Fungal Infections of the Spine. Issue 12 (15th June 2015)

• Record Type: Journal Article
• Authors: Ganesh, Devin; Gottlieb, Jonathan; Chan, Sherilynn; Martinez, Octavio; Eismont, Frank
• Is Part Of: Spine. Volume 40:Issue 12(2015)
• Publication Date: 2015-06-15
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000903
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Review of the literature.</p> </sec> <sec> <title>Objective.</title> <p>To retrospectively examine the frequency of published fungal infections by species and the treatment algorithms used to eradicate the disease.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Fungal infections of the spine present unique challenges to the modern multispecialty treatment team. Although rare in comparison with bacterial infections, fungal infections have been increasing in incidence over the past several decades. Evidences-based practice is limited to referencing smaller case series.</p> </sec> <sec> <title>Methods.</title> <p>MEDLINE, Scopus, and EMBASE searches were carried out by one of the authors as well as by the research desk at the University of Miami/Calder Memorial Library. We included peer-reviewed articles published between 1948 and September 2010; case reports, series, and reviews were all examined and compiled into a database.</p> </sec> <sec> <title>Results.</title> <p>A total of 130 articles, representing 157 cases, were included in the review. <italic>Aspergillus</italic> (60 cases, 38.2% of the total) and <italic>Candida</italic> species (36 cases, 22.9% of the total) were the 2 most common organisms. Surgery was associated with a greater survival rate than medical management alone in patients with <italic>Aspergillus</italic> (26.9% mortality in surgical patients; 60% in medically treated patients) and <italic>Candida</italic> (0% <italic>vs</italic>. 28.6%). Overall mortality was 19.3%. The overall recurrence rate was 7.4%. Amphotericin use was associated with a higher mortality rate than azoles.</p> </sec> <sec> <title>Conclusion.</title> <p> <italic>Aspergillus</italic> is the most common published pathogen in fungal infections of the spine. Recent publications depicting the use of newer antifungal medications such as azoles report higher survival rates. Surgically treated patients in combination with antifungal therapy showed highest frequencies of patient survival in <italic>Aspergillus</italic> and <italic>Candida</italic> infections.</p> <p> <bold>Level of Evidence:</bold> 3</p> </sec> </abstract>