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      Espondilodiscitis por Candida albicans: Aportación de dos nuevos casos Translated title: Spondylodiskitis caused by Candida albicans: Report of two new cases

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          Abstract

          Recientemente hemos asistido a un incremento de la infección candidiásica. Los factores predisponentes son, la inmunodepresión, los catéteres, las enfermedades debilitantes, la antibioterapia prolongada, la infección por VIH y los usuarios de drogas por vía parenteral (UDVP). La espondilodiscitis debido a Candida sp.es una entidad rara. Se aportan dos casos de espondilodiscitis por Candida albicans: un varón de 29 años de edad y una mujer de 35 años. Ambos tenían antecedentes de UDVP e infección por VIH. La clínica predominante en ambos casos fue dolor, fiebre y síndrome constitucional. Presentamos las características clínicas, diagnósticas y terapéuticas de ambos casos.

          Translated abstract

          Recently, candidiasis infection is on the increase and several factors have been associated, such us immunodepression, catheters, weakening diseases, prolonged antibiotherapy, HIV infection and IDU. Spondylodiskitis due to Candida sp. is a rare entity. Two cases of spondylodiskitis due to Candida albicans were diagnosed: a 29 year-old man and a 35 year-old woman. Both were IDU’s with a previous history of HIV infection. The most prominent clinical features in both cases were pain, fever and constitutional syndrome. We describe the clinical, diagnostic, and therapeutic features of both cases.

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          Most cited references16

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          Vertebral osteomyelitis due to Candida species: case report and literature review.

          Candida species uncommonly cause vertebral osteomyelitis. We present a case of lumbar vertebral osteomyelitis caused by Candida albicans and review 59 cases of candidal vertebral osteomyelitis reported in the literature. The mean age was 50 years, and the lower thoracic or lumbar spine was involved in 95% of patients. Eighty-three percent of patients had back pain for >1 month, 32% presented with fever, and 19% had neurological deficits. The erythrocyte sedimentation rate was elevated in 87% of patients, and blood culture yielded Candida species for 51%. C. albicans was responsible for 62% of cases, Candida tropicalis for 19%, and Candida glabrata for 14%. Risk factors for candidal vertebral osteomyelitis were the presence of a central venous catheter, antibiotic use, immunosuppression, and injection drug use. Medical and surgical therapies were both used, and amphotericin B was the primary antifungal agent. Prognosis was good, with an overall clinical cure rate of 85%.
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            Candida osteomyelitis. Report of five cases and review of the literature.

            Candida species have emerged as important pathogens in human infection. Although a variety of deep-seated candidal infections have been reported, Candida osteomyelitis has rarely been described. Five patients with Candida osteomyelitis are presented, and the 32 adult cases previously reported are reviewed. Candida osteomyelitis is noted as a simultaneous occurrence or late manifestation of hematogenously disseminated candidiasis. Osteomyelitis may not be prevented by a course of amphotericin B adequate to control the acute episode of disseminated candidiasis, particularly in immunosuppressed patients. Less commonly, Candida osteomyelitis presents as a postoperative wound infection. Like bacterial osteomyelitis, the most common presenting symptom is local pain. The insidious progression of infection, the nonspecificity of laboratory data, and the failure to recognize Candida as a potential pathogen may lead to diagnostic delay. Diagnosis can be made by either open biopsy or closed needle aspiration. Successful therapeutic regimens have employed combinations of antifungal therapy (most often amphotericin B) with surgical debridement when indicated. It is anticipated that osteomyelitis will become a more commonly recognized manifestation of hematogenously disseminated candidiasis.
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              Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients.

              Of 38 heroin addicts treated for systemic candidal infections, 36 had metastatic cutaneous lesions (deep-seated scalp nodules and pustulosis in hairy zones), 15 had ocular localizations (mainly chorioretinitis), and 10 had osteoarticular involvement (vertebrae, costal cartilage, knees, and sacroiliac). Such cutaneous lesions have not previously been described in classical systemic candidiasis; we also observed hair invasion by candidal hyphae. Candida albicans was the exclusive species isolated, in contrast to other visceral candidiases in heroin addicts. All isolates were sensitive to amphotericin B, flucytosine, and ketoconazole. Thirty-one visceral localizations were treated only with ketoconazole. Results were favorable in 15 of 18 cutaneous, 6 of 6 ocular, and 4 of 7 osteoarticular cases of involvement. This outbreak coincided with introduction of a new heroin on the drug market in the Paris area. C. albicans was not isolated from the drug. Pathogenesis of this syndrome is unclear.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (, , Spain )
                0212-7199
                February 2005
                : 22
                : 2
                : 32-34
                Affiliations
                [01] Santiago de Compostela A Coruña orgnameHospital Clínico Universitario de Santiago orgdiv1Servicio de Medicina Interna orgdiv2Departamento de Medicina
                Article
                S0212-71992005000200006
                10.4321/s0212-71992005000200006
                5f10c8d5-0716-44aa-8939-f5073ed577aa

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 3
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                Espondilodiscitis,Candida,UDVP,Spondylodiskitis,IDU
                Espondilodiscitis, Candida, UDVP, Spondylodiskitis, IDU

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