Volume 3 | Issue 2 | October 2022-March 2023 | page: 113-118 | Udit D. Patel, Hitesh N. Modi
Authors: Udit D. Patel , Hitesh N. Modi 
 Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Thaltej, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Department of Spine Surgery, Zydus Hospitals and Healthcare Research Private Limited, Zydus hospital road, Thaltej, Ahmedabad, Gujarat, India.
Background: Spinal aspergillus infection is rare but can cause significant morbidity and mortality. Sometime it may mis-diagnosed as pyogenic or tuberculous infection in immunocompetent patients. Therefore, it causes delay in diagnosis and leads to spinal instability, neurological deficit, and sometimes death.
Case Report: Here we discussed a case of 68 years old female patient with severe back pain and difficulty in walking which was gradually increased over the period of time of two months. During this, she was diagnosed as koch’s spine based on MRI report and she had been started on empirical anti-tuberculous medication. But her condition was deteriorated. After that patient underwent surgical management and infected tissue sent for culture and sensitivity and histopathological examination. The report was positive for aspergillus fungal infection. she was started with anti-fungal medication and course of treatment was uneventful.
Conclusion: Early diagnosis of spinal fungal infection is often delayed in immunocompetent patients and it lead to delayed in anti-fungal management which lead to increase in morbidity and mortality.
Keywords: Aspergillus, Spinal fungal infection, Case Report
1. Zussman BS, Benjamin M, Penn MS, David L, Harrop MD, James S. Surgical management of fungal vertebral osteomyelitis. JHN Journal. 2011;6(2):2.
2. Casanova SR, Paulino R, Tavares J, Miranda AC, Sabino R, Veríssimo C, Toscano C, Mansinho K. Spondylodiscitis by Aspergillus nidulans: A Diagnostic Challenge. Journal of Microbiology and Infectious Diseases. 2021 Sep 1;11(03):162-5.
3. Batra S, Arora S, Meshram H, Khanna G, Grover SB, Sharma VK. A rare etiology of cauda equina syndrome. The Journal of Infection in Developing Countries. 2011;5(01):079-82.
4. Vaishya S, Sharma MS. Spinal Aspergillus vertebral osteomyelitis with extradural abscess: case report and review of literature. Surgical neurology. 2004 Jun 1;61(6):551-5.
5. Kim CW, Perry A, Currier B, Yaszemski M, Garfin SR. Fungal infections of the spine. Clinical Orthopaedics and Related Research (1976-2007). 2006 Mar 1;444:92-9.
6. Bazaz R, Denning DW. Aspergillosis: causes, types and treatment. Pharm. J. 2019;303:7927.
7. Dai G, Wang T, Yin C, Sun Y, Xu D, Wang Z, Luan L, Hou J, Li S. Aspergillus spondylitis: Case series and literature review. BMC Musculoskeletal Disorders. 2020 Dec;21(1):1-7.
8. Latgé JP, Chamilos G. Aspergillus fumigatus and Aspergillosis in 2019. Clinical microbiology reviews. 2019 Nov 13;33(1):e00140-18.
9. Perronne C, Saba J, Behloul Z, Salmon-Ceron D, Leport C, Vilde JL, Kahn MF. Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clinical Infectious Diseases. 1994 Oct 1;19(4):746-50.
10. Yang H, Shah AA, Nelson SB, Schwab JH. Fungal spinal epidural abscess: a case series of nine patients. The Spine Journal. 2019 Mar 1;19(3):516-22.
11. Tew CW, Han FC, Jureen R, Tey BH. Aspergillus vertebral osteomyelitis and epidural abscess. Singapore Med J. 2009 Apr 1;50(4):e151-4.
12. Son JM, Jee WH, Jung CK, Kim SI, Ha KY. Aspergillus spondylitis involving the cervico-thoraco-lumbar spine in an immunocompromised patient: a case report. Korean Journal of Radiology. 2007 Oct 1;8(5):448-51.
13. Yoon KW, Kim YJ. Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult. British Journal of Neurosurgery. 2015 Mar 4;29(2):277-9.
14. Raj KA, Srinivasamurthy BC, Nagarajan K, Sinduja MI. A rare case of spontaneous Aspergillus spondylodiscitis with epidural abscess in a 45-year-old immunocompetent female. Journal of Craniovertebral Junction and Spine. 2013 Jul;4(2):82.
15. Su KC, Chou KT, Hsiao YH, Tseng CM, Su VY, Lee YC, Perng DW, Kou YR. Measuring (1, 3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study. BMC infectious diseases. 2017 Dec;17(1):1-9.
16. Yeo SF, Wong B. Current status of nonculture methods for diagnosis of invasive fungal infections. Clinical microbiology reviews. 2002 Jul;15(3):465-84.
17. Lyons MK, Neal MT, Patel NP, Vikram HR. Progressive back pain due to Aspergillus nidulans vertebral osteomyelitis in an immunocompetent patient: surgical and antifungal management. Case Reports in Orthopedics. 2019 Jul 2;2019.
18. Patterson TF, Thompson III GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clinical infectious diseases. 2016 Aug 15;63(4):e1-60.
19. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. New England Journal of Medicine. 2002 Aug 8;347(6):408-15.
20. Herbrecht R, Patterson TF, Slavin MA, Marchetti O, Maertens J, Johnson EM, Schlamm HT, Donnelly JP, Pappas PG. Application of the 2008 definitions for invasive fungal diseases to the trial comparing voriconazole versus amphotericin B for therapy of invasive aspergillosis: a collaborative study of the Mycoses Study Group (MSG 05) and the European Organization for Research and Treatment of Cancer Infectious Diseases Group. Clinical Infectious Diseases. 2015 Mar 1;60(5):713-20.
21. Koehler P, Tacke D, Cornely OA. Aspergillosis of bones and joints–a review from 2002 until today. Mycoses. 2014 Jun;57(6):323-35.
22. van Ooij A, Beckers JM, Herpers MJ, Walenkamp GH. Surgical treatment of aspergillus spondylodiscitis. European Spine Journal. 2000 Feb;9(1):75-9.
23. Gupta PK, Mahapatra AK, Gaind R, Bhandari S, Musa MM, Lad SD. Aspergillus spinal epidural abscess. Pediatric neurosurgery. 2001;35(1):18-23.
24. Chi CY, Fung CP, Liu CY. Aspergillus flavus epidural abscess and osteomyelitis in a diabetic patient. Journal of Microbiology, Immunology, and Infection. 2003 Jun 1;36(2):145-8.
25. Saigal G, Post MJ, Kozic D. Thoracic intradural Aspergillus abscess formation following epidural steroid injection. American journal of neuroradiology. 2004 Apr 1;25(4):642-4.
26. Chang HM, Yu HH, Yang YH, Lee WI, Lee JH, Wang LC, Lin YT, Chiang BL. Successful treatment of Aspergillus flavus spondylodiscitis with epidural abscess in a patient with chronic granulomatous disease. The Pediatric infectious disease journal. 2012 Jan 1;31(1):100-1.
27. Jiang Z, Wang Y, Jiang Y, Xu Y, Meng B. Vertebral osteomyelitis and epidural abscess due to Aspergillus nidulans resulting in spinal cord compression: Case report and literature review. Journal of international medical research. 2013 Apr;41(2):502-10.
28. McCaslin AF, Lall RR, Wong AP, Lall RR, Sugrue PA, Koski TR. Thoracic spinal cord intramedullary aspergillus invasion and abscess. Journal of Clinical Neuroscience. 2015 Feb 1;22(2):404-6.
29. Shweikeh F, Zyck S, Sweiss F, Sangtani A, Shweikeh M, Issa H, Steinmetz MP, Markarian GZ. Aspergillus spinal epidural abscess: Case presentation and review of the literature. Spinal Cord Series and Cases. 2018 Mar 7;4(1):1-9.
30. Ono R, Uehara K, Kitagawa I. Emphysematous osteomyelitis of the spine: a case report and literature review. Internal Medicine. 2018 Jul 15;57(14):2081-7.
31. Senosain-Leon V, Hidalgo-Benites A, Arriola-Montenegro J, D’Angelo-Piaggio L, Beas R. Invasive pulmonary aspergillosis with Aspergillus vertebral osteomyelitis in an HIV-infected adult: a case report. International journal of STD & AIDS. 2019 Oct;30(11):1140-2.
32. Aghapoor M, Alijani BA. Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case ReportA Case Report. Iranian Journal of Neurosurgery. 2019 Nov 10;5(3):155-60.
33. Takagi Y, Yamada H, Ebara H, Hayashi H, Kidani S, Okamoto S, Nakamura Y, Kitano Y, Kagechika K, Demura S, Ueno T. Aspergillus terreus spondylodiscitis following an abdominal stab wound: a case report. Journal of Medical Case Reports. 2019 Dec;13(1):1-6.
34. Perna A, Ricciardi L, Fantoni M, Taccari F, Torelli R, Santagada DA, Fumo C, Tamburrelli FC, Proietti L. Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review. Neurospine. 2021 Mar;18(1):23.
35. Makhdoomi R, Malik N, Charan J, Malik A, Singh S. Spinal aspergillosis: a rare complication of COVID-19 infection. Egyptian Journal of Neurosurgery. 2022 Dec;37(1):1-3.
|How to Cite this Article: Patel UD, Modi HN | A Case Report of Aspergillus Fungal Spinal Infection in Immunocompetent Patient and Review of Literature | Back Bone: The Spine Journal | October 2022-March 2023; 3(2): 113-118. https://doi.org/10.13107/bbj.2022.v03i02.049