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CLC number: R681.5+1

On-line Access: 2016-11-03

Received: 2016-02-24

Revision Accepted: 2016-06-23

Crosschecked: 2016-10-18

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Xiang-jin Lin

http://orcid.org/0000-0003-0062-0448

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

http://doi.org/10.1631/jzus.B1600077


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.

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author="Lie-dao Yu, Zhi-yun Feng, Xuan-wei Wang, Zhi-heng Ling, Xiang-jin Lin",
journal="Journal of Zhejiang University Science B",
volume="17",
number="11",
pages="874-881",
year="2016",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1600077"
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%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

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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
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DOI - 10.1631/jzus.B1600077


Abstract: 
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.

念珠菌脊柱感染发生在H7N9治愈的患者一例报道及文献分析念珠菌脊柱感染和曲霉菌脊柱感染的临床区别

目的:报道在H7N9治愈患者中发现念珠菌脊柱感染病例,并总结念珠菌和曲霉菌脊柱感染的临床表现,处理方法和预后等不同点。
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。
结论:念珠菌脊柱感染的治愈率相对曲霉菌脊柱感染更高,这可能与念珠菌可以早期发现,神经损害较少,更多地选用彻底病灶清除和唑类抗真菌药有关。真菌脊柱感染可以通过合适的手术和抗真菌药取得良好临床疗效。

关键词:真菌脊柱感染;H7N9感染;念珠菌;曲霉菌;综述

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

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