Spondylodiscitis Caused by Aspergillus Species.

Christos Koutserimpas,Kalliopi Alpantaki,George Samonis,Konstantinos Raptis,Symeon Naoum,Diamantis P. Kofteridis,Ifigeneia Chamakioti

doi:10.3390/diagnostics11101899

Abstract

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

Highlights

IntroductionAspergillus osteomyelitis represents a rare extra-pulmonary manifestation of invasive
Aspergillus osteomyelitis represents a rare extra-pulmonary manifestation of invasiveAspergillosis, while vertebral Aspergillosis depicts the most common type of osseous infection by this mold [1]
The mean time interval between symptoms onset and firm diagnosis was 5.7 months (SD = 8.5). Another site of Aspergillus infection was present in 52 cases

Summary

Introduction

Aspergillus osteomyelitis represents a rare extra-pulmonary manifestation of invasive. Aspergillosis, while vertebral Aspergillosis depicts the most common type of osseous infection by this mold [1]. Rare, it represents a severe condition, often under- or misdiagnosed. Three different pathogenetic mechanisms have been proposed: direct invasion by contiguous pulmonary foci, hematogenous diffusion, and iatrogenic or traumatic inoculation [1,2]. Vertebral Aspergillosis may be presented with osteolytic radiological findings, intervertebral disc lesions, and epidural space collections. Immunocompromised patients, such as solid organ recipients, patients with hematologic malignancies, those with severe neutropenia, and those receiving high-dose steroids are the more susceptible to invasive aspergillosis [1,3]. The disease may result in neurological deficit and spinal deformities [3]

Methods

Results

Conclusion