Candida spondylitis: case report and review of the literature

Candida species have emerged as important pathogens in human infection. Alt hough a variety of deep-seated candidal infections have been reported, Cand ida spondylitis has rarely been described. One patient with candida tropica lis spondylitis L I and L II in combination with candida coxitis is present ed, and the 31 adult cases with vertebral involvement previously reported a re reviewed. Candida spondylitis is noted as a simultaneous occurrence or l ate manifestation of hematogenously disseminated candidiasis. Spondylitis m ay not be prevented by a course of Amphotericin B adequate to control the a cute episode of disseminated candidiasis, particularly in immune suppressed patients. Spondylitis does not present as a postoperative wound infection. The insidious progression of infection, the nonspecificity of laboratory d ata, and the failure to recognise Candida as a potential pathogen may lead to diagnostic delay. Diagnosis can be made by either open biopsy or CT cont rolled needle aspiration. Successful therapeutic regimes have employed comb inations of antifungal therapy (Amphotericin B or fluconazole) with radical surgical debridement. Ventral and facultatively dorsal instumentation is r equired to stabilize the spine. It is anticipated that the spondylitis will become a more commonly recognised manifestation of hematogenously dissemin ated candidiasis. A increasing significance of candida species as etiologic agents of infection immune compromised humans has been recognised in the r ecent years. In those patients whom an antecedent Candida septicaemia was d ocumented, a striking delay of 3.3 months was found between the septicaemia and the onset of symptoms as well as the time of diagnosis.