Table 4.
Clinical Manifestations, Radiological Features, and Inflammatory Markers of Aspergillus Osteomyelitis
| Clinical Manifestationsa (N=180) | |
|---|---|
| No (%) | |
| Local symptoms | |
| Pain/ tenderness | 145 (80) |
| Erythema | 15 (8) |
| Edema | 26 (14) |
| Fever | 39 (22) |
| Limitation of function/ movement | 18 (10) |
| Draining pus/ sinus | 48 (27) |
| Neurological deficits related to vertebral aspergillosis | 39 (22) |
| Fracture developing as a sequela of Aspergillus osteomyelitis | 2 (1) |
| Initial Presentation of Aspergillosis | |
| De novo Aspergillus osteomyelitis | 138 (77) |
| Breakthrough aspergillosis | 42 (23) |
| Radiological Featuresa | |
| Osteolysis/ bone destruction/ bone erosion | 117 (65) |
| Extension into soft tissues | 47 (26) |
| Spinal cord compression | 39 (22) |
| Increase of Nuclear Scan uptake (Tc99m/ Ga67) (n=41) | 36/41 (87) |
| Increase of density in CT | 27 (15) |
| MRI characteristics (n=51) | |
| Decrease of signal intensity on T1 (MRI) | 23/51 (45) |
| Increase of signal intensity on T2 (MRI) | 21/51 (41) |
| Increase of contrast-enhanced T1 (MRI) | 19/51 (37) |
| Decrease of intervertebral space | 16 (9) |
| Paraspinal abscess | 16 (9) |
| Epidural abscess | 14 (8) |
| Fracture | 10 (6) |
| Necrotic bone | 9 (5) |
| Periosteal reaction | 6 (3) |
| Spondylolisthesis | 5 (3) |
| Decreased articular space | 5 (3) |
| Bone abscess | 3 (2) |
| Subdural abscess | 2 (1) |
| Sequestrum | 2 (1) |
| Inflammatory markers | ||
|---|---|---|
| % elevated (n) | Median (range) | |
| WBC (/mm3) | >10,000/mm3; 45% (n=53) | 9,270 (100–37,000) |
| PMNs (%) | >80%; 30% (n=30) | 79.3 (10.3–90) |
| ESR (mm/h) | >15 mm/hr; 96% (n=58) | 86 (10–148) |
| CRP (mg/dl) | > 1 mg/dL; 100% (n=15) | 51.5 (1.5–151) |
a
Clinical manifestations not reported in the case reports are assumed to be absent.
b
Radiological methods included conventional radiographs (83), computed tomography (69), magnetic resonance (51), radionuclide scanning (41), and ultrasound (3)