First line treatment of Candida osteomyelitis of the sternum: Is there really a need for radical surgical debridement and reconstructive surgery in Candida osteomyelitis of the sternum after cardiac surgery?

Fungal osteomyelitis and soft tissue infections: Simple solutions to uncommon scenarios

“…Our study highlights the same, with AFT duration ranging from 30 to 180 days, with treatment being individualised on a case to case basis. Contrary to the finding by Neofytos et al, where they found shorter durations in those undergoing surgery; Dietl et al, questioned the basis of surgical debridement in Candida osteomyelitis of the sternum following cardiac surgery [7]. They reported worse outcomes in those subjected to debridement followed by a flap with local recurrence in all.…”

“…This, however, does not seem to hold true for all cases of FOaSI. Literature shows studies with variable results in spite of adequate debridement; the reasons can be manifold-negative culture, inconclusive histopathology, microscopic invasion of fungi in the tissues and vasculature beyond what seems to be macroscopically normal tissue, poor bone penetration of antifungals and immunocompromised state amongst others [2][3][4][5]7,[10][11][12][13]. This variability in results is distinctly highlighted in our case who underwent a second ray amputation following local recurrence [14].…”

“…Fungi rarely affect the musculoskeletal system, and have been notorious in causing chronic, low grade, persistent infections [5,6]. Delay in diagnosis can have effects ranging from contiguous spread of infection to haematogenous seeding with high mortality rates, more so in immunocompromised patients [2,[7][8][9]. There have been increasing reports of fungal osteomyelitis in immunocompetent patients, which can be haematogenous or due to direct inoculation [1,6,10].…”