title: Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases.
abstract: Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3-6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5-6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits.
authors.affiliation: Orthopaedics, Southend Hospital, Westcliff on sea, Essex, United Kingdom. rkhazim@hotmail.com
authors.forename: Rabi M
authors.initials: RM
authors.lastname: Khazim
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Debnath
authors.forename: Youssef
authors.initials: Y
authors.lastname: Fares
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001416:Back Pain / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D002176:Candida albicans / Q000502:physiology*; D002574:Cervical Vertebrae / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D003646:Debridement; D018450:Disease Progression; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008297:Male; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D019547:Neck Pain / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D019651:Plastic Surgery Procedures; D013117:Spinal Cord Compression / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole