Treatment outcomes of fungal vertebral osteomyelitis: A case series study and literature review

Meng Huang Wu, Yu Tsung Huang, Yen Yao Li, Tsung-Jen Huang, Chin Chang Cheng, Ching Yu Lee, Mel S. Lee, Robert Wen Wei Hsu

Research output: Contribution to journalArticle

Abstract

Introduction: Fungal vertebral osteomyelitis (FVO) is rare and difficult to treat. It is usually an opportunistic infection in immunocompromised patients or is related to a prior surgery. Difficulty diagnosing the infection often leads to delayed treatment. Medical treatment and surgical outcomes are not always predictable. Purpose: To report the outcomes of FVO in our hospital and to review cases reported in the literature. Methods: In this retrospective series, 15 cases between January 2000 through June 2014 in Chang Gung Memorial Hospital’s Spinal Surgery Registry were reviewed. Demographic data, surgical records, culture results, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and image studies (X-ray and magnetic resonance imaging) were reviewed. A PubMed and Medline literature review was also done. Results: The causative pathogens were primarily Candida species (86.6%, Candida albicans in 11 patients; others were Candida glabrata, Candida parapsilosis, and Candida tropicalis) and Cephalosporium. All 15 patients had severe back pain, 5 had radiculopathy, and 1 had paralysis. Ten patients (66.7%) had an epidural abscess and spinal cord compression. The time to diagnosis ranged from 8 to 237 days from the onset of symptoms. Thirteen patients were managed with surgical debridement and antifungal treatment, 1 with antifungal treatment without surgery, and 1 with neither surgery nor antifungal treatment. Although the infections resolved in 12 patients, 4 recurred before complete resolution. One patient died of fungal sepsis and 2 of systemic disease. Antifungal treatment usually required more than 3 months; and off treatment CRP and ESR levels were usually higher than the normal range. Conclusions: The post-treatment FVO recovery rate was 80%. Surgical treatment was usually necessary. When vertebral collapse and spinal cord compression occur, surgical debridement, fusion, and stabilization combined with antifungal medications eradicated the infection and resolved the neurological deficits.
Original languageUndefined/Unknown
Pages (from-to)89-97
Number of pages9
JournalFormosan Journal of Musculoskeletal Disorders
Volume6
Issue number3
DOIs
Publication statusPublished - 2015

Keywords

  • Candida
  • Cephalosporium
  • fungus
  • outcome
  • vertebral osteomyelitis

Cite this

Treatment outcomes of fungal vertebral osteomyelitis: A case series study and literature review. / Wu, Meng Huang; Huang, Yu Tsung; Li, Yen Yao; Huang, Tsung-Jen; Cheng, Chin Chang; Lee, Ching Yu; Lee, Mel S.; Hsu, Robert Wen Wei.

In: Formosan Journal of Musculoskeletal Disorders, Vol. 6, No. 3, 2015, p. 89-97.

Research output: Contribution to journalArticle

Wu, Meng Huang ; Huang, Yu Tsung ; Li, Yen Yao ; Huang, Tsung-Jen ; Cheng, Chin Chang ; Lee, Ching Yu ; Lee, Mel S. ; Hsu, Robert Wen Wei. / Treatment outcomes of fungal vertebral osteomyelitis: A case series study and literature review. In: Formosan Journal of Musculoskeletal Disorders. 2015 ; Vol. 6, No. 3. pp. 89-97.
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abstract = "Introduction: Fungal vertebral osteomyelitis (FVO) is rare and difficult to treat. It is usually an opportunistic infection in immunocompromised patients or is related to a prior surgery. Difficulty diagnosing the infection often leads to delayed treatment. Medical treatment and surgical outcomes are not always predictable. Purpose: To report the outcomes of FVO in our hospital and to review cases reported in the literature. Methods: In this retrospective series, 15 cases between January 2000 through June 2014 in Chang Gung Memorial Hospital’s Spinal Surgery Registry were reviewed. Demographic data, surgical records, culture results, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and image studies (X-ray and magnetic resonance imaging) were reviewed. A PubMed and Medline literature review was also done. Results: The causative pathogens were primarily Candida species (86.6{\%}, Candida albicans in 11 patients; others were Candida glabrata, Candida parapsilosis, and Candida tropicalis) and Cephalosporium. All 15 patients had severe back pain, 5 had radiculopathy, and 1 had paralysis. Ten patients (66.7{\%}) had an epidural abscess and spinal cord compression. The time to diagnosis ranged from 8 to 237 days from the onset of symptoms. Thirteen patients were managed with surgical debridement and antifungal treatment, 1 with antifungal treatment without surgery, and 1 with neither surgery nor antifungal treatment. Although the infections resolved in 12 patients, 4 recurred before complete resolution. One patient died of fungal sepsis and 2 of systemic disease. Antifungal treatment usually required more than 3 months; and off treatment CRP and ESR levels were usually higher than the normal range. Conclusions: The post-treatment FVO recovery rate was 80{\%}. Surgical treatment was usually necessary. When vertebral collapse and spinal cord compression occur, surgical debridement, fusion, and stabilization combined with antifungal medications eradicated the infection and resolved the neurological deficits.",
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author = "Wu, {Meng Huang} and Huang, {Yu Tsung} and Li, {Yen Yao} and Tsung-Jen Huang and Cheng, {Chin Chang} and Lee, {Ching Yu} and Lee, {Mel S.} and Hsu, {Robert Wen Wei}",
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TY - JOUR

T1 - Treatment outcomes of fungal vertebral osteomyelitis: A case series study and literature review

AU - Wu, Meng Huang

AU - Huang, Yu Tsung

AU - Li, Yen Yao

AU - Huang, Tsung-Jen

AU - Cheng, Chin Chang

AU - Lee, Ching Yu

AU - Lee, Mel S.

AU - Hsu, Robert Wen Wei

PY - 2015

Y1 - 2015

N2 - Introduction: Fungal vertebral osteomyelitis (FVO) is rare and difficult to treat. It is usually an opportunistic infection in immunocompromised patients or is related to a prior surgery. Difficulty diagnosing the infection often leads to delayed treatment. Medical treatment and surgical outcomes are not always predictable. Purpose: To report the outcomes of FVO in our hospital and to review cases reported in the literature. Methods: In this retrospective series, 15 cases between January 2000 through June 2014 in Chang Gung Memorial Hospital’s Spinal Surgery Registry were reviewed. Demographic data, surgical records, culture results, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and image studies (X-ray and magnetic resonance imaging) were reviewed. A PubMed and Medline literature review was also done. Results: The causative pathogens were primarily Candida species (86.6%, Candida albicans in 11 patients; others were Candida glabrata, Candida parapsilosis, and Candida tropicalis) and Cephalosporium. All 15 patients had severe back pain, 5 had radiculopathy, and 1 had paralysis. Ten patients (66.7%) had an epidural abscess and spinal cord compression. The time to diagnosis ranged from 8 to 237 days from the onset of symptoms. Thirteen patients were managed with surgical debridement and antifungal treatment, 1 with antifungal treatment without surgery, and 1 with neither surgery nor antifungal treatment. Although the infections resolved in 12 patients, 4 recurred before complete resolution. One patient died of fungal sepsis and 2 of systemic disease. Antifungal treatment usually required more than 3 months; and off treatment CRP and ESR levels were usually higher than the normal range. Conclusions: The post-treatment FVO recovery rate was 80%. Surgical treatment was usually necessary. When vertebral collapse and spinal cord compression occur, surgical debridement, fusion, and stabilization combined with antifungal medications eradicated the infection and resolved the neurological deficits.

AB - Introduction: Fungal vertebral osteomyelitis (FVO) is rare and difficult to treat. It is usually an opportunistic infection in immunocompromised patients or is related to a prior surgery. Difficulty diagnosing the infection often leads to delayed treatment. Medical treatment and surgical outcomes are not always predictable. Purpose: To report the outcomes of FVO in our hospital and to review cases reported in the literature. Methods: In this retrospective series, 15 cases between January 2000 through June 2014 in Chang Gung Memorial Hospital’s Spinal Surgery Registry were reviewed. Demographic data, surgical records, culture results, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, and image studies (X-ray and magnetic resonance imaging) were reviewed. A PubMed and Medline literature review was also done. Results: The causative pathogens were primarily Candida species (86.6%, Candida albicans in 11 patients; others were Candida glabrata, Candida parapsilosis, and Candida tropicalis) and Cephalosporium. All 15 patients had severe back pain, 5 had radiculopathy, and 1 had paralysis. Ten patients (66.7%) had an epidural abscess and spinal cord compression. The time to diagnosis ranged from 8 to 237 days from the onset of symptoms. Thirteen patients were managed with surgical debridement and antifungal treatment, 1 with antifungal treatment without surgery, and 1 with neither surgery nor antifungal treatment. Although the infections resolved in 12 patients, 4 recurred before complete resolution. One patient died of fungal sepsis and 2 of systemic disease. Antifungal treatment usually required more than 3 months; and off treatment CRP and ESR levels were usually higher than the normal range. Conclusions: The post-treatment FVO recovery rate was 80%. Surgical treatment was usually necessary. When vertebral collapse and spinal cord compression occur, surgical debridement, fusion, and stabilization combined with antifungal medications eradicated the infection and resolved the neurological deficits.

KW - Candida

KW - Cephalosporium

KW - fungus

KW - outcome

KW - vertebral osteomyelitis

U2 - 10.6492/FJMD.20150815

DO - 10.6492/FJMD.20150815

M3 - 文章

VL - 6

SP - 89

EP - 97

JO - Formosan Journal of Musculoskeletal Disorders

JF - Formosan Journal of Musculoskeletal Disorders

SN - 2210-7940

IS - 3

ER -