Aspergillus PJI – A systematic analysis of all known cases and report of a new one

Karczewski, Daniel; Khakzad, Thilo; Kriechling, Philipp; Akgün, Doruk

doi:10.1016/j.mycmed.2021.101141

Cited by 3 publications

(1 citation statement)

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“…Only 14 cases of fPJI caused by Aspergillus spp. have been reported in the literature [ 93 ]. Moreover, a high rate of mixed bacterial and fPJI have been reported (ranging between 16% [ 74 ] and 33% [ 17 ] of fPJIs), which increases difficulties in their diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

et al. 2022

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Fungal prosthetic joint infection (fPJI) is a rare complication; nonetheless, it represents a significant diagnostic and therapeutic challenge. There are no official guidelines on the most effective approach to identify and treat fPJIs. This systematic review aims to review the current literature on fPJI management and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Studies eligible for this systematic review were identified through an electronic systematic search of PubMed, Scopus, and Web of Science until 30 September 2022. Further references were obtained by cross-referencing. Sixty-three studies met the inclusion criteria, reporting on 372 cases of fPJI; such cases were described mostly in case reports and small case series with only a few larger cohort studies. Diagnosis of fPJI is challenging because of its chronic and indolent clinical course; it is further complicated by the technical difficulty of harvesting fungal cultures. A two-stage revision was the primary procedure in 239 (64.2%) patients whereas DAIR and one-stage approaches were reported in 30 (8.0%) and 18 (4.8 %) cases. In conclusion, our study highlights the heterogeneity of the reported treatments of fPJI, particularly in terms of medical management. With concern to a surgical approach, a two-stage revision arthroplasty is generally suggested, considering fPJI a delayed or late infection. The need for multicenter, prospective studies to provide standardized protocols and improve the treatment of fungal PJI clearly emerges.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

et al. 2022

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Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice

et al. 2022

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Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that allow the evaluation of fungal morphology and the identification of the etiologic agent of mycosis. Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that enable the examination of the fungi for further identification of the etiological agent of the mycosis. The isolation of fungi from pure cultures is typically recommended, as when more than one species is identified, the second agent is considered a contaminant. Fungi mostly survive in highly organized communities that provoke changes in phenotypic profile, increase resistance to antifungals and environmental stresses, and facilitate evasion from the immune system. Mixed fungal biofilms (MFB) harbor more than one fungal species, wherein exchange can occur that potentialize the effects of these virulence factors. However, little is known about MFB and their role in infectious processes, particularly in terms of how each species may synergistically contribute to the pathogenesis. Here, we review fungi present in MFB that are commensals of the human body, forming the mycobiota, and how their participation in MFB affects the maintenance of homeostasis. In addition, we discuss how MFB are formed on both biotic and abiotic surfaces, thus being a significant reservoir of microorganisms that have already been associated in infectious processes of high morbidity and mortality.

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Septic Obturation of a Knee Endoprosthesis Caused by Aspergillus clavatus

Kuthan,

Zaremba-Wróblewski,

Ott

et al. 2023

Pathogens

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Aspergillus clavatus is a rare opportunistic fungal pathogen that can be isolated from various environmental sources, including soil and animal feces. Although infrequent, infections caused by A. clavatus can be severe in immunocompromised patients. Here, we present a case of a prosthetic joint infection (PJI) in a 74-year-old female patient caused by A. clavatus. The patient presented with left knee pain, and septic loosening of the left knee endoprosthesis was diagnosed. She underwent surgical revision with the implantation of an antibiotic spacer and microbiologic testing. The results came back positive for both Staphylococcus lugdunensis and A. clavatus (which is found in only a fraction of a percent of PJIs). She was treated with oral antimicrobials for 3 months postoperatively. This case report vividly illustrates a clinical scenario that underscores the significance of rigorous microbiologic testing procedures, accurate pathogen identification, unwavering vigilance in testing protocols, and a cautious approach that avoids succumbing to the seductive simplicity of Occam’s razor.

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Aspergillus PJI – A systematic analysis of all known cases and report of a new one

Cited by 3 publications

References 20 publications

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice

Septic Obturation of a Knee Endoprosthesis Caused by Aspergillus clavatus

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