Top

Published in:

01-08-2013 | Brief Report

Aspergillus vertebral osteomyelitis in immunocompetent subjects: case report and review of the literature

Authors: A. Nicolle, A. de la Blanchardière, J. Bonhomme, M. Hamon, R. Leclercq, M. Hitier

Published in: Infection | Issue 4/2013

Abstract

Aspergillus spondylodiscitis (AS) is rare in immunocompetent (IC) patients. A 65-year-old diabetic IC male subject presented with cervical AS 18 months after otomycosis. Two serological tests, mastoidectomy and biopsy of the sphenoid bone, were negative. A prevertebral biopsy identified A. flavus. The patient was successfully treated with voriconazole. Forty-three cases of AS in IC patients have been published. A predisposition was found in 84 % of cases. Fever was reported in 20 % of cases, whereas neurological defects were present in 41 %. Serology was inconsistently positive (5/7) and diagnosis was confirmed by biopsy or surgery. A. fumigatus was the most frequently isolated species (74 %). All episodes were medically treated, associated with surgery in 57 % of cases, and 73 % of patients fully recovered. AS must be discussed in IC patients presenting with risk factors, including diabetes mellitus. Biopsy is necessary to confirm diagnosis, since serology offers low sensitivity. Nevertheless, the prognosis is good.

Shaw FW, Warthen HJ. Aspergillosis of bone. South Med J. 1936;29:1070–1.CrossRef

Redmond A, Carré IJ, Biggart JD, Mackenzie DWR. Aspergillosis (Aspergillus nidulans) involving bone. J Pathol Bacteriol. 1965;89:391–5.PubMedCrossRef

Seres JL, Ono H, Benner EJ. Aspergillosis presenting as spinal cord compression. Case report. J Neurosurg. 1972;36:221–4.PubMedCrossRef

Glotzbach RE. Aspergillus terreus infection of pseudoaneurysm of aortofemoral vascular graft with contiguous vertebral osteomyelitis. Am J Clin Pathol. 1982;77:224–7.PubMed

Dietz R, Huber G, Thetter O, Volkmer I. Aspergillosis of the lung with osteoclasis and paraplegia. Neuroradiology. 1982;23:219–21.PubMedCrossRef

Tack KJ, Rhame FS, Brown B, Thompson RC Jr. Aspergillus osteomyelitis. Report of four cases and review of the literature. Am J Med. 1982;73:295–300.PubMedCrossRef

McKee DF, Barr WM, Bryan CS, Lunceford EM Jr. Primary aspergillosis of the spine mimicking Pott’s paraplegia. J Bone Joint Surg Am. 1984;66:1481–3.PubMed

Anderson J, Kron IL. Treatment of Aspergillus infection of the proximal aortic prosthetic graft with associated vertebral osteomyelitis. J Vasc Surg. 1984;1:579–81.PubMed

Nasca RJ, McElvein RB. Aspergillus fumigatus osteomyelitis of the thoracic spine treated by excision and interbody fusion. Spine. 1985;10:848–50.PubMedCrossRef

10.

Brandt SJ, Thompson RL, Wenzel RP. Mycotic pseudoaneurysm of an aortic bypass graft and contiguous vertebral osteomyelitis due to Aspergillus fumigatus. Am J Med. 1985;79:259–62.PubMedCrossRef

11.

Brown DL, Musher DM, Taffet GE. Hematogenously acquired Aspergillus vertebral osteomyelitis in seemingly immunocompetent drug addicts. West J Med. 1987;147:84–5.PubMed

12.

Holmes PF, Osterman DW, Tullos HS. Aspergillus discitis. Report of two cases and review of the literature. Clin Orthop Relat Res. 1988;226:240–6.PubMed

13.

Govender S, Rajoo R, Goga IE, Charles RW. Aspergillus osteomyelitis of the spine. Spine. 1991;16:746–9.PubMedCrossRef

14.

Peters-Christodoulou MN, de Beer FC, Bots GTAM, Ottenhoff TMJ, Thompson J, van’T Wout JW. Treatment of postoperative Aspergillus fumigatus spondylodiscitis with itraconazole. Scand J Infect Dis. 1991;23:373–6.PubMedCrossRef

15.

McGregor A, McNicol D, Collignon P. Aspergillus-induced discitis. A role for itraconazole in therapy? Spine. 1992;17:1512–4.PubMedCrossRef

16.

Roux JP, Koussa A, Cajot MA, Marquette F, Goullard L, Gosselin B, Pol A, Warembourg H, Soots G. Primary Aspergillus endocarditis. Apropos of a case and review of the international literature. Ann Chir. 1992;46:110–5.PubMed

17.

D’Hoore K, Hoogmartens M. Vertebral aspergillosis. A case report and review of the literature. Acta Orthop Belg. 1993;59:306–14.PubMed

18.

Cortet B, Richard R, Deprez X, Lucet L, Flipo RM, Le Loët X, Duquesnoy B, Delcambre B. Aspergillus spondylodiscitis: successful conservative treatment in 9 cases. J Rheumatol. 1994;21:1287–91.PubMed

19.

Korovessis P, Repanti M, Katsardis T, Stamatakis M. Anterior decompression and fusion for Aspergillus osteomyelitis of the lumbar spine associated with paraparesis. Spine. 1994;19:2715–8.PubMed

20.

Liu Z, Hou T, Shen Q, Liao W, Xu H. Osteomyelitis of sacral spine caused by Aspergillus versicolor with neurologic deficits. Chin Med J. 1995;108:472–5.PubMed

21.

Witzig RS, Greer DL, Hyslop NE Jr. Aspergillus flavus mycetoma and epidural abscess successfully treated with itraconazole. J Med Vet Mycol. 1996;34:133–7.PubMedCrossRef

22.

Lang EW, Pitts LH. Intervertebral disc space infection caused by Aspergillus fumigatus. Eur Spine J. 1996;5:207–9.PubMedCrossRef

23.

Ba MC, Badiane M, Ndao AK, Badiane SB, Sakho Y, Gueye EM, Gueye M. Dorsal cord compression by aspergilloma. Apropos of a case. Dakar Med. 1997;42:74–6.PubMed

24.

Combes Dabrowski L, Marchou B, Dabrowski A. Aspergillus spondylodiscitis: 3 cases studies and review of literature. Med Mal Inf. 2003;33:258–65.CrossRef

25.

Chi CY, Fung CP, Liu CY. Aspergillus flavus epidural abscess and osteomyelitis in a diabetic patient. J Microbiol Immunol Infect. 2003;36:145–8.PubMed

26.

Stratov I, Korman TM, Johnson PDR. Management of Aspergillus osteomyelitis: report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review. Eur J Clin Microbiol Infect Dis. 2003;22:277–83.PubMed

27.

Salloum A, Rao S, Havasi A, Miljkovic G, Amoateng-Adjepong Y. Aspergillus rib and vertebral osteomyelitis in a former intravenous drug user. Am J Med. 2004;116:208–9.PubMedCrossRef

28.

Vaishya S, Sharma MS. Spinal Aspergillus vertebral osteomyelitis with extradural abscess: case report and review of literature. Surg Neurol. 2004;61:551–5.PubMedCrossRef

29.

Lenzi J, Agrillo A, Santoro A, Marotta N, Cantore GP. Postoperative spondylodiscitis from Aspergillus fumigatus in immunocompetent subjects. J Neurosurg Sci. 2004;48:81–5.PubMed

30.

Fain O. The image. Aspergillus spondylodiscitis. Rev Prat. 2006;56:827.PubMed

31.

Larson Kolbe AB, McKinney AM, Tuba Karagulle Kendi A, Misselt D. Aspergillus meningitis and discitis from low-back procedures in an immunocompetent patient. Acta Radiol. 2007;48:687–9.CrossRef

32.

Domergue V, Orlandini V, Begueret H, Couprie B, Huerre M, Tunon de Lara M, Beylot-Barry M, Doutre MS. Cutaneous, pulmonary and bone aspergillosis in a patient presumed immunocompetent presenting subacute cutaneous lupus erythematosus. Ann Dermatol Vénéréol. 2008;135:217–21.PubMedCrossRef

33.

Tew CW, Han FC, Jureen R, Tey BH. Aspergillus vertebral osteomyelitis and epidural abscess. Singapore Med J. 2009;50:e151–4.PubMed

34.

Nandeesh BN, Kini U, Alexander B. Vertebral osteomyelitis with a rare etiology diagnosed by fine-needle aspiration cytology. Diagn Cytopathol. 2010;38:360–3.

35.

Ranjan R, Mishra S, Ranjan S. Aspergillus vertebral osteomyelitis in an immunocompetent person. Neurol India. 2010;58:806–8.PubMedCrossRef

36.

Studemeister A, Stevens DA. Aspergillus vertebral osteomyelitis in immunocompetent hosts: role of triazole antifungal therapy. Clin Infect Dis. 2011;52:e1–6.PubMedCrossRef

37.

Perfect JR, Cox GM, Lee JY, Kauffman CA, de Repentigny L, Chapman SW, Morrison VA, Pappas P, Hiemenz JW, Stevens DA; Mycoses Study Group. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis. 2001;33:1824–33.PubMedCrossRef

38.

Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de Pauw B; Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Eng J Med. 2002;347:408–15.CrossRef

39.

Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF; Infectious Diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:327–60.PubMedCrossRef

Title: Aspergillus vertebral osteomyelitis in immunocompetent subjects: case report and review of the literature
Authors: A. Nicolle
A. de la Blanchardière
J. Bonhomme
M. Hamon
R. Leclercq
M. Hitier
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Infection / Issue 4/2013
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-013-0463-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Aspergillus vertebral osteomyelitis in immunocompetent subjects: case report and review of the literature

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Accuracy and applicability of the revised WHO classification (2009) of dengue in children seen at a tertiary healthcare facility in northern India

Descending thoracic aortitis due to Haemophilus influenzae: a case report and literature review

Clostridial abdominal gas gangrene masquerading as a bowel perforation in an advanced-stage ovarian cancer patient

Successful ganciclovir treatment of primary cytomegalovirus infection containing the UL97 mutation N510S in an intestinal graft recipient

Haemolytic anaemia after oral artemether–lumefantrine treatment in a patient affected by severe imported falciparum malaria

Early Lactococcus lactis endocarditis after mitral valve repair: a case report and literature review

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page