Stolberg-Stolberg Josef, Horn Dagmar, Roßlenbroich Steffen, Riesenbeck Oliver, Kampmeier Stefanie, Mohr Michael, Raschke Michael J, Hartensuer René
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.
Department of Pharmacy, University Hospital Münster, Münster, Germany.
Eur Spine J. 2017 Apr;26(4):1009-1018. doi: 10.1007/s00586-016-4827-3. Epub 2016 Nov 5.
Candida induced spondylodiscitis of the cervical spine in immunocompetent patients is an extremely rare infectious complication. Since clinical symptoms might be nonspecific, therapeutic latency can lead to permanent spinal cord damage, sepsis and fatal complications. Surgical debridement is strongly recommended but there is no standard antimycotic regime for postsurgical treatment. This paper summarizes available data and demonstrates another successfully treated case.
The systematic analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed and Web of Science were scanned to identify English language articles. Additionally, the authors describe the case of a 60-year-old male patient who presented with a Candida albicans induced cervical spondylodiscitis after an edematous pancreatitis and C. albicans sepsis. Anterior cervical corpectomy and fusion of C4-C6, additional anterior plating, as well as posterior stabilization C3-Th1 was followed by a 6-month antimycotic therapy. There was neither funding nor conflict of interests.
A systematic literature analysis was conducted and 4599 articles on spondylodiscitis were scanned. Only four cases were found reporting about a C. albicans spondylodiscitis in a non-immunocompromised patient. So far, our patient was followed up for 2 years. Until now, he shows free of symptoms and infection parameters. Standard testing for immunodeficiency showed no positive results.
Candida albicans spondylodiscitis of the cervical spine presents a potentially life-threatening disease. To our knowledge, this is the fifth case in literature that describes the treatment of C. albicans spondylodiscitis in an immunocompetent patient. Surgical debridement has to be considered, following antimycotic regime recommendations vary in pharmaceutical agents and treatment duration.
在免疫功能正常的患者中，念珠菌引起的颈椎椎体骨髓炎是一种极其罕见的感染性并发症。由于临床症状可能不具有特异性，治疗延迟可能导致永久性脊髓损伤、败血症和致命并发症。强烈建议进行手术清创，但术后治疗尚无标准的抗真菌方案。本文总结了现有数据，并展示了另一例成功治疗的病例。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统分析。检索了PubMed和科学网以识别英文文章。此外，作者描述了一名60岁男性患者的病例，该患者在发生水肿性胰腺炎和白色念珠菌败血症后出现白色念珠菌引起的颈椎椎体骨髓炎。对C4 - C6进行了颈椎前路椎体次全切除及融合术，附加前路钢板固定，以及C3 - Th1后路稳定术，随后进行了6个月的抗真菌治疗。本研究既无资金资助，作者也不存在利益冲突。
进行了系统的文献分析，共检索到4599篇关于椎体骨髓炎的文章。仅发现4例报告了非免疫功能低下患者的白色念珠菌椎体骨髓炎。到目前为止，对我们的患者进行了2年的随访。目前，他没有症状，感染指标正常。免疫缺陷的标准检测未显示阳性结果。
颈椎白色念珠菌椎体骨髓炎是一种潜在的危及生命的疾病。据我们所知，这是文献中描述免疫功能正常患者白色念珠菌椎体骨髓炎治疗的第五例病例。必须考虑手术清创，抗真菌治疗方案在药物制剂和治疗持续时间方面各不相同。
