957. Outcome and Demographics of Patients with Candida Vertebral Osteomyelitis: A Cohort Study
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Candida vertebral osteomyelitis (CVO) is a rare and frequently misdiagnosed condition. Since 1970 there have been 67 cases reported. The number of cases has increased over the past 20 years due to the increase in immunocompromised patients. Destruction of the vertebral bodies, spinal cord compression and neurological deficits may occur. The purpose of this study was to describe the demographics and determine the outcome of patients with CVO.

Methods: All patients with culture positive CVO seen between 01/01/1990 - 12/31/2009 at our institution were identified and their records were reviewed using a strict case definition. The cumulative probability of treatment success was assessed by using the Kaplan-Meier survival method. Patients were followed until death, failure, or loss of follow-up.

Results: 9 patients had VO due to Candida spp. during the study period. The median age at diagnosis was 59 years (range,33-77) and 33 % (3/9) of episodes occurred in women. 55.5% percent (5/9) of VO episodes involved the cervical spine.  Malignancy, diabetes mellitus, and steroid use were present in 33% (3/9), 33% (3/9) and 11% (1/9) of patients, respectively. 44% (4/9) patients had a contiguous infection between upper airways and the cervical spine. 78% (7/9) patients presented with mechanical-type pain. The median duration of symptoms was 84 days (range, 14-483 days). 44% (4/9) presented with concomitant epidural abscess. Candida albicans, Candida parapsilosis, and Candida glabrata were cultured in 33% (3/9) of cases, respectively. 66% (6/9) were polymicrobial with bacterial organisms present. 44% (4/9) were implant -associated. 89% (8/9) underwent surgery to manage their infection (5 underwent debridement, and 3 underwent surgery to manage spinal instability). 88.8% (8/9) were treated with a prolonged course using azoles. The cumulative incidence of success was 66± 19% at 1 year and 50 ±20% at 2 years of follow up.

Conclusion: Candida VO is associated with a long duration of symptoms. It often affects the cervical spine. Candida VO is associated with a poor outcome. 

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Amanda Ramos, Mayo Medical School, Rochester, MN, Paul Huddleston, MD, Mayo Clinic, Rochester, MN and Elie Berbari, MD, Division of Infectious Diseases, Mayo Clinic, Rochester, MN


A. Ramos, None

P. Huddleston, None

E. Berbari, None

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