Top

Published in:

01-04-2020 | Magnetic Resonance Imaging | Musculoskeletal

MRI and clinical features of acute fungal discitis/osteomyelitis

Authors: F. Joseph Simeone, Jad S. Husseini, Kaitlyn J. Yeh, Santiago Lozano-Calderon, Sandra B. Nelson, Connie Y. Chang

Published in: European Radiology | Issue 4/2020

Abstract

Objectives

To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies.

Methods

Our study was IRB-approved and HIPAA-compliant. A group of 11 fungal DO (FG) with MRI within 7 days of the biopsy and a control group (CG) of 19 Staphylococcus aureus DO were evaluated. Imaging findings (focal vs diffuse paravertebral soft tissue abnormality, partial vs complete involvement of the disc/endplate), biopsy location, pathology, duration of back pain, immune status, history of intravenous drug, history of prior infection, current antibiotic treatment, and history of invasive intervention. Differences were assessed using the Fisher exact test and Kruskal-Wallis test. Naïve Bayes predictive modeling was performed.

Results

The most common fungal organisms were Candida species (9/11, 82%). The FG was more likely to have focal soft tissue abnormality (p = 0.040) and partial disc/endplate involvement (p = 0.053). The clinical predictors for fungal DO, in order of importance, back pain for 10 or more weeks, current antibiotic use for 1 week or more, and current intravenous drug use. History of invasive instrumentation within 1 year was more predictive of Staphylococcus aureus DO.

Conclusion

MRI features (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.

Key Points

• MRI features of discitis-osteomyelitis (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.

Corrah TW, Enoch DA, Aliyu SH, Lever AM (2011) Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients. QJM 104:201–207. https://doi.org/10.1093/qjmed/hcq178 CrossRefPubMed

Digby JM, Kersley JB (1979) Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br 61:47–55CrossRef

Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95. Scand J Infect Dis 33:527–532CrossRef

Chen C-H, Chen WL, Yen H-C (2013) Candida albicans lumbar spondylodiscitis in an intravenous drug user: a case report. BMC Res Notes 6:529. https://doi.org/10.1186/1756-0500-6-529 CrossRefPubMedPubMedCentral

Khazim RM, Debnath UK, Fares Y (2006) Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases. Eur Spine J 15:1404–1410. https://doi.org/10.1007/s00586-005-0038-z CrossRefPubMedPubMedCentral

Williams RL, Fukui MB, Meltzer CC, Swarnkar A, Johnson DW, Welch W (1999) Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. AJNR Am J Neuroradiol 20:381–385

Shaikh BS, Appelbaum PC, Aber RC (1980) Vertebral disc space infection and osteomyelitis due to Candida albicans in a patient with acute myelomonocytic leukemia. Cancer 45:1025–1028CrossRef

Gathe JC Jr, Harris RL, Garland B, Bradshaw MW, Williams TW Jr (1987) Candida osteomyelitis. Report of five cases and review of the literature. Am J Med 82:927–937

Gamaletsou MN, Kontoyiannis DP, Sipsas NV et al (2012) Candida osteomyelitis: analysis of 207 pediatric and adult cases (1970-2011). Clin Infect Dis 55:1338–1351. https://doi.org/10.1093/cid/cis660 CrossRefPubMedPubMedCentral

10.

Jensen AG, Espersen F, Skinhøj P, Frimodt-Møller N (1998) Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med 158:509–517CrossRef

11.

Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514. https://doi.org/10.1148/radiol.2282020752 CrossRefPubMed

12.

Kumar K (2016) Spinal tuberculosis, natural history of disease, classifications and principles of management with historical perspective. Eur J Orthop Surg Traumatol 26:551–558. https://doi.org/10.1007/s00590-016-1811-x CrossRefPubMed

13.

Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G (2017) Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases. Spinal Cord 55:59–63. https://doi.org/10.1038/sc.2016.85

14.

Miller DJ, Mejicano GC (2001) Vertebral osteomyelitis due to Candida species: case report and literature review. Clin Infect Dis 33:523–530. https://doi.org/10.1086/322634 CrossRefPubMed

15.

Celik AD, Ozaras R, Kantarcioglu S, Mert A, Tabak F, Ozturk R (2009) Spondylodiscitis due to an emergent fungal pathogen: Blastoschizomyces capitatus, a case report and review of the literature. Rheumatol Int 29:1237–1241. https://doi.org/10.1007/s00296-009-0928-1

16.

Yoshihara T, Mori K, Nishimura Y, Ishida H, Morimoto A, Imashuku S (2004) Osteocartilaginous involvement in Blastoschizomyces capitatus (Trichosporon capitatum) infection in a bone marrow transplant recipient. Br J Haematol 124:405. https://doi.org/10.1046/j.1365-2141.2003.04666.x

17.

Cha JG, Hong HS, Koh YW, Kim HK, Park JM (2008) Candida albicans osteomyelitis of the cervical spine. Skeletal Radiol 37:347–350. https://doi.org/10.1007/s00256-007-0429-9

18.

Torres-Ramos FM, Botwin K, Shah CP (2004) Candida spondylodiscitis: an unusual case of thoracolumbar pain with review of imaging findings and description of the clinical condition. Pain Physician 7:257–260PubMed

19.

Schilling A, Seibold M, Mansmann V, Gleissner B (2008) Successfully treated Candida krusei infection of the lumbar spine with combined caspofungin/posaconazole therapy. Med Mycol 46:79–83. https://doi.org/10.1080/13693780701552996 CrossRefPubMed

20.

Munk PL, Lee MJ, Poon PY et al (1997) Candida osteomyelitis and disc space infection of the lumbar spine. Skeletal Radiol 26:42–46CrossRef

Title: MRI and clinical features of acute fungal discitis/osteomyelitis
Authors: F. Joseph Simeone
Jad S. Husseini
Kaitlyn J. Yeh
Santiago Lozano-Calderon
Sandra B. Nelson
Connie Y. Chang
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Antibiotic
Osteomyelitis
Back Pain
Back Pain
Back Pain
Published in: European Radiology / Issue 4/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06603-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MRI and clinical features of acute fungal discitis/osteomyelitis

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 4/2020

Diffusion kurtosis imaging differs between primary central nervous system lymphoma and high-grade glioma and is correlated with the diverse nuclear-to-cytoplasmic ratio: a histopathologic, biopsy-based study

Bone marrow edema in non-traumatic hip: high accuracy of dual-energy CT with water-hydroxyapatite decomposition imaging

Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness

Development and validation of a MRI-based radiomics signature for prediction of KRAS mutation in rectal cancer

Imaging of sarcopenia: old evidence and new insights

A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation