiotics and more invasive surgical methods, such as abscess drainage or decompressive laminectomy for extensive infections. 1 - 3 …”

“…Interventions include intravenous or oral antibiotics and more invasive surgical methods, such as abscess drainage or decompressive laminectomy for extensive infections. [1][2][3] In this review, we focused on PSI patients with hematologic diseases, which included specifically sickle cell disease (SCD), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), multiple myeloma (MM), Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), alpha thalassemia, beta thalassemia, and hemolytic anemia. In each of these hematologic diseases, immunosuppression is often the result of both the disease and the regimens that are used to treat these conditions.…”