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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 >40 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.
Insights
Vertebral aspergillosis, a rare bone infection, often affects the lumbar spine, particularly in middle-aged men. Corticosteroid use is a key risk factor, with significant recovery rates but notable mortality.
Area of Science:
- Infectious Diseases
- Mycology
- Orthopedic Surgery
Background:
- Vertebral osteomyelitis is typically caused by bacteria, with fungal infections like aspergillosis being uncommon.
- Corticosteroid use is increasingly recognized as a predisposing factor for opportunistic infections.
Observation:
- This study reviews 39 cases of vertebral aspergillosis, with two additional cases involving lumbar vertebrae.
- The condition predominantly affects middle-aged males, with lumbar spine involvement being most frequent.
- Back pain is the primary symptom, and predisposing factors are present in a majority of patients.
Findings:
- Monomicrobial Aspergillus infections were observed in most cases.
- Elevated white blood cell counts and erythrocyte sedimentation rates were noted in a subset of patients.
- The overall recovery rate was 68.3%, with a mortality rate of 26.8%.
Implications:
- Early recognition and diagnosis of vertebral aspergillosis are crucial, especially in patients with risk factors like corticosteroid use.
- While medical management is primary, surgical intervention may be necessary in severe or refractory cases.
- Further research into optimal treatment strategies for this rare but serious infection is warranted.