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- Title
Fungal Spinal Epidural Abscess: Characteristics and Differences From Bacterial Spinal Epidural Abscess.
- Authors
Huiliang Yang; Im, Gi Hye; Shah, Akash A.; Nelson, Sandra B.; Yueming Song; Schwab, Joseph H.
- Abstract
Introduction: Fungal spinal epidural abscess (FSEA) is a rare entity, with few reports that describe its clinical features, diagnosis, treatment, and outcomes. Similarly, the characteristics of FSEA and the more common bacterial spinal epidural abscess (BSEA) have not been compared. Therefore, we describe the clinical features, diagnosis, treatment, and outcomes of FSEA and report differences from bacterial spinal epidural abscess (BSEA). Material and Methods: We reviewed the electronic medical records of patients with FSEA who were treated within our hospital system in the last 23 years. We compared our findings to all reported FSEA cases in the English-language literature from 1952 to 2017. We compared our FSEA cases to the BSEA cases in our database. Results: From a database of 879 patients, we identified nine patients with FSEA. Aspergillus fumigatus was isolated from 2 (22%) patients, and Candida species were isolated from 7 (78%). Local spine pain, neurologic deficit, and fever were demonstrated in 89%, 50%, and 44% of FSEA cases, respectively. Patients with FSEA had longer symptom duration (> 2 weeks) prior to presentation than those with BSEA (p = 0.020). Fifty-six percent of FSEAs involved the thoracic spine, and 89% were located anterior to the thecal sac. Fifty-nine patients with FSEA were identified through literature review. Aspergillus and Candida were responsible for 60% and 29% of cases, respectively. FSEA was less likely to cause fungemia than BSEA was to cause bacteremia (p = 0.023). FSEA cases were more likely to have longer symptom duration (> 2 weeks) prior to presentation than BSEA cases (p = 0.020). Additionally, FSEA cases had a higher probability of having concurrent immunosuppression, vertebral osteomyelitis, and a history of malignant tumor than BSEA cases (p = 0.029, p = 0.040, and p = 0.044, respectively). Finally, the rate of recurrence and mortality within 90 days in FSEA are higher than in BSEA (p = 0.033 and p = 0.018, respectively). Conclusion: The most common pathogens identified in FSEA are Aspergillus and Candida species. Empiric treatment for FSEA should cover these species while definitive identification is pending. The three most common symptoms for FSEA are local spine pain, neurologic deficit, and fever. The thoracic and lumbar regions of the spine are most likely to be involved. FSEA cases had a higher probability of having longer symptom duration prior to presentation, concurrent immunosuppression, vertebral osteomyelitis, and a history of malignant tumor than BSEA cases. Additionally, FSEA has a higher rate of recurrence and mortality than BSEA.
- Publication
Global Spine Journal, 2018, Vol 8, p130S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030