Vertebral Osteomyelitis Due to <i>Candida</i>Species: A Cohort Study and Review of the Literature

• 作者: Amanda Ramos Elie F. Berbari Emily Vetter Paul M. Huddleston Robin Patel
• 来源期刊: 矫形学期刊(英文)
• 学科: 医学
• 关键词: VERTEBRAL OSTEOMYELITIS CANDIDA Back Pain ANTIFUNGAL Therapy
• 年，卷（期）: 2013,（2）
• 页码范围: 81-89
• 页数: 9页
• 分类号: R73

摘要

Objective: To describe the demographics and outcome of patients with candidal vertebral osteomyelitis (CVO). CVO is a rare and frequently misdiagnosed condition. It may lead to destruction of the vertebral bodies, spinal cord compression and neurological deficits. Methods: The medical records of all patients diagnosed with CVO at our institution between 01/01/1990-12/31/2009 were reviewed. The cumulative probability of treatment success was assessed by the Kaplan-Meier survival method. Patients were followed until death, failure, or loss of follow-up. Results: Nine patients developed CVO during the 20 year study period. The cervical spine was involved in 5 cases. Seven patients presented with mechanical-type pain, while 2 patients had an elevated temperature at diagnosis. A contiguous infection between the upper airways and the cervical spine was present in 4 patients. One patient presented with concomitant candidemia. Candida albicans, Candida parapsilosis, and Candida glabrata were cultured in 3 of 9 cases respectively. Eight of 9 were treated with azole-based therapy. Patients were followed for an average of 20 months (range 1 - 75 months). The cumulative incidence of success was 66% ± 19% at 1 year and 55% ± 20% at 2 years of follow-up. Conclusions: CVO presents insidiously and is associated with a long duration of symptoms. It most frequently affects the cervical spine and is associated with a poor outcome.