amphotericin-b and Paraplegia

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

A case of invasive pulmonary aspergillosis in a 33-year-old, non-immunocompromised male presenting with lower limb paraplegia is reported. The clinical manifestations, diagnosis, and combined medical and surgical management of this rare condition are described.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Itraconazole; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Paraplegia; Polyneuropathies; Radiography, Thoracic; Tomography, X-Ray Computed

Aspergillus infection of the spine is rare; for it to lead to paraplegia is still more rare. When this does occur it is usually treated by decompression and antifungal agents, but the results have usually been poor. We report two cases of successful conservative treatment of Aspergillus paraplegia in patients with chronic granulomatous disease.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Aspergillus niger; Child; Drug Therapy, Combination; Flucytosine; Humans; Male; Paraplegia; Radiography; Spondylitis; Thoracic Vertebrae

Skeletal cryptococcosis is an uncommon infection. Isolated osteomyelitis due to Cryptococcus neoformans is quite rare. Only seven cases of skeletal cryptococcosis with involvement of vertebrae but no systemic infection have been reported. In only one was there paraplegia. Since vertebral cryptococcosis seems not to have been reported previously in Japan, this case of a 50-year-old coal miner successfully treated for paraparesis caused by cryptococcal spondylitis of the ninth, tenth, and 11th thoracic vertebrae is noteworthy. Two decompression operations and combined amphotericin B and flucytosine therapy reduced the patient's paraparesis, and no sign of recurrence was seen for 21 months after the second operation.

Topics: Amphotericin B; Combined Modality Therapy; Cryptococcosis; Flucytosine; Humans; Male; Middle Aged; Muscle Spasticity; Osteomyelitis; Paraplegia; Thoracic Vertebrae; Time Factors

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Humans; Male; Osteomyelitis; Paraplegia; Thoracic Vertebrae; Tuberculosis, Spinal

Topics: Adolescent; Africa; Amphotericin B; Black People; Bone Diseases; Child; Diagnosis; Fractures, Bone; Fractures, Spontaneous; Histoplasma; Histoplasmosis; Humans; Nigeria; Paraplegia; Pathology; Radiography; Ribs; Skull; Spinal Cord Compression; Spinal Diseases