Management of destructive Candida albicans spondylodiscitis of the cervical spine: a systematic analysis of literature illustrated by an unusual case.
Candida induced spondylodiscitis of the cervical spine in immunocompetent patients is an extremely rare infectious complication. Since clinical symptoms might be nonspecific, therapeutic latency can lead to permanent spinal cord damage, sepsis and fatal complications. Surgical debridement is strongly recommended but there is no standard antimycotic regime for postsurgical treatment. This paper summarizes available data and demonstrates another successfully treated case.



The systematic analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed and Web of Science were scanned to identify English language articles. Additionally, the authors describe the case of a 60-year-old male patient who presented with a Candida albicans induced cervical spondylodiscitis after an edematous pancreatitis and C. albicans sepsis. Anterior cervical corpectomy and fusion of C4-C6, additional anterior plating, as well as posterior stabilization C3-Th1 was followed by a 6-month antimycotic therapy. There was neither funding nor conflict of interests.



A systematic literature analysis was conducted and 4599 articles on spondylodiscitis were scanned. Only four cases were found reporting about a C. albicans spondylodiscitis in a non-immunocompromised patient. So far, our patient was followed up for 2 years. Until now, he shows free of symptoms and infection parameters. Standard testing for immunodeficiency showed no positive results.



Candida albicans spondylodiscitis of the cervical spine presents a potentially life-threatening disease. To our knowledge, this is the fifth case in literature that describes the treatment of C. albicans spondylodiscitis in an immunocompetent patient. Surgical debridement has to be considered, following antimycotic regime recommendations vary in pharmaceutical agents and treatment duration.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany. Josef.Stolberg-Stolberg@ukmuenster.de.
Josef
J
Stolberg-Stolberg
Department of Pharmacy, University Hospital Münster, Münster, Germany.
Dagmar
D
Horn
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
Steffen
S
Roßlenbroich
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
Oliver
O
Riesenbeck
Institute of Hygiene, University Hospital Münster, Münster, Germany.
Stefanie
S
Kampmeier
Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
Michael
M
Mohr
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
Michael J
MJ
Raschke
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
René
R
Hartensuer
D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans; D002177:Candidiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D002574:Cervical Vertebrae / Q000601:surgery*; D003646:Debridement / Q000379:methods; D015299:Discitis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods*; D013166:Spondylitis / Q000628:therapy; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents
Antibiotic treatment; Candida albicans; Cervical spine; Infection; Spondylodiscitis