Diagnosis and treatment of Candida vertebral osteomyelitis: clinical experience with a short course therapy of amphotericin B lipid complex

Surg Neurol. 2004 Sep;62(3):234-7; discussion 237. doi: 10.1016/j.surneu.2003.11.018.

Abstract

Background: Musculoskeletal candidiasis occurs in some patients with candidemia resulting from organ infection, IV drug use, or indwelling central venous catheters. Diagnosis is often difficult because of vague symptomatology and a frequent afebrile course.

Case description: Three patients with Candida vertebral osteomyelitis are presented. All followed the use of indwelling central venous access catheters and antimicrobial therapy between 6 months and 3 years earlier. In 2, fungemia with the same Candida spp. preceded the spondylodiskitis. These 3 patients bring to nearly 75 the number of reported individuals with what was once quite rare. Although IV amphotericin B doxycholate and fluconazole have usually been effective therapy over prolonged periods of time, we used liposomal amphotericin B to treat 2 of our 3 patients. Both received 5 mg/kg daily for 18-42 days that resulted in total disappearance of signs and symptoms.

Conclusion: This relatively brief duration of therapy reduces treatment time and is cost-effective.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Candidiasis / diagnosis
  • Candidiasis / drug therapy*
  • Discitis / diagnosis
  • Discitis / drug therapy*
  • Drug Administration Schedule
  • Drug Combinations
  • Humans
  • Lumbar Vertebrae / microbiology
  • Male
  • Middle Aged
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy*
  • Phosphatidylcholines / administration & dosage
  • Phosphatidylcholines / therapeutic use*
  • Phosphatidylglycerols / administration & dosage
  • Phosphatidylglycerols / therapeutic use*
  • Thoracic Vertebrae / microbiology

Substances

  • Antifungal Agents
  • Drug Combinations
  • Phosphatidylcholines
  • Phosphatidylglycerols
  • liposomal amphotericin B
  • Amphotericin B