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Candida tropicalis vertebral osteomyelitis: a late sequela of fungemia
C Ferra1, B N Doebbeling, R J Hollis
1Department of Internal Medicine, University of Iowa College of Medicine, Iowa City.
Abstract:
Two adult patients who had undergone bone marrow transplantation had transient fungemia due to Candida tropicalis during the posttransplantation neutropenic period and later (at 5 and 14 months post-transplantation) developed vertebral osteomyelitis due to the same organism. The courses of all adult patients who underwent bone marrow transplantation at our center during this time were reviewed for determining the frequency of this problem. Molecular typing techniques were used to establish the relationship between the organisms isolated during the initial fungemia and those causing the subsequent osteomyelitis. Only two of 532 adults who received transplants at our center from 1980 to 1993 developed candidal osteomyelitis. Moreover, they are part of a subset of 13 patients (2.4% of the total) whose cultures were positive for C. tropicalis; five of the 13 had fungemia. The study of fungal isolates from prior sites of colonization and from blood sampled during the original fungemia and of subsequently recovered vertebral bone isolates by means of DNA restriction fragment analysis (with use of standard agarose gel electrophoresis or pulsed-field gel electrophoresis) showed that the colonizing, bloodstream, and bone isolates were identical in each case. Transient C. tropicalis fungemia in severely immunocompromised patients may cause important late infectious complications, including osteomyelitis. Although these initial septic events may appear to resolve easily, the outcome in the two cases in this report suggests that special treatment considerations, such as immediate removal of the central venous catheter and intensive treatment with amphotericin B, may be required in selected cases for prevention of late sequelae.
Insights
Transient fungemia from Candida tropicalis in bone marrow transplant patients can lead to late-stage vertebral osteomyelitis. Early identification and aggressive treatment are crucial for preventing severe complications in immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Hematology
- Mycology
Background:
- Bone marrow transplantation (BMT) recipients are highly susceptible to infections due to profound immunosuppression.
- Candida tropicalis is an opportunistic fungal pathogen that can cause invasive infections in immunocompromised hosts.
- Fungal fungemia and subsequent deep-seated infections pose significant challenges in BMT patients.
Observation:
- Two adult BMT patients developed transient Candida tropicalis fungemia during the neutropenic phase.
- These patients later developed vertebral osteomyelitis caused by the same Candida tropicalis strain, 5 and 14 months post-transplantation.
- Molecular typing confirmed the identical genetic relationship between initial fungemia isolates and subsequent osteomyelitis isolates.
Findings:
- Candidal osteomyelitis occurred in 2 of 532 BMT patients (0.38%) over a 13-year period.
- Candida tropicalis was identified in 13 patients (2.4%), with 5 experiencing fungemia.
- DNA restriction fragment analysis demonstrated that colonizing, bloodstream, and bone isolates were genetically identical in both cases.
Implications:
- Transient Candida tropicalis fungemia, even if seemingly resolved, can lead to serious late infectious complications like osteomyelitis in severely immunocompromised patients.
- Aggressive management, potentially including central venous catheter removal and intensive amphotericin B therapy, may be necessary to prevent long-term sequelae.
- This highlights the importance of vigilant monitoring and tailored treatment strategies for fungal infections in BMT recipients.