Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review

Abstract

Objective: Vertebral aspergillosis is quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy, and sometimes, surgical treatments. The present investigations were aimed to investigate the epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis.

Methods: A systematic review of the pertinent English literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed, and Scopus using as search-terms "Aspergillus," "vertebral osteomyelitis," "spondylodiscitis," "spine infection." A case of vertebral aspergillosis conservatively managed was also reported.

Results: Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at the last follow-up evaluation; in 7 patients (6.3%) radiological signs of chronic infection were reported, whereas 32 patients (28.8%) died during the follow-up.

Conclusion: This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives, and their outcomes.

Keywords: Aspergillosis; Aspergillus flavus; Discitis; Osteomyelitis; Spinal osteomyelitis.

Fig. 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow-chart. ^*The names of the authors who performed the review.

Fig. 2.

(A, B) TC images showing enlargement of the L2–3 disc space with erosion of the adjacent endplates with no evidences of epidural or paravertebral abscess. (C) Magnetic resonance images showing a T2 hyperintense signal on the L2–3 disc space with edema on the adjacent vertebral endplates, and partial obliteration of the anterior epidural space suggestive for L2–3 spondylodiscitis.

Fig. 3.

(A) Magnetic resonance images at 6 months of follow-up showing the reduction of hyperintense signal on the L2–3 space and the reduction of the epidural abscess. (B, C) Radiograph at 6-month follow-up.