Candidal vertebral osteomyelitis: Report of 6 patients, and a review

The incidence of deep-seated candidal infection is increasing, but candidal vertebral osteomyelitis is still rare. We describe 6 patients recently tre ated in our hospital. Conservative treatment failed in all. We reviewed the literature and identified 59 additional cases of candidal vertebral osteom yelitis. Candidemia was documented in 61.5% of them. The interval between t he diagnosis of candidemia and the onset of symptoms of vertebral osteomyel itis varied widely, from days to >1 year. In patients without documented ca ndidemia, there was a similar interval between the occurrence of risk facto rs for candidemia (present in 72% of the patients) and the onset of symptom s of vertebral osteomyelitis. Clinical, laboratory, and radiological findin gs are not specific for candidal spondylodiskitis. Final diagnosis is deter mined by means of culture of a biopsy specimen from the infected vertebra o r disk. Treatment consisted of prolonged antifungal treatment, and it often included surgery. On the basis of our experience (for all 6 patients, init ial conservative treatment with only antifungals failed), we recommend cons ideration of early surgical debridement in combination with prolonged antif ungal therapy.