Case series of Candida albicans spondylodiscitis and a brief review of the literature

Introduction: Candida albicans is the most frequent fungal organism causing vertebral spondylodiskitis. Given limited research, this study aimed to describe patient characteristics, treatment, and outcomes of the C. albicans spondylodiscitis patients in Southern Denmark using a case series and literature review. Methods: We conducted a retrospective review of all consecutive patients treated for infectious spondylodiscitis during 2009-2023 at the Department of Infectious Diseases, Odense University Hospital, Denmark. All medical records were reviewed and cases of C. albicans were included. A review of the English literature from the last decade was conducted with a predefined search string. We excluded articles not aligning with our objectives. Results: Among five fungal cases, four were C. albicans infections. Two patients presented with pain/fever in the vertebra column. All were initially treated as having bacterial spondylodiscitis. Half of the patients had positive blood cultures and all had positive biopsies taken. The two remaining patients had experienced candidemia within one year prior to being diagnosed with spondylodiscitis. All were initially treated with fluconazole with a median duration of 9 months (range 6–12 months). The median time to diagnosis was 27 days (range 23–35 days). Two patients died during treatment. The median follow-up was 7 months (range 6–8 months). Thirteen studies were included in the literature review. Conclusion: The study described the characteristics, treatment and outcome of C. albicans spondylodiscitis patients in Southern Denmark. Noting prior candidemia episodes can improve early identification and outcomes. Furthermore, our patients exhibit clinical similarities to those in the literature review.