Full Text:   <2533>

Summary:  <1711>

Suppl. Mater.: 

CLC number: R681.5+1

On-line Access: 2016-11-03

Received: 2016-02-24

Revision Accepted: 2016-06-23

Crosschecked: 2016-10-18

Cited: 0

Clicked: 4567

Citations:  Bibtex RefMan EndNote GB/T7714


Xiang-jin Lin


-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.11 P.874-881


Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis

Author(s):  Lie-dao Yu, Zhi-yun Feng, Xuan-wei Wang, Zhi-heng Ling, Xiang-jin Lin

Affiliation(s):  Department of Orthopedic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

Corresponding email(s):   doclinxiangjin@163.com

Key Words:  Spondylodiscitis, Spinal infection, H7N9 virus, Avian influenza virus, Candida, Aspergillus, Fungi, Review

Lie-dao Yu, Zhi-yun Feng, Xuan-wei Wang, Zhi-heng Ling, Xiang-jin Lin. Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis[J]. Journal of Zhejiang University Science B, 2016, 17(11): 874-881.

@article{title="Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis",
author="Lie-dao Yu, Zhi-yun Feng, Xuan-wei Wang, Zhi-heng Ling, Xiang-jin Lin",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis
%A Lie-dao Yu
%A Zhi-yun Feng
%A Xuan-wei Wang
%A Zhi-heng Ling
%A Xiang-jin Lin
%J Journal of Zhejiang University SCIENCE B
%V 17
%N 11
%P 874-881
%@ 1673-1581
%D 2016
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1600077

T1 - Fungal spondylodiscitis in a patient recovered from H7N9 virus infection: a case study and a literature review of the differences between Candida and Aspergillus spondylodiscitis
A1 - Lie-dao Yu
A1 - Zhi-yun Feng
A1 - Xuan-wei Wang
A1 - Zhi-heng Ling
A1 - Xiang-jin Lin
J0 - Journal of Zhejiang University Science B
VL - 17
IS - 11
SP - 874
EP - 881
%@ 1673-1581
Y1 - 2016
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1600077

To report a rare case of fungal spondylodiscitis in a patient recovered from h7N9 virus infection and perform a literature review of the different characteristics of Candida and Aspergillus spondylodiscitis, we reviewed cases of spondylodiscitis caused by Candida and Aspergillus species. Data, including patients’ information, pathogenic species, treatment strategy, outcomes, and relapses, were collected and summarized. The characteristics of Candida and Aspergillus spondylodiscitis were compared to see if any differences in clinical features, management, or consequences could be detected. The subject of the case study was first misdiagnosed as having a vertebral tumor, and then, following open biopsy, was diagnosed as having fungal spondylodiscitis. The patient made a good recovery following radical debridement. Seventy-seven additional cases of Candida spondylodiscitis and 94 cases of Aspergillus spondylodiscitis were identified in the literature. Patients with Candida spondylodiscitis tended to have a better outcome than patients with Aspergillus spondylodiscitis (cure rate 92.3% vs. 70.2%). Candida was found more frequently (47.8%) than Aspergillus (26.7%) in blood cultures, while neurological deficits were observed more often in patients with Aspergillus spondylodiscitis (43.6% vs. 25.6%). Candida spinal infections were more often treated by radical debridement (60.5% vs. 39.6%). Patients with Candida spondylodiscitis have better outcomes, which may be associated with prompt recognition, radical surgical debridement, and azoles therapy. A good outcome can be expected in fungal spondylodiscitis with appropriate operations and anti-fungal drugs.


创新点:首次报道在H7N9禽流感治愈患者中出现念珠菌脊柱感染,经过彻底的清创融合内固定和唑类抗真菌药治疗取得良好疗效。文献研究发现了念珠菌和曲霉菌这两大主要真菌在脊柱感染中的临床表现、处理方法和临床结局均有不同。念珠菌脊柱感染治愈率为92.3%,而曲霉菌为70.2%。其可能的原因有以下四点,念珠菌血培养结果阳性率更高(41.0% vs. 24.5%),神经损害发生概率更低(25.6% vs. 43.6%),手术方式更多地选用彻底病灶清除加融合内固定(60.5% vs. 39.6%),术后多选用唑类抗真菌药。
方法:在PubMed和Google Scholar搜集念珠菌和曲霉菌脊柱感染的病例,提取患者一般信息、临床症状、感染部位、病原学结果、治疗方法、治疗结局和复发等情况进行总结分析。


Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Bridwell, K., Campbell, J.W., Barenkamp, S.J., 1990. Surgical treatment of hematogenous vertebral Aspergillus osteomyelitis. Spine, 15(4):281-285.

[2]Broner, F.A., Garland, D.E., Zigler, J.E., 1996. Spinal infections in the immunocompromised host. Orthop. Clin. N. Am., 27(1):37-46.

[3]Ceroni, D., Dubois-Ferrière, V., Cherkaoui, A., et al., 2013. 30 years of study of Kingella kingae: post tenebras, lux. Future Microbiol., 8(2):233-245.

[4]Ceroni, D., Kampouroglou, G., Valaikaite, R., et al., 2014. Osteoarticular infections in young children: what has changed over the last years? Swiss Med. Wkly., 144:w13971.

[5]Chen, Y., Liang, W.F., Yang, S.G., et al., 2013. Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet, 381(9881):1916-1925.

[6]Chia, S.L., Tan, B.H., Tan, C.T., et al., 2005. Candida spondylodiscitis and epidural abscess: management with shorter courses of anti-fungal therapy in combination with surgical debridement. J. Infect., 51(1):17-23.

[7]Cortet, B., Richard, R., Deprez, X., et al., 1994. Aspergillus spondylodiscitis: successful conservative treatment in 9 cases. J. Rheumatol., 21(7):1287-1291.

[8]D'Agostino, C., Scorzolini, L., Massetti, A.P., et al., 2010. A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection, 38(2):102-107.

[9]Ersoy, A., Dizdar, O.S., Koc, A.O., 2011. Aspergillus fumigatus spondylodiskitis in renal transplant patient: voriconazole experience. Exp. Clin. Transplant., 9(4):265-269.

[10]Frazier, D.D., Campbell, D.R., Garvey, T.A., et al., 2001. Fungal infections of the spine. Report of eleven patients with long-term follow-up. J. Bone Joint Surg. Am., 83-A(4):560-565.

[11]Gao, H.N., Lu, H.Z., Cao, B., et al., 2013. Clinical findings in 111 cases of influenza A (H7N9) virus infection. N. Engl. J. Med., 368(24):2277-2285.

[12]Groll, A.H., Walsh, T.J., 2001. Uncommon opportunistic fungi: new nosocomial threats. Clin. Microbiol. Infect., 7(Suppl. 2):8-24.

[13]Hendrickx, L., Wijngaerden, E.V., Samson, I., et al., 2001. Candidal vertebral osteomyelitis: report of 6 patients, and a review. Clin. Infect. Dis., 32(4):527-533.

[14]Hennequin, C., Bourée, P., Hiesse, C., et al., 1996. Spondylodiskitis due to Candida albicans: report of two patients who were successfully treated with fluconazole and review of the literature. Clin. Infect. Dis., 23(1):176-178.

[15]Iwata, A., Ito, M., Abumi, K., et al., 2014. Fungal spinal infection treated with percutaneous posterolateral endoscopic surgery. J. Neurol. Surg. Part A: Cent. Eur. Neurosurg., 75(3):170-176.

[16]Kim, C.W., Perry, A., Currier, B., et al., 2006. Fungal infections of the spine. Clin. Orthop. Relat. Res., 444:92-99.

[17]Kwon, J.W., Hong, S.H., Choi, S.H., et al., 2011. MRI findings of Aspergillus spondylitis. Am. J. Roentgenol., 197(5):W919-W923.

[18]Lenzi, J., Agrillo, A., Santoro, A., et al., 2004. Postoperative spondylodiscitis from Aspergillus fumigatus in immunocompetent subjects. J. Neurosurg. Sci., 48(2):81-85.

[19]Liem, N.T., Tung, C.V., Hien, N.D., 2009. Clinical features of human influenza A (H5N1) infection in Vietnam: 2004– 2006. Clin. Infect. Dis., 48(12):1639-1646.

[20]Mawk, J.R., Erickson, D.L., Chou, S.N., et al., 1983. Aspergillus infections of the lumbar disc spaces. Report of three cases. J. Neurosurg., 58(2):270-274.

[21]Nasca, R.J., McElvein, R.B., 1985. Aspergillus fumigatus osteomyelitis of the thoracic spine treated by excision and interbody fusion. Spine, 10(9):848-850.

[22]Palmisano, A., Benecchi, M., Filippo, M.D., 2011. Candida sake as the causative agent of spondylodiscitis in a hemodialysis patient. Spine J., 11(3):e12-e16.

[23]Pappas, P.G., Kauffman, C.A., David, A., et al., 2009. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin. Infect. Dis., 48(5):503-535.

[24]Pemán, J., Jarque, I., Bosch, M., et al., 2006. Spondylodiscitis caused by Candida krusei: case report and susceptibility patterns. J. Clin. Microbiol., 44(5):1912-1914.

[25]Rachapalli, S.M., Malaiya, R., Mohd, T., et al., 2010. Successful treatment of Candida discitis with 5-flucytosine and fluconazole. Rheumatol. Int., 30(11):1543-1544.

[26]Shashidhar, N., Tripathy, S.K., Balasubramanian, S., et al., 2014. Aspergillus spondylodiscitis in an immunocompetent patient following spinal anesthesia. Orthop. Surg., 6(1):72-77.

[27]Shi, J.M., Pei, X.Y., Luo, Y., et al., 2015. Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 16(9):796-804.

[28]Skaf, G.S., Kanafani, Z.A., Araj, G.F., et al., 2010. Non-pyogenic infections of the spine. Int. J. Antimicrob. Agents, 36(2):99-105.

[29]Storm, L., Lausch, K.R., Arendrup, M.C., et al., 2014. Vertebral infection with Candida albicans failing caspofungin and fluconazole combination therapy but successfully treated with high dose liposomal amphotericin B and flucytosine. Med. Mycol. Case Rep., 6:6-9.

[30]Sugar, A.M., Saunders, C., Diamond, R.D., 1990. Successful treatment of Candida osteomyelitis with fluconazole. A noncomparative study of two patients. Diagn. Microbiol. Infect. Dis., 13(6):517-520.

[31]Tan, A.C., Parker, N., Arnold, M., 2014. Candida glabrata vertebral osteomyelitis in an immunosuppressed patient. Int. J. Rheuma. Dis., 17(2):229-231.

[32]Theodoros, K., Sotirios, T., 2012. Successful treatment of azole-resistant Candida spondylodiscitis with high-dose caspofungin monotherapy. Rheumatol. Int., 32(9):2957-2958.

[33]Uyeki, T.M., Cox, N.J., 2013. Global concerns regarding novel influenza A (H7N9) virus infections. N. Engl. J. Med., 368(20):1862-1864.

[34]Walsh, T.J., 2008. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin. Infect. Dis., 46(3):327-360.

[35]Williams, R.L., Fukui, M.B., Meltzer, C.C., et al., 1999. Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. Am. J. Neuroradiol., 20(20):381-385.

[36]Yagupsky, P., 2004. Kingella kingae: from medical rarity to an emerging paediatric pathogen. Lancet Infect. Dis., 4(6):358-367.

[37]Yang, S.G., Cao, B., Liang, L.R., et al., 2012. Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1) virus. PLOS ONE, 7(1):e29652.

[38]List of electronic supplementary materials

[39]Case reports or case serials related to the Candida or Aspergillus spondylosidcitis

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE