amphotericin-b and Discitis

The study includes a case report and a literature review. The main objective of this study is to present a case of spondylodiscitis due to a fungal pathogen, Blastoschizomyces capitatus and to review the published literature on this emergent fungus in etiology of spondylodiscitis, and osteomyelitis. Osteoarticular involvement due to B. capitatus has been reported in six cases, and vertebral involvement has been seen in five of them. All of these cases had underlying malignancy. Infection is usually advanced at presentation. Case notes and online databases were reviewed. Organism was isolated from bone material in all of the cases and antibiotic treatment by antifungal agents cured the infection. We present another case of infectious spondylodiscitis due to B. capitaus, which is reported first in Turkey and tried to attract attendance to this emergent fungal pathogen as an etiologic agent of spine infections in cancer patients.

Topics: Aged; Amphotericin B; Antifungal Agents; Dipodascus; Discitis; Fluconazole; Humans; Itraconazole; Ketoconazole; Lumbar Vertebrae; Male; Microbial Sensitivity Tests; Naphthalenes; Opportunistic Infections; Radiography; Terbinafine; Treatment Outcome

Candida species rarely cause spondylodiscitis. During 3 y, 3 cases of vertebral osteomyelitis due to Candida spp. (Candida albicans and Candida tropicalis) were diagnosed, 2 of which were associated with a spinal epidural abscess.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Discitis; Female; Fluconazole; Follow-Up Studies; Fungemia; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteomyelitis; Risk Assessment; Severity of Illness Index; Treatment Outcome

Sixteen patients with spinal infection from Coccidioides immitis were treated. Lesion location was cervical in two, thoracic in four, lumbar in six, sacroiliac joint in one, and disseminated spinal in three. The neurological status was intact in 11 patients. One patient had incomplete quadriplegia, three patients had incomplete paraplegia, and a fifth patient had a lumbar root lesion. Treatment was medical only in 4 patients (one of whom required surgery 2 years later) and combined medical and surgical in 13 patients. All patients received amphotericin B intravenously. Follow-up averaged 24 months in 15 patients (range, 12-42 months). The outcome in four patients treated medically alone was one death, one remission, one relapse with disease progression, and one without follow-up. The outcome in the combined medical and surgical group was nine fusions, one pseudarthrosis, and three lesional excisions, all with remission. Successful treatment outcome is disease arrest, as opposed to "cure."

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; California; Cervical Vertebrae; Coccidioidomycosis; Combined Modality Therapy; Debridement; Discitis; Disease Outbreaks; Female; Follow-Up Studies; Humans; Internal Fixators; Lumbar Vertebrae; Lung Diseases, Fungal; Male; Middle Aged; Nerve Compression Syndromes; Paraplegia; Postoperative Complications; Prisoners; Quadriplegia; Remission Induction; Ribs; Sacroiliac Joint; Spinal Fusion; Spinal Nerve Roots; Spondylitis; Thoracic Vertebrae; Treatment Outcome

Aspergillus osteomyelitis of the vertebral body and disc space is rare. This report discusses a case that occurred in an immunosuppressed 29-year-old man and reviews the pertinent medical literature.. To review the management and treatment of Aspergillus osteomyelitis of the vertebral body and disc space.. The patient presented with acute neurologic compromise resulting from L5-S1 discitis and a large epidural soft tissue component secondary to the Aspergillus infection.. The patient underwent aggressive surgical debridement along with treatment with amphotericin B and had a complete clinical recovery.. The authors recommend a combined medical-surgical approach in most cases of vertebral Aspergillus osteomyelitis. Early surgery with vigorous surgical debridement along with antifungal treatment seems to yield a good outcome.

Topics: Abscess; Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Debridement; Discitis; Humans; Lumbar Vertebrae; Male; Osteomyelitis; Sacrum

Five cases of Aspergillus discitis in male patients are reported. Three patients had impaired immune responses as a result of immunosuppressive therapy following a heart transplant (two cases) or hairy cell leukemia (one case). Two patients had a recent history of mycobacterial infection. All five patients were hospitalized for severe spinal pain suggestive of an inflammatory disease with no neurological abnormalities. Erythrocyte sedimentation rate was elevated in every case. The diagnosis of discitis was suspected on spinal roentgenograms and established by computed tomography and/or magnetic resonance imaging. In three patients the spine was the only site of Aspergillus infection (lumbar discitis in two cases and thoracic discitis in one case). One patient developed Aspergillus infection of several disks (L1-L2, L2-L3, and L4-L5) after Aspergillus endocarditis with embolization to the left lower limb. Another patient developed discitis after an Aspergillus lung infection. In every case, Aspergillus fumigatus was recovered in cultures of specimens harvested by a percutaneous needle biopsy of the intervertebral disk. All five patients were treated by itraconazole which was given as single drug therapy in one case and in combination with 5-flucytosine and amphotericin B in four cases. Recovery was achieved in every case after four to six months of this drug therapy. In contrast to most previously reported cases, none of the five patients reported herein required surgical treatment. Efficacy of conservative treatment in this study may be related to the use of itraconazole in every case.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Discitis; Flucytosine; Humans; Immunocompromised Host; Itraconazole; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

Spondylodiscitis is an inflammatory disease, usually infectious, of one or more vertebral bodies and of corresponding intervertebral discs. The fungal aetiology is rare (less than 5% of cases), affecting mostly immunocompromised individuals. It is often a delayed diagnosis by the indolence of symptoms, presenting itself as a serious infection, which may result in important functional consequences. The authors present the case of a 75-year-old male, with constitutional complaints and intense back pain. Prior recent history of left hemicolectomy due to diverticulitis with multiple surgical complications, resulted in prolonged intensive care unit hospitalisation, and, later on, an episode of fungal endophthalmitis. The diagnosis of spondylodiscitis L5/S1 was performed by MRI. The patient underwent surgical disco-vertebral debridement and isolation of a Candida albicans was seen in the collected surgical material. No evidence of an immunossupressive status was found. Treatment was complemented with liposomal amphotericin B in the maximum recommended dose.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Combined Modality Therapy; Debridement; Diagnosis, Differential; Discitis; Endophthalmitis; Humans; Magnetic Resonance Imaging; Male

A 37-year-old woman, during her second remission of acute myeloid leukemia, presented with severe neck pain and cervico-brachial neuralgia. Investigation revealed a C5-C6 spondylodiscitis. A CT-guided anterior biopsy decompressed the mass, immediately alleviated the symptoms, and isolated a rare yeast: Blastoschizomyces capitatus. To our knowledge, only three cases of spondylodiscitis with this yeast have been described. Six months of voriconazole and liposomal amphotericin B treatment produced a complete resolution on CT and MRI imaging. However, the ongoing severe yeast infection prevented the planned bone marrow allograft.

Topics: Adult; Amphotericin B; Antifungal Agents; Cervical Vertebrae; Dipodascus; Discitis; Female; Humans; Leukemia, Myeloid, Acute; Mycoses; Neck; Pyrimidines; Tomography, X-Ray Computed; Triazoles; Ultrasonography; Voriconazole

In recent years, the incidence of systemic infections due to Candida increased, but the incidence of spondylodiscitis remained low, and epidural involvement during such infection was seldom reported. The purpose of this study was to report the cases of 2 young male heroin addicts who developed spondylodiscitis due to Candida sp., with epidural involvement. In one case, a microbiological diagnosis was obtained after biopsy. In the other case, the diagnosis was based on serological data and Candida antigenemia. In both cases, an oral fluconazole based therapy was administered at first (because of a poor peripheral venous system), but proved to be inefficient. A secondary therapy by liposomal amphotericin B proved efficient allowing a favourable evolution. This pathology raised a number of problems concerning diagnosis and treatment. The clinical data was non-specific the paraclinical diagnosis required MRI, and biopsy. When microbiological assessment is negative, serology and the antigenemia can be useful. The treatment pattern suggested for the management of bone and joint infections is: intravenous amphotericine B for 2-3 weeks, followed by oral administration of fluconazole or voriconazole for 6-12 month. Surgical treatment is recommended only to patients ay risk of neurological disorders or severe epidural abscess.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Discitis; Fluconazole; Humans; Magnetic Resonance Imaging; Male; Spine

A 62-year-old man with amphotericin B-resistant Candida krusei spondylodiscitis, following an episode of candidemia caused by the same strain, was successfully treated with caspofungin plus voriconazole. Amphotericin B fungicidal concentrations were better predictors of the clinical outcome than were MICs. This is the first case of C. krusei spondylodiscitis reported in the literature.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Caspofungin; Discitis; Drug Resistance, Fungal; Echinocandins; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Middle Aged; Peptides, Cyclic; Pyrimidines; Triazoles; Voriconazole

Musculoskeletal candidiasis occurs in some patients with candidemia resulting from organ infection, IV drug use, or indwelling central venous catheters. Diagnosis is often difficult because of vague symptomatology and a frequent afebrile course.. Three patients with Candida vertebral osteomyelitis are presented. All followed the use of indwelling central venous access catheters and antimicrobial therapy between 6 months and 3 years earlier. In 2, fungemia with the same Candida spp. preceded the spondylodiskitis. These 3 patients bring to nearly 75 the number of reported individuals with what was once quite rare. Although IV amphotericin B doxycholate and fluconazole have usually been effective therapy over prolonged periods of time, we used liposomal amphotericin B to treat 2 of our 3 patients. Both received 5 mg/kg daily for 18-42 days that resulted in total disappearance of signs and symptoms.. This relatively brief duration of therapy reduces treatment time and is cost-effective.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Discitis; Drug Administration Schedule; Drug Combinations; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Phosphatidylcholines; Phosphatidylglycerols; Thoracic Vertebrae

A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Discitis; Drug Therapy, Combination; Humans; Itraconazole; Leukemia, Myeloid, Acute; Male; Middle Aged; Opportunistic Infections; Osteomyelitis; Scedosporium; Sepsis

A case of Candida albicans spondylodiscitis in a 20-year-old female liver transplant recipient is reported. The patient was successfully treated with sequential therapy with liposomal amphotericin B and fluconazole. A review of the literature showed 10 cases of Candida albicans spondylodiscitis successfully treated either with fluconazole alone or a sequential therapy with amphotericin B and fluconazole. If long-term amphotericin B therapy is not feasible, a prolonged course of fluconazole in a daily dose of 200-400 mg may be considered as an alternative.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Discitis; Drug Therapy, Combination; Female; Fluconazole; Humans; Liver Transplantation

The authors describe the case of a 53-year-old woman who suffered from an Aspergillus fumigatus infection of the L2/3 intervertebral disc space unrelated to previous operations on her lumbar spine. After surgical debridement combined with amphotericin therapy she died on the 23rd postoperative day from a fulminant bacterial sepsis of pulmonary origin. Although she had intermittently used steroids for bronchial asthma, this is an unusual case of fungal infection of the lumbar spine in an apparently immunocompetent patient.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy, Needle; Discitis; Fatal Outcome; Female; Humans; Infusions, Intravenous; Intervertebral Disc; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Tomography, X-Ray Computed

To assess the effectiveness of medical treatment by clinical, radiological, and biological analysis of outcome in 9 patients with aspergillus spondylodiscitis.. Retrospective study including 9 patients with aspergillus discitis, in which 7 were immunosuppressed; 3 were heart transplant patients, 2 had acute lymphoblastic leukemia, 1 hairy cell leukemia and one was receiving prednisone for bronchial asthma. Four patients had isolated spinal aspergillosis infection. In 4 cases, disc space infection occurred after pulmonary aspergillosis. In the last case the spondylodiscitis occurred after aspergillus endocarditis and mycotic limb embolism. In all cases a percutaneous needle biopsy of the intervertebral disc was performed; the subsequent culture produced Aspergillus fumigatus in 8 cases and Aspergillus flavus in 1. Itraconazole was given to all patients (mean dose: 350 mg/day); it was given alone in 2 cases, in addition to 5 flucytosine and amphotericin B in 6 cases, and in addition to amphotericin B in the last case.. Improvement was obtained in the 9 cases, with full recovery in the absence of any surgical debridement after a mean treatment duration of 5.5 months and a mean followup delay of 16 months.. Early recognition of aspergillus spondylodiscitis in immunocompromised hosts is important. Itraconazole alone or in combination is an effective therapy. There may be an increased incidence of aspergillus discitis due to the increasing frequency of immunosuppression associated conditions including organ transplantation, chemotherapy, or acquired immune deficiency syndrome.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Discitis; Drug Therapy, Combination; Female; Flucytosine; Humans; Immunosuppression Therapy; Itraconazole; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Myelography; Retrospective Studies; Spondylitis; Thoracic Vertebrae

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Discitis; Humans; Itraconazole; Ketoconazole; Lumbar Vertebrae; Male