Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review

Abstract

Objective Vertebral aspergillosis is quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy, and sometimes, surgical treatments. The present investigations were aimed to investigate the epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis. Methods A systematic review of the pertinent English literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed, and Scopus using as search-terms “Aspergillus,” “vertebral osteomyelitis,” “spondylodiscitis,” “spine infection.” A case of vertebral aspergillosis conservatively managed was also reported. Results Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at the last follow-up evaluation; in 7 patients (6.3%) radiological signs of chronic infection were reported, whereas 32 patients (28.8%) died during the follow-up. Conclusion This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives, and their outcomes.

Spondylodiscitis Caused by Aspergillus Species

“…Fungal spondylodiscitis represents a rare and severe life-threatening clinical entity, requiring long-term medical, and, often, surgical treatment [1,3,83]. Aspergillosis represents a rare disease, as its incidence is 12 cases per year/1,000,000 people [91].…”

“…The mean time interval between symptoms' onset and diagnosis was 5.7 months. Fungal infections usually have an insidious onset with non-specific symptoms, and, therefore, diagnosis may be delayed [3,94,95].…”

“…The severity of Aspergillus infections may require also surgical intervention, as has occurred in some of the reviewed cases [3,61,83]. Vertebral instability, neurological deterioration, and the infection's progression during the course of antifungal therapy should be closely observed and carefully considered as criteria for surgical intervention.…”

“…Vertebral Aspergillosis may be presented with osteolytic radiological findings, intervertebral disc lesions, and epidural space collections. Immunocompromised patients, such as solid organ recipients, patients with hematologic malignancies, those with severe neutropenia, and those receiving high-dose steroids are the more susceptible to invasive aspergillosis [1,3]. The disease may result in neurological deficit and spinal deformities [3].…”

“…Early diagnosis, achieved by cultures and/or histopathology after direct sampling and proper therapy are of paramount importance regarding diagnosis and management [1,3]. All patients require causative antifungal treatment (AFT) and many of them additional surgical intervention [1][2][3]. Few Aspergillus spondylodiscitis cases can be found in the literature.…”