Fungal spondylodiscitis due to Candida albicans: an atypical case and review of the literature

Kulcheski, Álynson Larocca; Graells, Xavier Soler i; Benato, Marcel Luiz; Santoro, Pedro Grein Del; Sebben, André Luís

doi:10.1016/j.rboe.2015.10.005

Cited by 7 publications

(9 citation statements)

References 10 publications

(7 reference statements)

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“…MRI is the best imaging modality for spondylodiscitis; it delineates early erosive bony changes consisting of hypointensities in the vertebral bodies on T1-weighted images, the absence of disc hyperintensity, and preservation of the intranuclear cleft in the disc on T2-weighted images. [3,5,6] Plain radiographs and CT spinal images may later detect vertebral abnormalities in conjunction with Candida spondylodiscitis. The definitive diagnosis typically requires image-guided biopsy, surgery, and/or direct documentation with fungal studies.…”

Section: Discussionmentioning

confidence: 99%

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Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature

Huang

Kappel

Peterson

et al. 2019

Surgical Neurology International

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Background: Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis. Case Description: A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew Candida albicans. Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew C. albicans. The patient was treated with intravenous micafungin for 14 days followed by 6–12 months of 400 mg oral fluconazole daily. Conclusion: There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.

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Section: Discussionmentioning

confidence: 99%

“…The definitive diagnosis typically requires image-guided biopsy, surgery, and/or direct documentation with fungal studies. [4,5]…”

Section: Discussionmentioning

confidence: 99%

Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature

Huang

Kappel

Peterson

et al. 2019

Surgical Neurology International

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“…osteomiyeliti subakut veya kronik seyir gösterebilmektedir [7,53] . Erişkinde osteoartiküler sistemde en sık etkilenen bölge vertebralar olup sıklıkla lomber bölge tutulmaktadır [7,38] . Kandida vertebra tutulumunda, genellikle intervertebral diskin merkezine yerleşerek disk kıkırdağının daralmasına neden olur.…”

Section: Kandidaunclassified

“…Kandida osteomiyelitinde cerrahi debridman sıklıkla antifungal tedavi ile birlikte yapılır [4,52,67] . Özellikle cerrahi tedavi vertebral osteomiyelitte, medikal tedavi altında nörolojik defisiti gelişen, vertebral instabilite olan, büyük apseleri veya kötüleşen semptomları olan hastalarda endikedir [7,13,14,38] . IDSA 2016'da kandida kılavuz güncellemesinde de seçilmiş hastalarda, cerrahi tedavi güçlü öneri, düşük kanıt düzeyinde önerilmiştir [3] .…”

Section: Mi̇ka→ Flkunclassified

Osteoarticular Candida Infection: Case Reports and Literature Review

Aksoy¹,

Aydın²,

Ertuğrul³

et al. 2019

mjima

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Funguslara bağlı kemik eklem enfeksiyonları nadirdir. Kandida türlerine bağlı osteomiyelit de oldukça nadir görülen bir durumdur. Etken olarak en sık Candida albicans görülür, ancak son yıllarda non-albicans Candida'ların da osteomiyelitlerde sıklığının arttığı bildirilmektedir. Bu yazıda nonalbicans Candida osteomiyeliti olan üç olgu sunuldu. Osteoartiküler tutuluma bakıldığında olguların birinde lomber vertebra, birinde el, diğerinde ise ayak osteomiyeliti vardı. Olguların üçünde diabetes mellitus ve uzun süreli antibiyotik kullanımı ortak risk faktörleriydi. Vertebral osteomiyelit olan olguda ayrıca cerrahi girişim ve yabancı cisim varlığı diğer risk faktörleriydi. Olguların tanısında manyetik rezonans görüntüleme kullanıldı ve alınan derin doku kültüründe etken izole edildi. Tüm olgulara cerrahi debritman yapılarak altı hafta ile 24 hafta arasında değişen sürede antifungal tedavi verildi. Olgularda klinik ve radyolojik takiplerde enfeksiyon tekrarlamadı. Ayağında osteomiyeliti olan olgu akut serebrovasküler hastalık nedeni ile eksitus oldu. Çalışmamızda Nisan 2010-Haziran 2019 tarihleri arasında osteoartiküler Candida enfeksiyonu ile ilgili literatür taraması yapıldı ve 44 olgu derlendi. Çalışmamızda bu olguları sunmadaki amacımız, kandidaya bağlı osteoartiküler enfeksiyonlara dikkati çekmek ve etken tanımlanmasıyla hedefe yönelik tedavinin önemini vurgulamaktır. Anahtar Kelimeler: Spondilodiskit, flukonazol, kaspofungin, sistematik derleme, lipozomal amfoterisin b Fungal infections in the bones and joints are rare. Candida spp. osteomyelitis is also a very rare entity. The most common pathogen is Candida albicans, but an increase in the incidence of non-albicans Candida osteomyelitis has been reported in recent years. Herein, we present three patients with non-albicans Candida osteomyelitis. Osteoarticular involvement occurred in the lumbar vertebrae in one patient, in the hand in one patient, and the foot in the other patient. Diabetes mellitus and long-term antibiotic use were common risk factors in all three cases. In the patient with vertebral osteomyelitis, surgical intervention and foreign body were other risk factors. Magnetic resonance imaging was used in the diagnosis and the pathogens were isolated from deep tissue cultures. Surgical debridement was performed in all cases and antifungal treatment was given for 6-24 weeks. There was no reinfection or relapse during clinical and radiological follow-up. The patient with osteomyelitis of the foot died due to to acute cerebrovascular disease. In our study, the literature review for publications related to osteoarticular Candida infection was made between April 2010 and June 2019 and 44 cases are reviewed. Our aim in this study was to draw attention to Candida osteoarticular infections and to emphasize the importance of targeted treatment by defining the pathogen.

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“…Spinal infections are rare, representing around 1% of all bone infections and comprising <2 per 10,000 of all hospitalizations in tertiary care centers (1,2). Factors associated with this disease include diabetes, renal disease on dialysis, cirrhosis, chronic immunosuppression, AIDS, and intravenous drug users (2).…”

mentioning

confidence: 99%

Case Report: SARS-CoV-2 Infection—Are We Redeemed? A Report of Candida Spondylodiscitis as a Late Complication

et al. 2021

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Background: We describe a case of candida spondylodiscitis secondary to coronavirus disease (COVID-19).Case report: A 47-year-old man diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) required prolonged admission to the intensive care unit (ICU). Four months later, he was diagnosed with thoracic candida spondylodiscitis. Medical management was insufficient, so he eventually underwent surgery.Discussions: Fungal infections seem to be more likely in patients with COVID-19, but it is unknown whether they are directly attributed to COVID-19 or other surrounding factors. Regardless of the answer, the diagnosis is complicated, and the mortality rate is high.Lessons: COVID-19 is posing a challenge to the society, and new and unexpected diseases that had once disappeared have risen again. It is our duty to suspect them and to treat them in the most effective way possible.

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Fungal spondylodiscitis due to Candida albicans: an atypical case and review of the literature

Cited by 7 publications

References 10 publications

Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature

Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature

Osteoarticular Candida Infection: Case Reports and Literature Review

Case Report: SARS-CoV-2 Infection—Are We Redeemed? A Report of Candida Spondylodiscitis as a Late Complication

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