- Discussion:
- occur primarily as opportunistic infections in immunocompromised patients;
- most often due to
candida;
- histology: noncaseating, acid-fast-negative infections;
- organism are identified with a positive fungal culture, potassium hydroxide slide preparation, or Gomori methenamine silver stain
- in the report by Daveed D. Frazier, MD, the authors analyzed eleven patients with spinal osteomyelitis caused by a fungus;
- for 10 of the 11 patients, the average delay in the diagnosis was ninety-nine days;
- 9 patients were immunocompromised secondary to diabetes mellitus, corticosteroid use, chemotherapy
for a tumor, or malnutrition;
- sources of the spinal infections included direct implantation from trauma (one patient),
hematogenous spread (four patients), and local extension (two patients);
- infection followed elective spine surgery in three patients, and the cause was unknown in one;
- paralysis secondary to the spine infection developed in eight patients;
- 10 patients were treated with surgical débridement;
- all eleven patients were treated with systemic antifungal medications for a minimum of six weeks;
- one patient died of generalized sepsis at thirty-three days, and another patient died of GI hemorrhage at five months;
- after an average of 6.3 years of follow-up, the infection had resolved in all nine surviving patients;
- ref: Fungal Infections of the Spine.
Report of Eleven Patients with Long-Term Follow-up
Daveed D. Frazier, MD et al. JBJS 83:560 (2001)
