Fungal infections of the spine

Devin Ganesh, Jonathan Gottlieb, Sherilynn Chan, Octavio V. Martinez, Frank J Eismont

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Study Design. Review of the literature. Objective. To retrospectively examine the frequency of published fungal infections by species and the treatment algorithms used to eradicate the disease. Summary of Background Data. Fungal infections of the spine present unique challenges to the modern multispecialty treatment team. Although rare in comparison with bacterial infections, fungal infections have been increasing in incidence over the past several decades. Evidences-based practice is limited to referencing smaller case series. Methods. MEDLINE, Scopus and EMBASE searches were carried out by one of the authors as well as by the research desk at the University of Miami/Calder Memorial Library. We included peerreviewed articles published between 1948 and September 2010; case reports, series, and reviews were all examined and compiled into a database. Results. A total of 130 articles, representing 157 cases, were included in the review. Aspergillus (60 cases, 38.2% of the total) and Candida species (36 cases, 22.9% of the total) were the 2 most common organisms. Surgery was associated with a greater survival rate than medical management alone in patients with Aspergillus (26.9% mortality in surgical patients; 60% in medically treated patients) and Candida (0% vs . 28.6%). Overall mortality was 19.3%. The overall recurrence rate was 7.4%. Amphotericin use was associated with a higher mortality rate than azoles. Conclusion. Aspergillus is the most common published pathogen in fungal infections of the spine. Recent publications depicting the use of newer antifungal medications such as azoles report higher survival rates. Surgically treated patients in combination with antifungal therapy showed highest frequencies of patient survival in Aspergillus and Candida infections.

Original languageEnglish (US)
Pages (from-to)E719-E728
JournalSpine
Volume40
Issue number12
DOIs
StatePublished - 2015

Keywords

  • Aspergillus osteomyelitis
  • Candida osteomyelitis
  • Fungal discitis
  • Fungal infection of the spine
  • Fungal osteomyelitis
  • Fungal vertebral osteomyelitis
  • Review fungal infections spine
  • Treatment fungal spine infection

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

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