Aspergillus vertebral osteomyelitis in immunocompetent hosts: role of triazole antifungal therapy.

BACKGROUND A review of published cases, in addition to a recently treated patient, is presented that describes the clinical features and outcomes of triazole therapy for vertebral aspergillosis in immunocompetent patients. METHODS Using the Medline database, cases of vertebral aspergillosis in immunocompetent patients treated with triazole were reviewed. Clinical and radiological findings, therapeutic interventions, and outcomes were analyzed. RESULTS.: Twenty-one cases of vertebral aspergillosis treated with itraconazole or voriconazole were identified. Most cases were caused by Aspergillus fumigatus. The most common presenting symptom was back pain. The majority of cases were acquired by hematogenous infection, although one-quarter occurred after a spinal procedure. Most patients were treated successfully with a combination of antifungal therapy and surgery. Patients presenting with paraplegia had a poor outcome. The overall mortality rate was 20%. CONCLUSIONS This report extends the information on invasive aspergillosis in immunocompetent patients and supports the conclusion that triazole therapy should be considered for this serious infection.