TY - JOUR
T1 - Candida osteomyelitis
T2 - Analysis of 207 pediatric and adult cases (1970-2011)
AU - Gamaletsou, Maria N.
AU - Kontoyiannis, Dimitrios P.
AU - Sipsas, Nikolaos V.
AU - Moriyama, Brad
AU - Alexander, Elizabeth
AU - Roilides, Emmanuel
AU - Brause, Barry
AU - Walsh, Thomas J.
N1 - Funding Information:
Financial support. This work was supported by the Special Account for Research Funds (to M. N. G., N. V. S.) of the National and Kapodistri-an University of Athens; National Institutes of Health through an MD Anderson Cancer Center Support Grant (CA016672); Save Our Sick Children Foundation (T. J. W.); Weill Cornell Clinical and Translational Science Center; and Postdoctoral Scientist Award (KL2RR024997 to E. A.).
Funding Information:
Potential conflicts of interest. D. P. K. is a consultant and board member and received payment for lectures from Schering-Plough, Pfizer, and Astellas Pharma US; and has received grant support from Astellas Pharma US and Merck; and has received honorarium from Enzon Pharmaceuticals. T. J. W. has received research grant support from Astellas Pharma US and Novartis and has served as consultant to iCo, Draius, Trius, Astellas Pharma US, and Sigma Tau Pharmaceuticals. All other authors report no potential conflicts.
PY - 2012/11
Y1 - 2012/11
N2 - Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90 of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67), direct inoculation (25), and contiguous infection (9). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95 confidence interval [CI],. 04-.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95 CI, 8.4-48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35 of cases. Bacteria were recovered concomitantly from 12 of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21. Combined surgery and antifungal therapy were used in 48 of cases. The overall complete response rate of Candida osteomyelitis of 32 reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32 who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6-12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome.
AB - Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90 of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67), direct inoculation (25), and contiguous infection (9). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95 confidence interval [CI],. 04-.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95 CI, 8.4-48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35 of cases. Bacteria were recovered concomitantly from 12 of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21. Combined surgery and antifungal therapy were used in 48 of cases. The overall complete response rate of Candida osteomyelitis of 32 reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32 who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6-12 months of antifungal therapy, and surgical intervention, when indicated, may improve outcome.
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U2 - 10.1093/cid/cis660
DO - 10.1093/cid/cis660
M3 - Article
C2 - 22911646
AN - SCOPUS:84868007575
SN - 1058-4838
VL - 55
SP - 1338
EP - 1351
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -