TITLE:
Vertebral Osteomyelitis Due to Candida Species: A Cohort Study and Review of the Literature
AUTHORS:
Amanda Ramos, Paul M. Huddleston, Robin Patel, Emily Vetter, Elie F. Berbari
KEYWORDS:
Vertebral Osteomyelitis; Candida ; Back Pain; Antifungal Therapy
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.3 No.2,
June
6,
2013
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.