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Cryptococcal osteomyelitis of the spine
S Govender1, E Mutasa, A H Parbhoo
1Department of Orthopaedic Surgery, University of Natal, Durban, South Africa.
Abstract:
We have treated seven patients with cryptococcal spondylitis. Five presented with a neurological deficit and one was HIV-positive. Amphotericin-B and 5-flucytosine were used in five patients and ketoconazole was given orally in the remaining two. Three patients made a complete neurological recovery. Since these lesions mimic spinal tuberculosis, which is commonly seen in our environment, we draw attention to the importance of obtaining a tissue diagnosis.
Insights
Cryptococcal spondylitis, a fungal infection of the spine, can cause neurological deficits. Early tissue diagnosis is crucial for effective treatment and recovery, especially in endemic areas.
Area of Science:
- Infectious Diseases
- Neurology
- Neurosurgery
Background:
- Cryptococcal spondylitis is a rare but serious spinal infection.
- Neurological deficits are common presentations.
- Spinal tuberculosis is a frequent mimic in endemic regions.
Purpose of the Study:
- To report on the treatment and outcomes of cryptococcal spondylitis.
- To highlight the diagnostic challenges and importance of tissue biopsy.
Main Methods:
- Retrospective case series of seven patients with cryptococcal spondylitis.
- Treatment regimens included Amphotericin-B with 5-flucytosine or ketoconazole.
- Clinical and neurological outcomes were assessed.
Main Results:
- Five patients presented with neurological deficits; one was HIV-positive.
- Three patients achieved complete neurological recovery with treatment.
- Fungal infection mimicked spinal tuberculosis.
Conclusions:
- Cryptococcal spondylitis requires prompt diagnosis and treatment.
- Tissue diagnosis is essential to differentiate from spinal tuberculosis.
- Antifungal therapy can lead to neurological recovery.