Table 1 Main characteristics of 18 published cases of spine cryptococcal osteomyelitis
Author | Age (years)/sex | Site | Comorbidities | Initial diagnosis | Diagnosis techniques | Isolated or disseminated | Surgery | Antifungal drug | Method of medication | Course of medication | Follow up | Clinical outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Adsul et al.[1] | 44/F | T4 | Diabetes | Tuberculosis | Postoperative culture and histopathological examinations revealed cryptococcal infection | Isolated | T4 decompression with pedicle screw fixation | Amphotericin B Fluconazole Flucytosine | 3 months of intravenous amphotericin B and flucytosine postoperative, then 5 months of oral fluconazole and flucytosine | 8 months | 8 months | Improvement |
Al-Tawfiq and Ghandour [4] | 34/F | L4 | Tuberculous lymphadenitis | Pyogenic osteomyelitis | Abscess culture grew C. neoformans. The serum cryptoccocal antigen (-) | Isolated | The vertebral abscess was drained and aspirated | Fluconazole | 12 weeks of oral fluconazole | 12 weeks | 12 months | Full recovery |
Joo et al.[2] | 66/F | L2 | Rectal cancer with adjuvant chemotherapy | Metastatic tumor | Postoperative pathologic examination. CSF culture and cryptococcal antigen (-) | Isolated | Corpectomy of L2 vertebral body | Amphotericin B Fluconazole | 1 week of intravenous amphotericin B and fluconazole, then, 1 year of oral fluconazole | 12 months | 12 months | Full recovery |
Lai et al. [20] | 25/M | L1, S1 | No | Osteosarcoma | Preoperative biopsy revealed an infected lesion, postoperative microbial identification revealed cryptococcal infection | Disseminated | Lumbosacral debridement | Amphotericin B | 4 weeks of intravenous amphotericin B and then 8 weeks of oral amphotericin B | 12 weeks | 9 months | Full recovery |
Li et al. [17] | 17/F | L1 | Immune hemolytic anemia | Tuberculosis | C. neoformans was isolated in CSF cultures. CSF cryptococcus antigen (+), Preoperative specific stains for C. neoformans (+) | Isolated | Spinal debridement and fusion | Fluconazole | 3 months of oral fluconazole | Unclear | 3 months | Full recovery |
Nankeu et al. [10] | 29/M | S1,S2 | Chronic hepatitis B | Cryptococcal infection | Blood cultures and biopsy specimen were positive for C. neoformans. Cerebrospinal fluid C.neoformans antigen (+) | Disseminated | No | Amphotericin B, Fluconazole, Flucytosine | 4 weeks of intravenous amphotericin B and flucytosine, followed by 18 months of oral fluconazole | 19 months | 2 years | Full recovery |
Noh et al. [21] | 21/F | The sacrum | Autoimmune hepatitis with chronic steroid therapy | Cryptococcal infection | Cryptococcal antigen of serum and cerebrospinal fluid (+), Fungal culture (+) | Disseminated | Incision and debridement | Amphotericin B | Unclear | 3 months | 3 years | Full recovery |
Wang et al. [5] | 67/F | T2, T3 | No | Cryptococcal infection | Preoperative serum cryptococcal antigen (+), Postoperative pathological examination(+) | Isolated | Lesion clearance followed by intramedullary nailing and allogeneic bone transplantation | Voriconazole Fluconazole | 8 weeks of intravenous voriconazole and then 4 weeks of oral fluconazole | 12 weeks | 12 weeks | Full recovery |
Wang et al.[6] | 41/F | L4 | No | Cryptococcal infection | Preoperative percutaneous biopsy(+), Postoperative Microbial culture(-) Next-generation sequencing | Disseminated | Posterior lumbar open-window focal debridement | Flucytosine, Amphotericin B, Fluconazole | Unclear | 20 days | 12 years | Full recovery |
Zhou et al. [3] | 40/F | L4 | Rheumatoid arthritis and scleroderma | Cryptococcal infection | Needle aspiration biopsy(+), Microbial culture(+) | Isolated | No | Fluconazole | 6 months of oral fluconazole | 6 months | 12 months | Full recovery |
Gupta et al. [7] | 42/F | T2, T3 | Tuberculous lymphadenopathy | Tuberculosis | Postoperative histopathological examination | Isolated | T2, T3 costotransversectomy | Amphotericin B Flucytosine | Unclear | 2 weeks | 2 weeks | Death |
Wildstein et al.[18] | 20/M | T12-L2 | Sarcoidosis with prednisone therapy | Cryptococcal infection | Cryptococcal antigen (-) Biopsy of the paraspinal mass histologically revealed the presence of fungal organisms | Disseminated | No | Fluconazole | Oral fluconazole | unclear | 6 months | Full recovery |
Cook [19] | 24/F | T1-T3 | Sarcoidosis with corticosteroids therapy | Cryptococcal infection | Needle aspiration biopsy(+), Microbial culture(+) Cryptococcal antigen (-) | Isolated | Percutaneous puncture drainage | Fluconazole, Flucytosine, Amphotericin B | 12 months of oral antifungal drug | 12 months | 16 months | Full recovery |
Gurevitz et al.[12] | 67/F | L3 | No | Cryptococcal infection | Open biopsy(+), Microbial culture(+) Cryptococcal antigen (+) | Isolated | No | Fluconazole, 5-fluorocytosine | 6 weeks of intravenous amphotericin B and oral 5-fluorocytosine | 6 weeks | 2 years | Full recovery |
Jain et al.[22] | 72/F | T6 | Diabetes | Tuberculosis | FNAP Fungal culture | Isolated | No | Flucytosine, Amphotericin B | 3 months of intravenous amphotericin B and oral flucytosine | 3 months | 5 years | Full recovery |
Glynn et al. [23] | 52/F | L1-L3 | No | Cryptococcal infection | Needle percutaneous biopsy showed chronic inflammation but culture revealed C. neoformans | Isolated | No | Amphotericin B 5- Fluorocytosine Ketoconazole | 6 weeks of intravenous amphotericin B and oral 5-fluorocytosine and then 18 weeks of oral ketoconazole | 24 weeks | 7 years | Full recovery |
Ruan et al. [24] | 68/M | T5-T11 | No | pyogenic infection Tuberculosis | Cultures of blood and percutaneous aspiration culture of pus revealed C. neoformans | Disseminated | Excision of paravertebral abscess | Amphotericin B Itraconazole Fluconazole Fluorocytosine | Starting with intravenous amphotericin B and itraconazole, followed by oral fluconazole and fluorocytosine | 4 months | 18 months | Improvement |
Xu et al. [25] | 42/F | L1-L5 | Sjögren’s syndrome and treated with methylprednisolone | Cryptococcal infection | Tissue biopsies granulomatous lesions with visible cryptosporidium | Disseminated | No | Fuconazole | 6 months of oral fluconazole | 6 months | 1 years | Full recovery |