Related Experiment Videos
Candidal vertebral osteomyelitis: report of 6 patients, and a review
L Hendrickx1, E Van Wijngaerden, I Samson
1Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium.
Abstract:
The incidence of deep-seated candidal infection is increasing, but candidal vertebral osteomyelitis is still rare. We describe 6 patients recently treated in our hospital. Conservative treatment failed in all. We reviewed the literature and identified 59 additional cases of candidal vertebral osteomyelitis. Candidemia was documented in 61.5% of them. The interval between the diagnosis of candidemia and the onset of symptoms of vertebral osteomyelitis varied widely, from days to >1 year. In patients without documented candidemia, there was a similar interval between the occurrence of risk factors for candidemia (present in 72% of the patients) and the onset of symptoms of vertebral osteomyelitis. Clinical, laboratory, and radiological findings are not specific for candidal spondylodiskitis. Final diagnosis is determined by means of culture of a biopsy specimen from the infected vertebra or disk. Treatment consisted of prolonged antifungal treatment, and it often included surgery. On the basis of our experience (for all 6 patients, initial conservative treatment with only antifungals failed), we recommend consideration of early surgical debridement in combination with prolonged antifungal therapy.
Insights
Candidal vertebral osteomyelitis, though rare, requires prompt diagnosis and treatment. Early surgical debridement combined with antifungal therapy is recommended for better outcomes in deep-seated candidal infections.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Medical Mycology
Background:
- Deep-seated candidal infections are rising, with candidal vertebral osteomyelitis being a rare but serious manifestation.
- Understanding the diagnostic challenges and treatment outcomes for this condition is crucial.
Observation:
- Six recent hospital cases of candidal vertebral osteomyelitis were analyzed, alongside a literature review of 59 additional cases.
- Candidemia preceded vertebral infection in 61.5% of cases, with variable time intervals.
- Risk factors for candidemia were present in 72% of patients without documented candidemia.
Findings:
- Clinical, laboratory, and radiological findings are non-specific for candidal spondylodiskitis.
- Diagnosis relies on fungal culture from biopsy specimens of infected vertebrae or discs.
- Initial conservative treatment with antifungals alone failed in all observed cases.
Implications:
- Early surgical debridement in conjunction with prolonged antifungal therapy is recommended.
- This combined approach may improve outcomes for patients with candidal vertebral osteomyelitis.
- Further research into optimal treatment strategies for this rare infection is warranted.