Aspergillus spondylodiscitis: successful conservative treatment in 9 cases.
OBJECTIVE
To assess the effectiveness of medical treatment by clinical, radiological, and biological analysis of outcome in 9 patients with aspergillus spondylodiscitis.


METHODS
Retrospective study including 9 patients with aspergillus discitis, in which 7 were immunosuppressed; 3 were heart transplant patients, 2 had acute lymphoblastic leukemia, 1 hairy cell leukemia and one was receiving prednisone for bronchial asthma. Four patients had isolated spinal aspergillosis infection. In 4 cases, disc space infection occurred after pulmonary aspergillosis. In the last case the spondylodiscitis occurred after aspergillus endocarditis and mycotic limb embolism. In all cases a percutaneous needle biopsy of the intervertebral disc was performed; the subsequent culture produced Aspergillus fumigatus in 8 cases and Aspergillus flavus in 1. Itraconazole was given to all patients (mean dose: 350 mg/day); it was given alone in 2 cases, in addition to 5 flucytosine and amphotericin B in 6 cases, and in addition to amphotericin B in the last case.


RESULTS
Improvement was obtained in the 9 cases, with full recovery in the absence of any surgical debridement after a mean treatment duration of 5.5 months and a mean followup delay of 16 months.


CONCLUSIONS
Early recognition of aspergillus spondylodiscitis in immunocompromised hosts is important. Itraconazole alone or in combination is an effective therapy. There may be an increased incidence of aspergillus discitis due to the increasing frequency of immunosuppression associated conditions including organ transplantation, chemotherapy, or acquired immune deficiency syndrome.
Department of Rheumatology, Centre André Verhaeghe, Centre Hospitalier Régional et Universitaire de Lille, France.
B
B
Cortet
R
R
Richard
X
X
Deprez
L
L
Lucet
R M
RM
Flipo
X
X
Le Loët
B
B
Duquesnoy
B
B
Delcambre
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology; D015299:Discitis / Q000175:diagnosis / Q000382:microbiology*; D004359:Drug Therapy, Combination; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D017964:Itraconazole / Q000627:therapeutic use*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D012189:Retrospective Studies; D013166:Spondylitis / Q000175:diagnosis / Q000382:microbiology*; D013904:Thoracic Vertebrae
D017964:Itraconazole; D000666:Amphotericin B; D005437:Flucytosine