[Harrison]

A reminder on culture-based diagnostics, here: it's a 160 year old method! If it's a difficult or mysterious the condition, the doctor should use better tools. Culture-based methods can detect up to, and only, 5% of all microbes that can cause human health problems.
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Microbiology Case Study: A 73 Year Old Man with Back Pain

Case History

A 73 year old man with a history of multiple back surgeries presented with bilateral lower extremity back pain of over greater than one month duration. Prior surgeries included L4/L5 fusion with pedicel screws and a decompression laminectomy one year prior to presentation. Imaging of his spine showed a fluid collection in his lumbar spine and he underwent several tissue biopsies over the course of a month which consistently showed no growth.

Despite negative cultures he was treated with doxycycline and levoquin for 30 days. He was transferred to University of Vermont Medical Center (UVMMC) for IR drainage and tissue biopsy of this lumbar abscess as he continued to complain of back pain and had begun to develop bilateral lower extremity weakness. Cultures grow the organism below and close inspection revealed the presence of small feet. The organism was confirmed to be Candida albicans.

Discussion

Vertebral osteomyelitis due to Candida is rare, however, a review of the literature reveals that most patients have lower thoracic or lumbar spine involvement and over 80% present with >1 month of lower back pain. An elevated white blood cell count is not as sensitive as an elevated erythrocyte sedimentation rate and of all patients, less than a quarter have neurologic signs.

Candida albicans was responsible for almost 2/3 of cases and the remaining cases were caused by Candia tropicalis or Candida glabrata. Risk factors include IV drug abuse for patients under 25 years old; for elderly patients a central venous catheter, antibiotic use and immunosuppression.

Reference

Miller, D and Mejicano, George. Vertebral Osteomyelitis due to Candida species: Case report and review of the literature. Clinical Infectious Diseases, 2001;33:523-530.

-Agnes Balla, MD is a 3rd year anatomic and clinical pathology resident at the University of Vermont Medical Center.

-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.

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