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Xu K, Charles D, Ismael S, Zhang J. A Case of Severe Chronic Multifocal Osteomyelitis of the Skull Caused by Klebsiella pneumoniae in Mali. Infect Drug Resist 2023; 16:6139-6143. [PMID: 37719648 PMCID: PMC10505023 DOI: 10.2147/idr.s426775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
Highly invasive infections caused by Klebsiella pneumonia, which includes bacteremia, liver abscess, meningitis, septic arthritis, and osteomyelitis, in not commonly seen in adult immunocompetent and immunocompromised patients. Here, we report an adult case of chronic multifocal osteomyelitis with severe cranial involvement caused by Klebsiella pneumonia. The patient has a 5-year history of orbital abscess and multiple scalp traumas. CT scan showed right temporal and periorbital osteolysis, multiple parietal osteolysis. The pus was collected twice and routine culture was positive for Klebsiella pneumoniae. Good clinical outcome was achieved with debridement and antibiotic treatment. Microbiologists and clinicians should promptly perform bacteriological cultures on biopsy specimens to facilitate diagnosis when imaging or intraoperative findings of bone infection are suspected, especially in the Mali population.
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Affiliation(s)
- Ke Xu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
- Laboratory and Anatomical Pathology Department of the Mali Hospital, Bamako, Mali
| | - Dara Charles
- Neurosurgery Department of the Mali Hospital, Bamako, Mali
| | - Salami Ismael
- Neurosurgery Department of the Mali Hospital, Bamako, Mali
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People’s Hospital Bijie Hospital, Bijie, Guizhou, People’s Republic of China
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Kim MGJ, Overton K. Successful treatment of vertebral osteomyelitis due to Aspergillus flavus in an immunocompetent patient. BMJ Case Rep 2022; 15:e251101. [PMID: 36414342 PMCID: PMC9684962 DOI: 10.1136/bcr-2022-251101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aspergillus osteomyelitis (AO) is a rare and often lethal opportunistic infection in predominantly immunocompromised patients. Treatment has shifted from amphotericin therapy to voriconazole monotherapy due to increased effectiveness and less toxicity. We report a case of an immunocompetent woman with vertebral osteomyelitis due to Aspergillus flavus who was successfully treated with surgery (requiring hardware implantation) and monotherapy posaconazole (following intolerance and hepatitis due to voriconazole). She remained well at follow-up post cessation of 12 months of antifungal therapy. We provide an updated literature review examining the role of azole monotherapy as the gold standard of treatment for AO.
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Affiliation(s)
- Myong Gyu Joshua Kim
- University of New South Wales, Prince of Wales Clinical School, Randwick, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Kristen Overton
- University of New South Wales, Prince of Wales Clinical School, Randwick, New South Wales, Australia
- Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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Tsantes AG, Papadopoulos DV, Markou E, Zarokostas K, Sokou R, Trikoupis I, Mavrogenis AF, Houhoula D, Piovani D, Bonovas S, Tsantes AE, Tsakris A, Vrioni G. Aspergillus spp. osteoarticular infections: an updated systematic review on the diagnosis, treatment and outcomes of 186 confirmed cases. Med Mycol 2022; 60:myac052. [PMID: 35867975 PMCID: PMC9849853 DOI: 10.1093/mmy/myac052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 01/22/2023] Open
Abstract
Aspergillus spp. osteoarticular infections are destructive opportunistic infections, while there is no clear consensus on their management. The purpose of this review is to investigate the current literature regarding Aspergillus spp. osteoarticular infections. An electronic search of the PubMed and Scopus databases was conducted considering studies that assessed osteoarticular infections from Aspergillus spp. We included only studies with biopsy proven documentation of positive cultures or histological findings for Aspergillus spp., and those with essential information for each case such as the anatomical location of the infection, the type of treatment (conservative, surgical, combination), the antifungal therapy, and the outcome. Overall, 148 studies from 1965 to 2021 including 186 patients were included in the review. One hundred and seven (57.5%) patients underwent surgical debridement in addition to antifungal therapy, while 79 (42.7%) patients were treated only conservatively. Complete infection resolution was reported in 107 (57.5%) patients, while partial resolution in 29 (15.5%) patients. Surgical debridement resulted in higher complete infection resolution rate compared to only antifungal therapy (70.0% vs. 40.5%, P < 0.001), while complete resolution rate was similar for antifungal monotherapy and combination/sequential therapy (58.3% vs. 54.5%; P = 0.76). Last, complete resolution rate was also similar for monotherapy with amphotericin B (58.1%) and voriconazole (58.6%; P = 0.95). The results of this study indicate that antifungal monotherapy has similar efficacy with combination/sequential therapy, while voriconazole has similar efficacy with amphotericin B. Moreover, surgical debridement of the infected focus results in better outcomes in terms of infection eradication compared to conservative treatment. LAY SUMMARY Antifungal monotherapy has similar efficacy with combination/sequential therapy, and voriconazole has similar efficacy with amphotericin B for the treatment of Aspergillus spp. osteoarticular infections, while surgical debridement of the infected focus improves the infection eradication rate.
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Affiliation(s)
- Andreas G Tsantes
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
- Department of Microbiology, ‘Saint Savvas’ Oncology Hospital, 11522 Athens, Greece
| | | | - Eleftheria Markou
- Department of Microbiology, University Hospital of Ioannina, Ioannina 45500, Greece
| | | | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus 18454, Greece
| | - Ioannis Trikoupis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens 15772, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens 15772, Greece
| | - Dimitra Houhoula
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve MI, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano 20089 MI, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve MI, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano 20089 MI, Milan, Italy
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
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Duration of posaconazole therapy for Aspergillus fumigatus osteomyelitis dictated by serial monitoring of 1,3-beta-D glucan. Infection 2020; 48:959-963. [PMID: 32720130 DOI: 10.1007/s15010-020-01489-2] [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: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Here, we present a case of an immunocompetent 37-year old male who developed Aspergillus fumigatus osteomyelitis 16 years after extensive chest wall reconstructive surgery for Ewing sarcoma. His treatment course was complicated by a severe adverse drug reaction to voriconazole, requiring the use of oral posaconazole therapy. Serum 1,3-beta-D glucan assay was utilized to dictate the duration of posaconazole therapy. The patient successfully completed 9 months of oral posaconazole therapy and has not had clinical recurrence for 9 months off antifungal therapy.
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Yang X, Zhang Y, Jing Q, Xu J. Aspergillus Osteomyelitis of Clivus. World Neurosurg 2018; 120:15-16. [PMID: 30149159 DOI: 10.1016/j.wneu.2018.08.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 02/05/2023]
Abstract
A 64-year-old man presented with a 2-month history of headache. The patient had a history of 30 years of diabetes. Magnetic resonance imaging revealed a lesion involving the sphenoid sinus and clivus. Surgery was performed through a transsphenoidal approach. Pathology suggested the diagnosis of the presence of Aspergillus. The patient received voriconazole treatment for 8 weeks, and 3-month follow-up demonstrated no progression. Aspergillus osteomyelitis of the skull base is uncommon, and accurate preoperative diagnosis is difficult. However, when there is a clear history of diabetes, a diagnosis of fungal osteomyelitis should be considered.
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Affiliation(s)
- Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University Chengdu, P. R. China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University Chengdu, P. R. China
| | - Qiuyang Jing
- Department of Pathology, West China Hospital, Sichuan University Chengdu, P. R. China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University Chengdu, P. R. China.
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