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Published on: May 23, 2021
Candida Spondylitis Considered as Microbial Substitution After Multiple Surgeries for Postoperative Lumbar Spine
Yusuke Eda1, Toru Funayama1, Masaki Tatsumura2
1Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN.
Abstract:
Candida spondylitis is a relatively rare disease. The primary risk factor is an immunocompromised status. Here, we report an immunocompetent patient who developed Candida spondylitis. The patient was a 70-year-old male. After multiple surgeries, he developed a fever and was diagnosed with chronic pyogenic spondylitis of the lumbar spine, which was treated by long-term antimicrobial therapy. However, his back pain persisted and the inflammatory response was prolonged. We performed posterior thoracolumbar pelvic fixation with a percutaneous pedicle screw system to stabilize the infected vertebral bodies and simultaneously performed a full-endoscopic intervertebral disc biopsy to identify the causative organisms. Candida parapsilosis was identified from a fungal culture of the biopsy specimen. The patient was diagnosed with Candida spondylitis and started on antifungal treatment with fluconazole. His back pain disappeared quickly after surgery, and up to the time of this writing, the patient has continued to receive fluconazole. We attributed the development of Candida spondylitis to the patient's long-term antibiotic treatment of a postoperative infection of the lumbar spine, which was associated with multiple back surgeries. Fungal spondylitis, including spondylitis caused by Candida spp., should be suspected in patients, even immunocompetent patients, with intractable postoperative spinal infections and pyogenic spondylitis due to microbial substitution. Long-term antimicrobial therapy without definitive identification of the causative organism of a postoperative infection of the lumbar spine that is associated with multiple surgeries can be a cause of Candida spondylitis. A biopsy is strongly recommended for the definitive diagnosis.
Insights
This case study highlights a rare instance of Candida spondylitis in an immunocompetent patient. Long-term antibiotic use for spinal infections may lead to fungal overgrowth, emphasizing the need for accurate diagnosis via biopsy.
Area of Science:
- Infectious Diseases
- Mycology
- Spinal Surgery
Background:
- Candida spondylitis is typically associated with immunocompromised individuals.
- Postoperative spinal infections often involve bacterial pathogens.
- Long-term antimicrobial therapy can alter the microbial environment.
Observation:
- An immunocompetent 70-year-old male developed persistent lumbar spondylitis after multiple surgeries.
- Initial treatment with broad-spectrum antibiotics failed to resolve symptoms.
- Surgical intervention included posterior thoracolumbar pelvic fixation and endoscopic disc biopsy.
Findings:
- Fungal culture of the biopsy specimen identified Candida parapsilosis as the causative agent.
- The patient was diagnosed with Candida spondylitis.
- Surgical stabilization and subsequent antifungal treatment with fluconazole led to symptom resolution.
Implications:
- Candida spondylitis can occur in immunocompetent patients, challenging typical risk factor assumptions.
- Microbial substitution during prolonged antibiotic treatment for spinal infections is a potential cause.
- Definitive diagnosis of spinal infections, especially post-surgery, requires thorough microbiological investigation, including fungal cultures.
- Spinal biopsy is crucial for identifying causative organisms in refractory cases of pyogenic spondylitis.
