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Fungal Vertebral Osteomyelitis

- Discussion:
    - occur primarily as opportunistic infections in immunocompromised patients;
    - most often due to candida;
    - histology: noncaseating, acid-fast-negative infections;
           - organism are identified with a positive fungal culture, potassium hydroxide slide preparation, or Gomori methenamine silver stain
    - in the report by Frazier DD, the authors analyzed eleven patients with spinal osteomyelitis caused by a fungus;
           - for 10 of the 11 patients, the average delay in the diagnosis was ninety-nine days;
           - 9 patients were immunocompromised secondary to diabetes mellitus, corticosteroid use, chemotherapy for a tumor, or malnutrition;
           - sources of the spinal infections included direct implantation from trauma (one patient), hematogenous spread (four patients), and local extension (two patients);
                  - infection followed elective spine surgery in three patients, and the cause was unknown in one;
           - paralysis secondary to the spine infection developed in eight patients;
           - 10 patients were treated with surgical débridement;
           - all eleven patients were treated with systemic antifungal medications for a minimum of six weeks;
           - one patient died of generalized sepsis at thirty-three days, and another patient died of GI hemorrhage at five months;
           - after an average of 6.3 years of follow-up, the infection had resolved in all nine surviving patients;
           - ref: Fungal Infections of the Spine.  Report of Eleven Patients with Long-Term Follow-up 

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