Fungal infections of the spine are noncaseating, acid-fast-negative
infections that occur primarily as opportunistic infections in immunocompromised patients.
We analyzed eleven patients with spinal osteomyelitis caused by
a fungus, and we developed suggestions for treatment.
All patients with a fungal infection of the spine treated by
the authors over a sixteen-year period at three teaching institutions
were evaluated. There was a total of eleven patients. Medical records
and roentgenograms were available for every patient. Long-term follow-up
of the nine surviving patients was performed by direct examination
by the authors or by the patient’s primary physician.
For ten of the eleven patients, the average delay in the diagnosis
was ninety-nine days. Nine patients were immunocompromised secondary
to diabetes mellitus, corticosteroid use, chemotherapy for a tumor,
or malnutrition. The sources of the spinal infections included direct
implantation from trauma (one patient), hematogenous spread (four
patients), and local extension (two patients). The infection followed
elective spine surgery in three patients, and the cause was unknown
in one. Paralysis secondary to the spine infection developed in
eight patients. Ten patients were treated with surgical débridement.
All eleven patients were treated with systemic antifungal medications
for a minimum of six weeks. One patient died of generalized sepsis
at thirty-three days, and another patient died of gastrointestinal
hemorrhage at five months. After an average of 6.3 years of follow-up,
the infection had resolved in all nine surviving patients.
Treatment of fungal spondylitis is often delayed because of difficulty
with the diagnosis. Delay in the diagnosis led to poorer results
in terms of neurologic recovery in our study. Performing fungal cultures
whenever a spinal infection is suspected might hasten the diagnosis.
Patients should be given a guarded prognosis and informed of the many
possible complications of the disease.