<i>Aspergillus</i>spp. osteoarticular infections: an updated systematic review on the diagnosis, treatment and outcomes of 186 confirmed cases

Tsantes, Andreas G.; Papadopoulos, Dimitrios V.; Markou, Eleftheria; Zarokostas, Konstantinos; Sokou, Rozeta; Trikoupis, Ioannis; Mavrogenis, Andreas F.; Houhoula, Dimitra; Piovani, Daniele; Bonovas, Stefanos; Tsantes, Argirios Ε.; Tsakris, Athanasios; Vrioni, Georgia

doi:10.1093/mmy/myac052

Cited by 5 publications

(3 citation statements)

References 151 publications

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“…Surgical intervention may be necessary depending on the severity of the osseous coccidioidal infections [84,85]. In total, surgical debridement was carried out in 132 patients (80.9%), while 31 (19.1%) were treated conservatively with antifungal therapy.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

Tsantes,

Koutserimpas,

Naoum

et al. 2024

JoF

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Extrapulmonary infections by Coccidioides spp., though rare, can occur via dissemination, affecting singular or multiple sites, including the skin and musculoskeletal system. Skeletal involvement often manifests as osteomyelitis, particularly in the axial skeleton. The present systematic review evaluates all documented cases of skeletal coccidioidomycosis to assess the diagnostic and treatment strategies alongside the outcomes, drawing insights from an analysis of 163 verified cases. A systematic review following PRISMA guidelines identified all studies reporting skeletal infections by Coccidioides spp. up to 2023 from the PubMed and Scopus databases. Eligible studies evaluated osteoarticular infections from Coccidioides spp. Data extraction included demographics, microbiological data, diagnostic methods, and treatment outcomes. Of the 501 initially identified records, a total of 163 patients from 69 studies met the inclusion criteria. Most cases were from the USA, predominantly males, while the median age of the population was 36 years. Diabetes mellitus was the common comorbidity (14.7%). C. immitis was the most prevalent pathogen. The spine and hand were common sites of infection (17.5% and 15.1%, respectively). Osteomyelitis by Coccidioides spp. was diagnosed, in most cases, by positive cultures (n = 68; 41.7%), while, in 49 (30.9%), both the histological examination and cultures yielded the fungus. Surgical debridement was performed in 80.9% of cases. A total of 118 (72.3%) patients were treated with monotherapy, while combination therapy with two or more antifungal agents was reported in 45 (17.7%). Amphotericin B (either liposomal or deoxycholate) was the most commonly given agent as monotherapy in 51 (31.2%) patients, while 30 (18.4%) patients received itraconazole as monotherapy. The rate of infection’s resolution was higher in patients undergoing surgical debridement (79.5%), compared to those treated only with antifungal agents (51.6%, p = 0.003). Treatment outcomes showed complete resolution in 74.2% of patients, with a mortality rate of 9.2%. Coccidioidal osseous infections present diagnostic and therapeutic challenges. Surgical intervention is often necessary, complementing antifungal therapy. Vigilance for Coccidioides spp. infections, especially in regions with endemicity, is crucial, particularly when bacterial cultures yield negative results.

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Section: Discussionmentioning

confidence: 99%

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

Tsantes,

Koutserimpas,

Naoum

et al. 2024

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“…An intriguing finding was that four of the patients included in our study exhibited concurrent infection with fungal and bacterial pathogens. This condition has been extensively studied during the last years in adult populations, with various reports raising the percentage of bacteremia in hospitalized patients with candidemia to 27–67% [ 32 , 33 ]. The hypothesis that fungal infection carries an increased risk of bacterial coinfection could have serious implications on the treatment choices and management of neonates with fungal liver abscess.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors, Diagnosis, and Treatment of Neonatal Fungal Liver Abscess: A Systematic Review of the Literature

Taliaka

Tsantes

Konstantinidi

et al. 2023

Life

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(1) Background: Although invasive fungal infections are a major cause of neonatal morbidity and mortality, data on the incidence and outcomes of localized abscesses in solid organs due to fungal infections are scarce. The aim of this study was to consolidate evidence and enhance our understanding on neonatal liver abscesses due to invasive fungal infections. (2) Methods: An electronic search of the PubMed and Scopus databases was conducted, considering studies that evaluated fungal liver abscesses in the neonatal population. Data on the epidemiology, clinical course, treatment, and outcome of these infections were integrated in our study. (3) Results: Overall, 10 studies were included presenting data on 19 cases of neonatal fungal liver abscesses. Candida spp. were the most common causative pathogens (94.7%). Premature neonates constituted the majority of cases (93%), while umbilical venous catheter placement, broad spectrum antibiotics, and prolonged parenteral nutrition administration were identified as other common predisposing factors. Diagnosis was established primarily by abdominal ultrasonography. Medical therapy with antifungal agents was the mainstay of treatment, with Amphotericin B being the most common agent (47%). Abscess drainage was required in four cases (21%). Eradication of the infection was achieved in the majority of cases (80%). (4) Conclusions: Even though fungal liver abscess is a rare entity in the neonatal population, clinicians should keep it in mind in small, premature infants who fail to respond to conventional treatment for sepsis, particularly if an indwelling catheter is in situ. A high index of suspicion is necessary in order to achieve a timely diagnosis and the initiation of the appropriate treatment.

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“…Aspergillosis can present in various forms and symptoms depend on severity. The fungus enters the fish through the respiratory tract (Tsantes et al 2022). It then grows and produces spores that can cause inflammation and necrosis of the lung tissue.…”

Section: Aspergillosismentioning

confidence: 99%

Fungal Zoonotic Infections in Fish an emerging threat to Aquatic and Terrestrial life

2023

IJAB

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Fish fungal infections represent an emerging threat with important implications for both animal and human health. Several primary fish pathogens have zoonotic potential, underscoring the relevance of fish mycoses for public health issues globally. Fungal pathogens of free-living and farmed fish are ubiquitous in aquatic environments. They cause superficial to disseminated infections and play a significant role in morbidity and mortality events in cultured and wild fish stocks. Although most published cases of fungal infections in fish refer to opportunistic pathogens that take advantage of compromised host immunity to invade the host, some fungi can behave as primary pathogens, able to cause disease even in apparently immunocompetent fish. The genera with the greatest number of pathogenic species for fish include Aphanomyces, Aspergillus, Candida, Chrysosporium, Exophiala, Fusarium, Ichthyophonus, Paecilomyces, Penicillium, Phoma, Saprolegnia, Trichophyton, and Trichosporon although zoonotic species are described mainly within genera Chrysosporium, Histoplasma, Paracoccidioides, Sporothrix or Cryptococcus. Yeasts play a role in algun pseudomycoses and mycoses. Saprolegniasis, epizootic ulcerative syndrome, branchiomycosis and dermal pseudomycoses are some examples of emerging fungal infectious diseases causing morbidity and mortality in farmed fish and amphibians and economic losses to aquaculture. This chapter examines the incidence and distribution of clinically relevant fungi in fish hosts, pathological findings associated with infection, and present knowledge on transmission routes. Challenges related to therapy and preventive strategies are discussed. Finally, the zoonotic potential and possible implications for public health will be addressed.

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Aspergillusspp. osteoarticular infections: an updated systematic review on the diagnosis, treatment and outcomes of 186 confirmed cases

Cited by 5 publications

References 151 publications

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

Risk Factors, Diagnosis, and Treatment of Neonatal Fungal Liver Abscess: A Systematic Review of the Literature

Fungal Zoonotic Infections in Fish an emerging threat to Aquatic and Terrestrial life

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