Fungal spinal infections: a narrative review on diagnosis, treatment strategies, and collaborative management approaches

TL;DR

This review summarizes the diagnosis, treatment, and management of rare fungal spinal infections, highlighting the importance of early detection and collaboration among specialists.

Contribution

The paper provides a comprehensive analysis of patient data and treatment outcomes for fungal spinal infections.

Findings

Candida albicans was the most common pathogen in fungal spinal infections.

Triazoles were the most frequently used antifungal treatment.

Collaboration between spine surgeons and radiologists is crucial for managing these infections.

Abstract

Spinal fungal infections are rare with a frequency of 2.2 times per 100,000 people annually. They are caused by pathogens such Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Candida albicans, and Aspergillus fumigatus (found globally).

This review on fungal spinal infections examines patient demographics, medicinal treatments, surgical methods, and outcomes.

All PubMed articles on fungal spine infections were analysed, regardless of fungus, publication year, or spinal segment. The patient’s age, gender, affected spinal section, microorganism, treatment regimens, surgical methods, follow-up period, and results were recorded.

Of the 134 analyzed patients, 66.4% were male. The mean age was 54.3±14.9 years. Most susceptible was the lumbar spine (47%), followed by the thoracic (29.9%) and lumbo-sacral (12.7%). The most common organism was Candida albicans (62.7%), followed by Aspergillus fumigatus (27.6%). Spondylodiscitis (35.8%) and osteomyelitis (31.3%) lead our review.

The most frequent antifungals were triazoles (55%), followed by polyenes (31%). Most procedures (59.5%) were non-fixation.

Back discomfort, fever, and neurological impairments were prominent signs of spine fungal infections. Blood tests, cultures, and MRI/CT scans were used to diagnose.

Spondylodiscitis had a letality of 6.25%, spinal osteomyelitis of 11%. Recovery requires long-term monitoring.

The review emphasises the significance of early detection and treatment, individualised antifungal regimens, and surgery in specific cases to enhance fungal spinal infection outcomes. Spine surgeons and radiologists must work together to solve diagnostic and therapeutic issues.

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