[Two cases of spondylodiscitis due to Candida sp].
In recent years, the incidence of systemic infections due to Candida increased, but the incidence of spondylodiscitis remained low, and epidural involvement during such infection was seldom reported. The purpose of this study was to report the cases of 2 young male heroin addicts who developed spondylodiscitis due to Candida sp., with epidural involvement. In one case, a microbiological diagnosis was obtained after biopsy. In the other case, the diagnosis was based on serological data and Candida antigenemia. In both cases, an oral fluconazole based therapy was administered at first (because of a poor peripheral venous system), but proved to be inefficient. A secondary therapy by liposomal amphotericin B proved efficient allowing a favourable evolution. This pathology raised a number of problems concerning diagnosis and treatment. The clinical data was non-specific the paraclinical diagnosis required MRI, and biopsy. When microbiological assessment is negative, serology and the antigenemia can be useful. The treatment pattern suggested for the management of bone and joint infections is: intravenous amphotericine B for 2-3 weeks, followed by oral administration of fluconazole or voriconazole for 6-12 month. Surgical treatment is recommended only to patients ay risk of neurological disorders or severe epidural abscess.
Frentiu
E
E
Service de maladies infectieuses et tropicales, hôpitaux de Brabois, CHU de Nancy, allée du Morvan, 54511 Vandoeuvre-Lès-Nancy, France.
Petitfrere
M
M
May
T
T
Rabaud
C
C
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000473:pathology*; D015299:Discitis / Q000188:drug therapy / Q000382:microbiology*; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013131:Spine / Q000473:pathology
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole