Faris Shweikeh1,2, Stephanie Zyck3, Fadi Sweiss4, Ajleeta Sangtani1, Mohammed Shweikeh5, Husam Issa6, Michael P Steinmetz7, Georges Z Markarian1. 1. 1Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA USA. 2. 2Summa Health System, College of Medicine, Northeast Ohio Medical University, Rootstown, OH USA. 3. 3Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY USA. 4. 4Department of Neurological Surgery, George Washington University, Washington, DC USA. 5. 5Family Medicine Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA. 6. 6Memorial Hermann Hospital, University of Texas Health Science Center, Houston, TX USA. 7. 7Center for Spine Health, Department of Neurosurgery, Cleveland Clinic, Cleveland, OH USA.
Abstract
STUDY DESIGN: In this review, we present a case of Aspergillus spinal epidural abscess (ASEA) and review the literature. OBJECTIVES: To provide further insight on a rare condition. SETTING: A description of a patient with ASEA in a 58-year-old woman that was successfully treated with conservative management is presented. METHODS: Following case presentation, a literature search (MedLine and PubMed) and assessment of epidemiology, presentation, diagnosis, treatments, and outcomes is performed. RESULTS: Review of the literature finds 26 reported cases. The infection occurs in males with a higher frequency (66.7%). The thoracic and lumbar regions are more likely afflicted (96.1%). Common symptoms are backache, neurological deficits, and fever. Most frequent comorbidities were malignancy, diabetes mellitus, and immunodeficiency. Complications were numerous and often catastrophic. Treatment entailed a combination of antibiotics and surgery. Overall, ASEA patients did poorly: death in majority (52%), minimal recovery in 22%, and others did attain full recovery (26%). CONCLUSIONS: Generally, this infection has high morbidity and mortality. Early identification is important to a successful outcome. Appropriate management with antifungals is central and proves to be effective as seen in the reported case though surgical intervention is usually a necessity as the literature suggests. From an epidemiological and public health perspective, particularly with recent outbreaks, understanding the treatment of this rare CNS infection becomes even more imperative.
STUDY DESIGN: In this review, we present a case of Aspergillus spinal epidural abscess (ASEA) and review the literature. OBJECTIVES: To provide further insight on a rare condition. SETTING: A description of a patient with ASEA in a 58-year-old woman that was successfully treated with conservative management is presented. METHODS: Following case presentation, a literature search (MedLine and PubMed) and assessment of epidemiology, presentation, diagnosis, treatments, and outcomes is performed. RESULTS: Review of the literature finds 26 reported cases. The infection occurs in males with a higher frequency (66.7%). The thoracic and lumbar regions are more likely afflicted (96.1%). Common symptoms are backache, neurological deficits, and fever. Most frequent comorbidities were malignancy, diabetes mellitus, and immunodeficiency. Complications were numerous and often catastrophic. Treatment entailed a combination of antibiotics and surgery. Overall, ASEA patients did poorly: death in majority (52%), minimal recovery in 22%, and others did attain full recovery (26%). CONCLUSIONS: Generally, this infection has high morbidity and mortality. Early identification is important to a successful outcome. Appropriate management with antifungals is central and proves to be effective as seen in the reported case though surgical intervention is usually a necessity as the literature suggests. From an epidemiological and public health perspective, particularly with recent outbreaks, understanding the treatment of this rare CNS infection becomes even more imperative.
Authors: Addason F McCaslin; Rishi R Lall; Albert P Wong; Rohan R Lall; Patrick A Sugrue; Tyler R Koski Journal: J Clin Neurosci Date: 2014-07-23 Impact factor: 1.961