Osteoarticular Infections Caused by Non-Aspergillus Filamentous Fungi in Adult and Pediatric Patients

Abstract

Osteoarticular mycoses due to non-Aspergillus moulds are uncommon and challenging infections.A systematic literature review of non-Aspergillus osteoarticular mycoses was performed using PUBMED and EMBASE databases from 1970 to 2013.Among 145 patients were 111 adults (median age 48.5 [16–92 y]) and 34 pediatric patients (median age 7.5 [3–15 y]); 114 (79.7%) were male and 88 (61.9%) were immunocompromised. Osteomyelitis was due to direct inoculation in 54.5%. Trauma and puncture wounds were more frequent in children (73.5% vs 43.5%; P = 0.001). Prior surgery was more frequent in adults (27.7% vs 5.9%; P = 0.025). Vertebral (23.2%) and craniofacial osteomyelitis (13.1%) with neurological deficits predominated in adults. Lower limb osteomyelitis (47.7%) and knee arthritis (67.8%) were predominantly seen in children. Hyalohyphomycosis represented 64.8% of documented infections with Scedosporium apiospermum (33.1%) and Lomentospora prolificans (15.8%) as the most common causes. Combined antifungal therapy and surgery was used in 69% of cases with overall response in 85.8%. Median duration of therapy was 115 days (range 5–730). When voriconazole was used as single agent for treatment of hyalohyphomycosis and phaeohyphomycosis, an overall response rate was achieved in 94.1% of cases.Non-Aspergillus osteoarticular mycoses occur most frequently in children after injury and in adults after surgery. Accurate early diagnosis and long-course therapy (median 6 mo) with a combined medical-surgical approach may result in favorable outcome.

Fungal Infections Complicating Lung Transplantation

“…Risk factors for scedosporiosis include: CF, [254][255][256] severe immunosuppression, 241 hematological malignancy (especially with neutropenia), 254,[257][258][259] OTR, 14,55,72,241,245,254,257,[260][261][262] HIV/ acquired immune deficiency syndrome (AIDS), 263,264 and near drowning. 265 Scedosporium rarely affects healthy individuals 266,267 but bone/joint, 268,269 ear, 270,271 and SSTI 272 have been reported in immunocompetent persons following trauma, surgery, or inoculation injury 241,257,269 or near drowning. [273][274][275][276][277]…”

“…Principal sites of involvement include: lungs, 254,257,273 sinuses, 257,267 CNS, 240,262,273,275 bone/joint, 254,269 skin/soft tissue, 278,279 ears (including malignant otitis), 280 eyes, [281][282][283][284][285] and dissemination. 241,254,257,278,286 In one multicenter study of 107 patients with scedosporiosis, most common sites of involvement were lung/sinuses (24%), CNS (20%), bone (18%), and disseminated (21%).…”

“…257 Surgical resection or debridement has an important adjunctive role in patients with localized soft tissue or bone involvement. 269 In a review of 145 patients with scedosporiosis involving bone or joints (62% of whom were immunocompromised), 69% were treated with VCZ plus surgery; 86% responded favorably. 269 Considerably lower responses can be expected for nonlocalized disease or in severely immunosuppressed patients.…”

Scedosporium prolificansSeptic Arthritis and Osteomyelitis of the Hip Joints in an Immunocompetent Patient: A Case Report and Literature Review

“…A recent systematic review included 23 reported cases of S. prolificans -associated osteoarticular infections in both immunocompetent or immunocompromised patients [9]. Our review of the English literature revealed 14 case reports of S. prolificans infection of the joints (Table 1) in only immunocompetent patients.…”

Fungi as causative agents of healthcare-associated infections

“…Grzybice kości i stawów zazwyczaj są wywoływane przez Candida i Aspergillus. Endemiczne zakażenia grzybami dymorficznymi również mogą przebiegać -głównie u pacjentów z immunosupresją -z zajęciem kości i stawów w wyniku rozsiewu drogą krwionośną, ale zwykle są to zakażenia pozaszpitalne [40].…”