Amanda Ramos, Paul M. Huddleston, Robin Patel, Emily Vetter, Elie F. Berbari
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA.
Division of Infectious Diseases, Mayo Clinic, Rochester, USA..
Mayo Medical School, Mayo Clinic, Rochester, USA.
DOI: 10.4236/ojo.2013.32016   PDF    HTML     5,566 Downloads   8,974 Views   Citations

Abstract

Objective: To describe the demographics and outcome of patients with candidal vertebral osteomyelitis (CVO). CVO is a rare and frequently misdiagnosed condition. It may lead to destruction of the vertebral bodies, spinal cord compression and neurological deficits. Methods: The medical records of all patients diagnosed with CVO at our institution between 01/01/1990-12/31/2009 were reviewed. The cumulative probability of treatment success was assessed by the Kaplan-Meier survival method. Patients were followed until death, failure, or loss of follow-up. Results: Nine patients developed CVO during the 20 year study period. The cervical spine was involved in 5 cases. Seven patients presented with mechanical-type pain, while 2 patients had an elevated temperature at diagnosis. A contiguous infection between the upper airways and the cervical spine was present in 4 patients. One patient presented with concomitant candidemia. Candida albicans, Candida parapsilosis, and Candida glabrata were cultured in 3 of 9 cases respectively. Eight of 9 were treated with azole-based therapy. Patients were followed for an average of 20 months (range 1 - 75 months). The cumulative incidence of success was 66% ± 19% at 1 year and 55% ± 20% at 2 years of follow-up. Conclusions: CVO presents insidiously and is associated with a long duration of symptoms. It most frequently affects the cervical spine and is associated with a poor outcome.

Keywords

Vertebral Osteomyelitis; Candida ; Back Pain; Antifungal Therapy

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Conflicts of Interest

The authors declare no conflicts of interest.

References

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