Candidal vertebral osteomyelitis: report of 6 patients, and a review.
The incidence of deep-seated candidal infection is increasing, but candidal vertebral osteomyelitis is still rare. We describe 6 patients recently treated in our hospital. Conservative treatment failed in all. We reviewed the literature and identified 59 additional cases of candidal vertebral osteomyelitis. Candidemia was documented in 61.5% of them. The interval between the diagnosis of candidemia and the onset of symptoms of vertebral osteomyelitis varied widely, from days to >1 year. In patients without documented candidemia, there was a similar interval between the occurrence of risk factors for candidemia (present in 72% of the patients) and the onset of symptoms of vertebral osteomyelitis. Clinical, laboratory, and radiological findings are not specific for candidal spondylodiskitis. Final diagnosis is determined by means of culture of a biopsy specimen from the infected vertebra or disk. Treatment consisted of prolonged antifungal treatment, and it often included surgery. On the basis of our experience (for all 6 patients, initial conservative treatment with only antifungals failed), we recommend consideration of early surgical debridement in combination with prolonged antifungal therapy.
Hendrickx
L
L
Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium.
Van Wijngaerden
E
E
Samson
I
I
Peetermans
W E
WE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000382:microbiology*; D013166:Spondylitis / Q000382:microbiology*