Diagnosis and treatment of Candida vertebral osteomyelitis:: Clinical experience with a short course therapy of amphotericin B lipid complex

BACKGROUND Musculoskeletal candidiasis occurs in some patients with candidemia resulting from organ infection, IV drug use, or indwelling central venous catheters. Diagnosis is often difficult because of vague symptomatology and a frequent afebrile course. CASE DESCRIPTION Three patients with Candida vertebral osteomyelitis are presented. All followed the use of indwelling central venous; access catheters and antimicrobial therapy between 6 months and 3 years earlier. In 2, fungemia with the same Candida spp. preceded the spondylodiskitis. These 3 patients bring to nearly 75 the number of reported individuals with what was once quite rare. Although IV amphotericin B doxycholate and fluconazole have usually been effective therapy over prolonged periods of time, we used liposomal amphotericin B to treat 2 of our 3 patients. Both received 5 mg/kg daily for 18-42 days that resulted in total disappearance of signs and symptoms. CONCLUSION This relatively brief duration of therapy reduces treatment time and is cost-effective. (C) 2004 Elsevier Inc. All rights reserved.