Spinal Aspergillus Osteomyelitis

Abstract

Aspergillus species are uncommon etiologic agents of vertebral osteomyelitis. We describe two patients with lumbar vertebral aspergillosis precipitated by the use of corticosteroids and review 39 cases in the literature. The mean age of the population was 40.04 years. There was male predominance (78% of cases), mainly lumbar involvement (53.7%), and monomicrobial nature of infection; 65.8% of the patients had predisposing factors, while 34.1% had none. Back pain (53.6% of cases) was the predominant symptom, while neurological deficits were present in 29.2% of the patients. White blood cell counts were elevated in 12.2% of the patients, and erythrocyte sedimentation rates were ú40 mm/h in 39%. The overall recovery rate was 68.3%, and the mortality rate was 26.8%. Although aspergillus osteomyelitis is primarily treated medically, certain cases may require surgical intervention.The widespread use of broad-spectrum antibiotics, corticotreatment showed resolution of the brain lesions, and serial determinations of the erythrocyte sedimentation rate (ESR) resteroids, and chemotherapeutic drugs has led to an increased frequency of opportunistic infections. However, the occurrence vealed a return to normal values. Six months later, she was readmitted to the hospital with an acute exacerbation of asthma of these infections in the spinal column is uncommon. Aspergillus is an ubiquitous saprophytic fungus widely disseminated and treated with intravenous steroids. in the environment. Although aspergillus infection may affect Eight months later, she was readmitted to the hospital with normal individuals, it is extremely rare in the absence of immulow-grade fever and unbearable low-back pain. A chest roentnosuppression. We report two cases of vertebral aspergillus genogram was unremarkable. Laboratory examination showed osteomyelitis of the lumbar spine that were precipitated by an ESR of 60 mm/h and a WBC count of 7.3/mm 3 , with 73% intravenous steroid therapy for other systemic diseases. Other segmented cells and 19% lymphocytes. Blood cultures were previously reported cases of spinal aspergillosis are reviewed.negative. Plain roentgenograms demonstrated destruction of the end plates of L5 and S1 vertebrae. An MRI of the lumbar spine showed osteomyelitis and diskitis of the L5-S1 disk Methods space. A MEDLINE search of the English-, French-, and Spanish-The patient underwent laminectomy with open biopsy of the language literature from 1966 to August 1998 and review of disk space and spinal fusion. Pathological examination of a reference lists for additional cases before 1966 yielded 39 cases biopsy specimen showed osteomyelitis with scattered giant of proven vertebral aspergillus osteomyelitis (tables 1 and 2). multinucleate cells containing particles of retractile material. Cases with radiological, gross, or histopathologic evidence of Grocott-Gomori methenamine -silver nitrate staining revealed vertebral aspergillus osteomyelitis were included in the review.fungal hyphae that were septated and branching at about 45Њ The a...

A rare etiology of cauda equina syndrome

“…Itraconazole is a newer drug which is given orally and is well tolerated. A few authors have reported good results with the use of itraconazole in spinal aspergillosis [5][6][7]21]. The patient presented here was also treated by oral itraconazole and responded well without any signs of toxicity.…”

“…It has been suggested that, when the only symptom is back pain without significant instability or neural compression, medical treatment alone is sufficient. When spinal instability or symptoms of spinal cord or radicular compression are present, surgical decompression is indicated [21].…”

Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient:case report

“…Eismont et al reported fungal organisms as the agent in 61 cases in the retrospective vertebral infection study they carried out (14). Vinas et al (15) in their systematic compilation stated that A.fumigatus was the agent in 71% of the 39 vertebral infections caused by Aspergillus types in the literature of 1966-1998. Vinas et al (15) detected underlying diseases including hematological malignancy, chronic granulamatosis, organ transplantation, corticosteroid use, surgical intervention history, tuberculosis in most of the patients in their study, while no immunosuppressants were reported in three patients as in our case.…”

“…Vinas et al (15) in their systematic compilation stated that A.fumigatus was the agent in 71% of the 39 vertebral infections caused by Aspergillus types in the literature of 1966-1998. Vinas et al (15) detected underlying diseases including hematological malignancy, chronic granulamatosis, organ transplantation, corticosteroid use, surgical intervention history, tuberculosis in most of the patients in their study, while no immunosuppressants were reported in three patients as in our case. Fibrous dysplasia and Aspergillus infections may interfere in the clinical diagnosis (16), however in our case there was a coexistence of Aspergillus infection and fibrous dysplasia.…”

Vertebral Aspergillosis in a Patient with Autosomal-Dominant Hyper-IgE Syndrome

“…However, Soler-Palacin et al (10) found that for patients aged 5 years and older, the median intravenous dose needed to achieve therapeutic levels was 15 mg kg Ϫ1 day Ϫ1 . Surgery is generally required when there is evidence of spinal cord (nerve root) compression or vertebral bony destruction (7,9).…”