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Fungal Infections of the Spine.
Devin Ganesh1, Jonathan Gottlieb, Sherilynn Chan
1From the *Orlando Health Orthopaedics Department, Orlando, FL †Department of Orthopaedics, University of Miami, Miami, FL ‡University of Miami, Coral Gables, FL.
Spine
|March 28, 2015
Summary
Fungal spine infections are increasing, with Aspergillus and Candida being most common. Combination antifungal therapy and surgery improve survival rates, especially for Aspergillus and Candida infections, compared to medical management alone.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Mycology
Background:
- Fungal spine infections pose significant challenges to treatment teams.
- The incidence of these infections has been rising over recent decades.
- Evidence-based treatment guidelines are limited, often relying on small case series.
Purpose of the Study:
- To determine the frequency of fungal species causing spinal infections.
- To analyze treatment algorithms employed for these infections.
- To evaluate treatment outcomes and survival rates.
Main Methods:
- A comprehensive literature review was conducted using MEDLINE, Scopus, and EMBASE databases.
- Peer-reviewed articles published between 1948 and September 2010 were included.
- Data from case reports, series, and reviews were compiled into a database.
Main Results:
- A total of 157 cases from 130 articles were analyzed.
- Aspergillus (38.2%) and Candida (22.9%) were the most frequent fungal pathogens.
- Surgical intervention combined with antifungal therapy demonstrated higher survival rates for Aspergillus and Candida infections compared to medical management alone.
Conclusions:
- Aspergillus is the predominant pathogen in published spinal fungal infections.
- Newer antifungal agents, such as azoles, are associated with improved survival rates.
- Combined surgical and antifungal treatment offers the best survival outcomes for Aspergillus and Candida spinal infections.
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