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Akuri MC, Bencardino JT, Peixoto JB, Sato VN, Miyahara LK, Kase DT, Dell'Aquila AM, do Amaral E Castro A, Fernandes ARC, Aihara AY. Fungal Musculoskeletal Infections: Comprehensive Approach to Proper Diagnosis. Radiographics 2024; 44:e230176. [PMID: 38900682 DOI: 10.1148/rg.230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. ©RSNA, 2024.
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Affiliation(s)
- Marina C Akuri
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Jenny T Bencardino
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Júlia B Peixoto
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Vitor N Sato
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Lucas K Miyahara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adriana M Dell'Aquila
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adham do Amaral E Castro
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
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Gonçalves JRR, Tres KE, Narciso LS, Corrêa R, Perez RD. Fungal Osteomyelitis of the Hip with Septic Arthritis: Case Report. Rev Bras Ortop 2024; 59:e49-e51. [PMID: 39027186 PMCID: PMC11254441 DOI: 10.1055/s-0042-1742604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
Fungal osteomyelitis, especially associated with septic arthritis, is uncommon in Brazil; therefore, sometimes it is difficult to diagnose and treat it. We report the case of a young patient, with no immunosuppressive risk factor, with osteomyelitis leading to septic arthritis of the hip. The diagnosis was performed after surgical drainage and visualization of Cryptococcus neoformans at pathological anatomy. Antifungal treatment resulted in complete remission of the symptoms. Since there is no consensus on the treatment of fungal osteomyelitis, this case report aims to inform orthopedists about the importance of hip arthritis differential diagnosis and the good evolution of clinical treatment after drainage and pathogen isolation.
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Affiliation(s)
- João Rodolfo Radtke Gonçalves
- Divisão em Cirurgia do Quadril, Instituto de Ortopedia e Traumatologia, Blumenau, SC, Brasil
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
| | | | | | - Ricardo Corrêa
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
- Departamento de Ortopedia da Universidade Regional Blumenau (FURB), Blumenau, SC, Brasil
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Peng G, Lin Y, Zou Q, Peng H, Lei A, Zou X, Xu Z, Sun H, Ning X, Huang M. Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review. BMC Infect Dis 2024; 24:643. [PMID: 38926679 PMCID: PMC11210095 DOI: 10.1186/s12879-024-09512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports. CASE PRESENTATION A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up. CONCLUSIONS M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.
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Affiliation(s)
- Guoxuan Peng
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Yuan Lin
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
- School of Clinical Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Qiang Zou
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Hongcheng Peng
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
- School of Clinical Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Anyi Lei
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
- School of Clinical Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Xu Zou
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
- School of Clinical Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Zhe Xu
- School of Clinical Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
- Guihang Guiyang Hospital, Guiyang, 550006, Guizhou, China
| | - Hong Sun
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Xu Ning
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China
| | - Mingzhi Huang
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, Guizhou, China.
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Grijalva JAG, de Oliveira VF, de Carvalho VC, de Oliveira PR, Lima ALL. Analysis of epidemiological and clinical aspects in cases of fungal osteomyelitis caused by non-Candida species. Braz J Microbiol 2024:10.1007/s42770-024-01418-7. [PMID: 38896342 DOI: 10.1007/s42770-024-01418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Osteomyelitis caused by non-Candida species is rare and often neglected, and current recommendations are based on primarily clinical experience and expert opinion. The objective of this study was to describe a case series of non-Candida fungal osteomyelitis. This retrospective study included 10 patients with non-Candida fungal osteomyelitis. Patients with osteomyelitis and microbiologically confirmed non-Candida species from bone fragment cultures were selected from the institution Infection Control Board database. Fusarium spp. were the most commonly isolated fungus from bone fragment cultures in five patients (50%). The majority did not present immunosuppression. The most common etiology was post-traumatic (n = 7, 70%), particularly open fractures. All patients were treated with antifungals associated with surgery. The antifungals used were itraconazole in five patients (50%), and voriconazole in another five patients (50%), with a median duration of antifungal therapy of four weeks (range: 3-25). There were no observed deaths within 30 days and one year. An antifungal approach combined with surgical treatment demonstrated favorable clinical outcomes, including low mortality rates and effective remission.
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Affiliation(s)
- Jorge Andrés González Grijalva
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vítor Falcão de Oliveira
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Vladimir Cordeiro de Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Rosalba de Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lúcia L Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Asperges E, Albi G, Truffelli F, Salvaderi A, Puci F, Sangani A, Zuccaro V, Scotti V, Orsolini P, Brunetti E, Bruno R. Fungal Osteomyelitis: A Systematic Review of Reported Cases. Microorganisms 2023; 11:1828. [PMID: 37513000 PMCID: PMC10383745 DOI: 10.3390/microorganisms11071828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Fungal osteomyelitis is considered a rare disease, and the published literature mainly comprises case reports, case series and narrative reviews. A systematic review was undertaken to provide a practice-based global perspective on this disease, focusing on epidemiology and treatment strategies. We searched MEDLINE, EMBASE and Cochrane Library between the 3rd and 8th of March 2023 using a predefined search string. We included studies with at least one patient with a diagnosis of fungal osteomyelitis published before the 1st of January 2023. We included all study designs except for reviews, and we excluded non-English languages and grey literature. After exclusion, 678 studies, mostly case reports, were included. Descriptive analysis was performed on 1072 patients. The most common aetiological agent was Aspergillus (26.5%), followed by Candida (20.7%) and Mucor (16.8%), and the bones most frequently involved were the vertebrae. We described the characteristics of patients divided by site of infection, and we found that diabetes mellitus, disseminated fungal infection, surgery and local lesion were major risk factors. We also successfully associated duration of treatment with outcome. We provided a general overview of this rare disease, and we highlighted the need for high-quality investigations on the subject.
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Affiliation(s)
- Erika Asperges
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giuseppe Albi
- Department of Electrical, Computer and Biomedical Engineering, Università di Pavia, 27100 Pavia, Italy
| | - Francesco Truffelli
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Andrea Salvaderi
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Flavia Puci
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Aurelia Sangani
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Valentina Zuccaro
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Valeria Scotti
- UOSD Grant Office, TTO e Documentazione Scientifica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paolo Orsolini
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Raffaele Bruno
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Henry MW, Miller AO. Management of Fungal Osteoarticular Infections. CURRENT FUNGAL INFECTION REPORTS 2023. [DOI: 10.1007/s12281-023-00453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Hsu YH, Yu YH, Chou YC, Lu CJ, Lin YT, Ueng SWN, Liu SJ. Sustained Release of Antifungal and Antibacterial Agents from Novel Hybrid Degradable Nanofibers for the Treatment of Polymicrobial Osteomyelitis. Int J Mol Sci 2023; 24:ijms24043254. [PMID: 36834663 PMCID: PMC9966905 DOI: 10.3390/ijms24043254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
This study aimed to develop a drug delivery system with hybrid biodegradable antifungal and antibacterial agents incorporated into poly lactic-co-glycolic acid (PLGA) nanofibers, facilitating an extended release of fluconazole, vancomycin, and ceftazidime to treat polymicrobial osteomyelitis. The nanofibers were assessed using scanning electron microscopy, tensile testing, water contact angle analysis, differential scanning calorimetry, and Fourier-transform infrared spectroscopy. The in vitro release of the antimicrobial agents was assessed using an elution method and a high-performance liquid chromatography assay. The in vivo elution pattern of nanofibrous mats was assessed using a rat femoral model. The experimental results demonstrated that the antimicrobial agent-loaded nanofibers released high levels of fluconazole, vancomycin, and ceftazidime for 30 and 56 days in vitro and in vivo, respectively. Histological assays revealed no notable tissue inflammation. Therefore, hybrid biodegradable PLGA nanofibers with a sustainable release of antifungal and antibacterial agents may be employed for the treatment of polymicrobial osteomyelitis.
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Affiliation(s)
- Yung-Heng Hsu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan
| | - Chia-Jung Lu
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Yu-Ting Lin
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Steve Wen-Neng Ueng
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan
- Correspondence: (S.W.-N.U.); (S.-J.L.)
| | - Shih-Jung Liu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan
- Correspondence: (S.W.-N.U.); (S.-J.L.)
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8
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Benchbani H, Mallett K, Warady BA, Ahmed AA. Histoplasma osteomyelitis in a 15-year-old kidney transplant patient. Transpl Infect Dis 2022; 24:e13953. [PMID: 36082416 DOI: 10.1111/tid.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/22/2022] [Accepted: 08/13/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Hanae Benchbani
- Departments of Pathology, University of Missouri, Kansas City, Missouri, USA
| | - Kathleen Mallett
- Division of Pediatric Nephrology, Children Mercy Hospital, Kansas City, Missouri, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children Mercy Hospital, Kansas City, Missouri, USA
| | - Atif A Ahmed
- Department of Pathology, Seattle Children's Hospital, Seattle, Washington, USA
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9
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Candida Albicans Osteomyelitis after Chest Wall Blunt Trauma: A Case Report. Case Rep Surg 2021; 2021:9987317. [PMID: 34188968 PMCID: PMC8192213 DOI: 10.1155/2021/9987317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Fungal osteomyelitis is a rare disease that can occur in immunocompromised patients. We report a case of a patient with a primary rib osteomyelitis after a blunt trauma of the chest wall. Aggressive surgical debridement along with antifungal therapy was the cornerstone of the disease management in this patient.
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10
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Tiourin E, Kanack M, Ng W, Leis A. Mucor Osteomyelitis of the Distal Radius Necessitating Ulnocarpal Fusion. Cureus 2021; 13:e12813. [PMID: 33500870 PMCID: PMC7817546 DOI: 10.7759/cureus.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This is a case report of a 60-year-old female who developed distal radius osteomyelitis secondary to Mucor infection from likely hematogenous spread that was managed with ulnocarpal wrist fusion. Following serial debridement and systemic antifungal therapy, ulnocarpal wrist fusion offered functional limb salvage rather than amputation in this patient with significant operative risk and comorbidities.
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Affiliation(s)
- Ekaterina Tiourin
- Plastic Surgery, University of California, Irvine School of Medicine, Orange, USA
| | - Melissa Kanack
- Plastic Surgery, University of California, Irvine School of Medicine, Orange, USA
| | - Wendy Ng
- Plastic Surgery, Children's Hospital of Orange County, Orange, USA
| | - Amber Leis
- Plastic Surgery, University of California, Irvine School of Medicine, Orange, USA
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11
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Ranjit E, Roxborough J, Davis D, Sapra A, Bhandari P. Clavicular Osteomyelitis Secondary to Candida Parapsilosis Infection. Cureus 2020; 12:e8699. [PMID: 32699695 PMCID: PMC7370671 DOI: 10.7759/cureus.8699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Candida parapsilosis osteomyelitis is a rare diagnosis. Candidal infection can occur via hematogenous or local spread. A localized swelling around a bony structure should raise clinical suspicion. Diagnosis is made by a combination of imaging modalities and biopsy. Anecdotal case reports have been reported in medical literature and treatment guidelines are very limited. Treatment modality includes a combination of surgical debridement and antifungal therapy.
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12
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Papachristou SG, Iosifidis E, Sipsas NV, Gamaletsou MN, Walsh TJ, Roilides E. Management of osteoarticular fungal infections in the setting of immunodeficiency. Expert Rev Anti Infect Ther 2020; 18:461-474. [PMID: 32213145 DOI: 10.1080/14787210.2020.1748499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Osteoarticular fungal infections (OAFIs) complicate the clinical course of high-risk patients, including immunosuppressed individuals. Their management, however, despite being intricate, is governed by evidence arising from sub-optimal quality research, such as case series. Guidelines are scarce and when present result in recommendations based on low quality evidence. Furthermore, the differences between the management of immunocompromised and immunocompetent patients are not distinct. This is a narrative review after a literature search in PubMed, up to November 2019.Areas covered: The major fungal groups causing osteomyelitis and/or arthritis are Candida spp., Aspergillus spp., non-Aspergillus filamentous fungi, non-Candida yeasts and endemic dimorphic fungi. Their epidemiology is briefly analyzed with emphasis on immunodeficiency and other risk factors. Management of OAFIs includes appropriate antifungal drug therapy (liposomal amphotericin B, triazoles or echinocandins), local surgery and immunotherapy for primary immunodeficiencies. Cessation of immunosuppressive drugs is also mandated.Expert opinion: Management of OAFIs includes affordable and available options and approaches. However, research on therapeutic practices is urgently required to be further improved, due to the rarity of affected patients. Evolution is expected to translate into novel antifungal drugs, less invasive and precise surgical approaches and targeted enhancement of immunoregulatory pathways in defense of challenging fungal pathogens.
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Affiliation(s)
- Savvas G Papachristou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria N Gamaletsou
- Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, New York, NY, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
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13
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Harirchian MH, Poursadeghfard M, Sadeghipour A, Kamali H, Sarraf P. Necrotizing fungal osteomyelitis and fingolimod, 4 years after treatment with fingolimod. Mult Scler Relat Disord 2020; 41:102021. [PMID: 32126512 DOI: 10.1016/j.msard.2020.102021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Fingolimod has been the first approved oral medication in MS for its relapsing remitting type. It is a non-selective sphingosine1-phosphate (S1P) receptor modulator on lymphocytes. Engagement of this receptor blocks the T cells and B cells migration from the lymph nodes into the inflamed central nervous system (CNS) via bloodstream. In spite of this known immunomodulatory mechanism, there are some reports about serious infection following the initiation of fingolimod therapy like herpes types or infections associated to the immunosuppressed situation (cryptococcal meningitis, primary cutaneous cryptococcosis and visceral leishmaniasis). To the best of our knowledge, in contrary to many reports about opportunistic or serious infections with fingolimod, there has been no report on fungal osteomyelitis associated to fingolimod until now. Here, we aimed to describe a woman who developed necrotizing fungal osteomyelitis four years after starting fingolimod, as a disease modifying drug for MS.
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Affiliation(s)
- Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Sadeghipour
- Department of Pathology, Oncopathology Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Hoda Kamali
- Neurology research center, Kerman University of Medical Sciences, Kerman, Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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14
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Gamaletsou MN, Meletiadis J, Chatziioannou S, Panayiotides IG, Agadakos E, Katsimpoulas M, Kostomitsopoulos N, Petraitis V, Walsh TJ, Sipsas NV. Experimental Candida albicans osteomyelitis: Microbiologic, antigenic, histologic, and 18FDG-PET-CT imaging characteristics in a newly established rabbit model. Med Mycol 2020; 57:1011-1017. [PMID: 30753591 DOI: 10.1093/mmy/myz001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Candida osteomyelitis is a debilitating disease that is difficult to diagnose and treat. As there are no animal models or prospective studies for this uncommon infection, little is known about the pathogenesis, diagnosis, or treatment. We therefore sought to establish an animal model for the study of the pathophysiology, diagnostic modalities, and therapeutic interventions of Candida osteomyelitis. We developed a modified version of the Norden rabbit model of tibial osteomyelitis, in which the right tibia was inoculated intraoperatively with different inocula of C. albicans or normal saline as control. On days 7, 14, and 21 after inoculation, the animals underwent bone radiography, 18-fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography (PET/CT) scan, and blood sampling for blood cultures, blood counts, erythrocyte sedimentation rate, and Candida mannan antigen serum levels. On day 21, animals were euthanized, and infected tibias harvested for culture and histology. Among eight evaluable animals inoculated with 1 × 106 to 1 × 107 cfu, histology and bone cultures established the presence of Candida osteomyelitis in seven, with a host response of neutrophils, mononuclear cells, multinucleate giant cells, fibrosis, and necrosis. Infected animals demonstrated radiological signs of osteomyelitis with significantly increased tracer uptake in 18FDG-PET/CT scans (P < .01) and elevated serum mannan levels (P < .01). All blood cultures were negative. Indices of inflammation were only slightly increased. In conclusion, we report successful establishment of a new animal model of Candida albicans osteomyelitis that may be applicable to advancing our understanding of the pathophysiology, diagnostic modalities, and treatment of this debilitating infection.
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Affiliation(s)
- Maria N Gamaletsou
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatziioannou
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,PET/CT Section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Ioannis G Panayiotides
- 2nd Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michalis Katsimpoulas
- Center for Experimental Surgery, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Nikolaos Kostomitsopoulos
- Center for Experimental Surgery, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece
| | - Vidmantas Petraitis
- Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Thomas J Walsh
- Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medicine of Cornell University, New York, NY, USA.,Department of Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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15
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Resorbable Beads Provide Extended Release of Antifungal Medication: In Vitro and In Vivo Analyses. Pharmaceutics 2019; 11:pharmaceutics11110550. [PMID: 31652891 PMCID: PMC6920839 DOI: 10.3390/pharmaceutics11110550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022] Open
Abstract
Fungal osteomyelitis has been difficult to treat, with first-line treatments consisting of implant excision, radical debridement, and local release of high-dose antifungal agents. Locally impregnated antifungal beads are another popular treatment option. This study aimed to develop biodegradable antifungal-agent-loaded Poly(d,l-lactide-co-glycolide) (PLGA) beads and evaluate the in vitro/in vivo release patterns of amphotericin B and fluconazole from the beads. Beads of different sizes were formed using a compression-molding method, and their morphology was evaluated via scanning electron microscopy. Intrabead incorporation of antifungal agents was evaluated via Fourier-transform infrared spectroscopy, and in vitro fluconazole liberation curves of PLGA beads were inspected via high-performance liquid chromatography. When we implanted the drug-incorporated beads into the bone cavity of rabbits, we found that a high level of fluconazole (beyond the minimum therapeutic concentration [MTC]) was released for more than 49 d in vivo. Our results indicate that compression-molded PLGA/fluconazole beads have potential applications in treating bone infections.
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16
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Abstract
Fungi are rare but important causes of osteoarticular infections, and can be caused by a wide array of yeasts and molds. Symptoms are often subacute and mimic those of other more common causes of osteoarticular infection, which can lead to substantial delays in treatment. A high index of suspicion is required to establish the diagnosis. The severity of infection depends on the inherent pathogenicity of the fungi, the immune status of the host, the anatomic location of the infection, and whether the infection involves a foreign body. Treatment often involves a combination of surgical debridement and prolonged antifungal therapy.
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Affiliation(s)
- Michael W Henry
- Division of Infectious Diseases, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Andy O Miller
- Division of Infectious Diseases, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA
| | - Thomas J Walsh
- Division of Infectious Diseases, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA; Department of Pediatrics, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Department of Microbiology & Immunology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Barry D Brause
- Division of Infectious Diseases, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY 10021, USA.
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17
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Taj-Aldeen SJ, Gamaletsou MN, Rammaert B, Sipsas NV, Zeller V, Roilides E, Kontoyiannis DP, Henry M, Petraitis V, Moriyama B, Denning DW, Lortholary O, Walsh TJ. Bone and joint infections caused by mucormycetes: A challenging osteoarticular mycosis of the twenty-first century. Med Mycol 2017; 55:691-704. [PMID: 28053147 PMCID: PMC6251651 DOI: 10.1093/mmy/myw136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/06/2016] [Accepted: 11/29/2016] [Indexed: 12/15/2022] Open
Abstract
Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.
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Affiliation(s)
- Saad J. Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Weill Cornell Medicine, Doha, Qatar
| | - Maria N. Gamaletsou
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - Blandine Rammaert
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - Nikolaos V. Sipsas
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
- National and Kapodistrian University of Athens, Athens, Greece
| | - Valerie Zeller
- Osteoarticular Reference Center, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Emmanuel Roilides
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University, School of Health Sciences, and Hippokration Hospital, Thessaloniki, Greece
| | | | - Michael Henry
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA
| | - Vidmantas Petraitis
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA
| | - Brad Moriyama
- Department of Pharmacy, NIH Clinical Center, Bethesda, MD, USA
| | - David W. Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - Olivier Lortholary
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- Université Paris-Descartes, Sorbonne Paris Cité, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, Paris, France
- Institut Pasteur, Mycology Molecular Unit, Paris, France
- Departments of Pediatrics, and Microbiology and Immunology, Weill Cornell Medical Center of Cornell University, New York, NY, USA
| | - Thomas J. Walsh
- Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA
- International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France
- Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA
- Departments of Pediatrics, and Microbiology and Immunology, Weill Cornell Medical Center of Cornell University, New York, NY, USA
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