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Suwal S, Singh A, Dzefi-Tettey K, Buchanan ME. Role of Imaging in Nondegenerative Arthritis in Low- and Middle-Income Countries. Semin Musculoskelet Radiol 2025; 29:315-326. [PMID: 40164086 DOI: 10.1055/s-0045-1802953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Arthritis is an important cause of disability globally, with high prevalence in low- and middle-income countries. Although osteoarthritis is the most common type of arthritis, various types of nondegenerative arthritis are prevalent in low- and middle-income countries. Multiple imaging modalities, such as radiography, ultrasound, computed tomography, and magnetic resonance imaging, are helpful in diagnosing and prognosticating arthritis. Although imaging appearances can overlap between types of arthritis, specific imaging findings have been described for the different etiologies. Knowing these imaging findings, especially on radiographs and ultrasound in resource-constrained areas, can be helpful in managing arthritis effectively.
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Affiliation(s)
- Sundar Suwal
- Department of Radiodiagnosis and Imaging, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Ashish Singh
- Department of Radiodiagnosis and Imaging, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Klenam Dzefi-Tettey
- Department of Radiology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mary Elizabeth Buchanan
- Department of Radiology - Musculoskeletal Imaging and Intervention, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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2
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Kong YX, Kong KO. Fungal arthritis. Best Pract Res Clin Rheumatol 2025:102058. [PMID: 40087103 DOI: 10.1016/j.berh.2025.102058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/02/2025] [Accepted: 03/04/2025] [Indexed: 03/16/2025]
Abstract
Fungal arthritis is a rare infection with a global distribution that affects neonates, the elderly, and immunocompromised individuals, resulting in severe outcomes. It presents a challenge for healthcare professionals due to its rarity, lack of characteristic features, and difficulty isolating and identifying responsible organisms. Studies on their pathophysiology and treatment have been limited, and evidence-based treatment options are lacking. The pathogens infect through direct inoculation, extension from adjacent infective foci, or distant dissemination via the bloodstream. Typically, it manifests as either monoarthritis or oligoarthritis, with the knee joint being the most common target. Systemic disease is often absent, while pulmonary and cutaneous diseases are the most frequent extra-articular manifestations. Diagnosis frequently necessitates the direct visualisation of the organism in specimens and cultures of synovial fluid and membranes. A combination of medical (antifungal) and surgical treatments is often required.
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Affiliation(s)
- Ying Xi Kong
- General Internal Medicine, Perth Royal Infirmary, PH11NX, Scotland, Perth, United Kingdom.
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore.
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Gronfula AG, Alsharif TH, Alamri RF, Almoutairi AL, Khawjah A, Alzahrani AA, Bukhari ZM, Abduljabbar F. Pediatric Fungal Septic Arthritis Following Intra-articular Administration of the Two-Month Vaccination: A Case Report. Cureus 2024; 16:e73777. [PMID: 39687818 PMCID: PMC11646825 DOI: 10.7759/cureus.73777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2024] [Indexed: 12/18/2024] Open
Abstract
The majority of pediatric fungal septic arthritis patients are infants. Risk factors include prematurity and neonatal septicemia with prolonged hospitalization. Here, we present a case of a two-month-old male infant, preterm at 28 weeks and NICU graduate. He was transferred to King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia due to left hip septic Candida arthritis that was unresponsive to antifungal treatment in an outside hospital. Initially, he was administered the two-month scheduled vaccines inadvertently in the intra-articular space of the left hip. Three days later, he developed candidemia and symptoms of septic arthritis in the left hip. Joint aspiration grew Candida and he was then commenced on anti-fungal treatment. In our hospital, he was vitally stable and febrile. Examination showed erythema, warmth, and severe tenderness, with pain and reduced range of motion of the left hip. Inflammatory markers were increased. X-ray of the left hip was unremarkable. MRI with contrast showed mild left hip effusion associated with synovial enhancement and soft tissue edema and enhancement. Incision and drainage was done after which he received vancomycin and meropenem for four weeks along with fluconazole for eight weeks. A back slab was applied for four weeks. The patient achieved successful recovery upon completion of the treatment and incision and drainage. To our knowledge, this is the first reported case of fungal septic arthritis as a consequence of intra-articular vaccination administration. This case highlights the importance of considering fungi as an etiology of pediatric septic arthritis, particularly in patients with the aforementioned risk factors.
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Affiliation(s)
- Amin G Gronfula
- Orthopedic Surgery, Al-Noor Specialist Hospital, Makkah, SAU
| | | | - Raef F Alamri
- Orthopedics and Traumatology, Al-Noor Specialist Hospital, Makkah, SAU
| | | | - Ahmed Khawjah
- General Surgery, Galway University Hospital, Galway, IRL
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Frost L, Xu Y, Fukuta Y. Fungal Osteomyelitis of a Diabetic Foot Infection Caused by Trichosporon asahii: A Case Report. Adv Skin Wound Care 2024; 37:1-4. [PMID: 39792526 DOI: 10.1097/asw.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
ABSTRACT Diabetic foot bacterial osteomyelitis is a serious infection that can lead to major amputations. However, fungal osteomyelitis in a diabetic foot ulcer is uncommon and has been underrecognized. It typically occurs in patients with underlying immunocompromised status and is associated with poor outcomes. Fungal osteomyelitis might be overlooked or diagnosed late because of underrecognition and the inability to differentiate it from bacterial osteomyelitis without specific laboratory testing, such as fungal culture of bone and histopathology including fungal stain. Treating fungal osteomyelitis involves a long course of antifungal treatment, along with surgical management and intensive wound care. In this report, the authors describe the case of a 78-year-old woman with peripheral arterial disease and diabetes who developed dry gangrene complicated by osteomyelitis due to the fungus Trichosporon asahii in the distal phalange of her right hallux. Initially, her pain and erythema around the gangrene improved with voriconazole; however, her gangrene worsened, likely because of nonadherence to wound care and offloading, and her comorbidities. Ultimately, she underwent a right foot guillotine transmetatarsal amputation. The authors also review the literature on fungal osteomyelitis, particularly in the context of diabetic foot infections and Trichosporon asahii infections.
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Affiliation(s)
- Livia Frost
- At Baylor College of Medicine, Houston, Texas, United States, Livia Frost, BS, is Medical Student, School of Medicine; Ya Xu, MD, PhD, is Assistant Professor, Department of Pathology & Immunology; and Yuriko Fukuta, MD, PhD, CWSP, is Assistant Professor, Department of Medicine, Section of Infectious Diseases
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Tancer S, Ressler A, Miceli MH, Wallace BI. Coccidiomycosis septic arthritis presenting as ankle monoarthritis in a patient with presumed psoriatic arthritis. BMJ Case Rep 2024; 17:e261809. [PMID: 39289033 DOI: 10.1136/bcr-2024-261809] [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: 09/19/2024] Open
Abstract
A man in his 50s with a history of psoriasis was evaluated for acute on chronic left ankle pain. His symptoms were attributed to psoriatic arthritis, and he tried several immunosuppressive regimens without improvement. Further diagnostic workup confirmed Coccidioides immitis/posadasii septic monarthritis thought secondary to a known remote history of Valley fever while residing in Arizona and subsequent reactivation in the setting of immunosuppression. The patient ultimately required prolonged anti-fungal therapy and multiple surgical debridements.Although psoriatic arthritis can present as monarthritis, it is uncommon, with more likely differential considerations including crystal arthropathies, trauma and both typical and atypical infections. Acute monarthritis should always prompt concern for a septic joint, even in a patient with autoimmune disease. The specific history elicited from the patient, including residence in an endemic region, and known prior Coccidioides infection, increased suspicion for Coccidioides and led to the correct diagnosis and management.
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Affiliation(s)
- Stephanie Tancer
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Adam Ressler
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marisa H Miceli
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Beth I Wallace
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Grijalva JAG, de Oliveira VF, de Carvalho VC, de Oliveira PR, Lima ALL. Analysis of epidemiological and clinical aspects in cases of fungal osteomyelitis caused by non-Candida species. Braz J Microbiol 2024; 55:2783-2788. [PMID: 38896342 PMCID: PMC11405654 DOI: 10.1007/s42770-024-01418-7] [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] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Osteomyelitis caused by non-Candida species is rare and often neglected, and current recommendations are based on primarily clinical experience and expert opinion. The objective of this study was to describe a case series of non-Candida fungal osteomyelitis. This retrospective study included 10 patients with non-Candida fungal osteomyelitis. Patients with osteomyelitis and microbiologically confirmed non-Candida species from bone fragment cultures were selected from the institution Infection Control Board database. Fusarium spp. were the most commonly isolated fungus from bone fragment cultures in five patients (50%). The majority did not present immunosuppression. The most common etiology was post-traumatic (n = 7, 70%), particularly open fractures. All patients were treated with antifungals associated with surgery. The antifungals used were itraconazole in five patients (50%), and voriconazole in another five patients (50%), with a median duration of antifungal therapy of four weeks (range: 3-25). There were no observed deaths within 30 days and one year. An antifungal approach combined with surgical treatment demonstrated favorable clinical outcomes, including low mortality rates and effective remission.
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Affiliation(s)
- Jorge Andrés González Grijalva
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vítor Falcão de Oliveira
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Vladimir Cordeiro de Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Rosalba de Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lúcia L Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Saifi I, Kar P, Kashikar SV, Parihar P, Saifi AI, Ansari K. MRI Findings of Acute on Chronic Osteomyelitis of Tibia in a 12-Year-Old Child. Cureus 2024; 16:e67679. [PMID: 39314600 PMCID: PMC11419406 DOI: 10.7759/cureus.67679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/24/2024] [Indexed: 09/25/2024] Open
Abstract
Pediatric patients with osteomyelitis, a serious bone infection, have several difficulties. A 12-year-old child with an acute osteomyelitis diagnosis is the subject of this case study. The child had decreased limb function, a fever, and localized pain. Laboratory testing and diagnostic imaging procedures verified that Staphylococcus aureus was the culprit for the infection. Surgical debridement and intravenous antibiotics were used in combination for treatment. Therapy responses were constantly examined, and modifications were made in response to clinical and radiological findings. Prompt intensive treatment and early detection were essential for controlling the infection and averting long-term consequences. This example emphasizes the value of a multidisciplinary approach to treating pediatric osteomyelitis, pointing out possible directions for future study and presenting best practices.
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Affiliation(s)
- Iram Saifi
- Radiodiagnosis, Jawaharlal Nehru Medical College, Wardha, IND
| | - Pallavi Kar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Wardha, IND
| | | | | | - Azeem I Saifi
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Khizer Ansari
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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Akuri MC, Bencardino JT, Peixoto JB, Sato VN, Miyahara LK, Kase DT, Dell'Aquila AM, do Amaral E Castro A, Fernandes ARC, Aihara AY. Fungal Musculoskeletal Infections: Comprehensive Approach to Proper Diagnosis. Radiographics 2024; 44:e230176. [PMID: 38900682 DOI: 10.1148/rg.230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. ©RSNA, 2024.
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Affiliation(s)
- Marina C Akuri
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Jenny T Bencardino
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Júlia B Peixoto
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Vitor N Sato
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Lucas K Miyahara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adriana M Dell'Aquila
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adham do Amaral E Castro
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
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Gonçalves JRR, Tres KE, Narciso LS, Corrêa R, Perez RD. Fungal Osteomyelitis of the Hip with Septic Arthritis: Case Report. Rev Bras Ortop 2024; 59:e49-e51. [PMID: 39027186 PMCID: PMC11254441 DOI: 10.1055/s-0042-1742604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
Fungal osteomyelitis, especially associated with septic arthritis, is uncommon in Brazil; therefore, sometimes it is difficult to diagnose and treat it. We report the case of a young patient, with no immunosuppressive risk factor, with osteomyelitis leading to septic arthritis of the hip. The diagnosis was performed after surgical drainage and visualization of Cryptococcus neoformans at pathological anatomy. Antifungal treatment resulted in complete remission of the symptoms. Since there is no consensus on the treatment of fungal osteomyelitis, this case report aims to inform orthopedists about the importance of hip arthritis differential diagnosis and the good evolution of clinical treatment after drainage and pathogen isolation.
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Affiliation(s)
- João Rodolfo Radtke Gonçalves
- Divisão em Cirurgia do Quadril, Instituto de Ortopedia e Traumatologia, Blumenau, SC, Brasil
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
| | | | | | - Ricardo Corrêa
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
- Departamento de Ortopedia da Universidade Regional Blumenau (FURB), Blumenau, SC, Brasil
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10
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Qin L, Yang S, Zhao C, Yang J, Li F, Xu Z, Yang Y, Zhou H, Li K, Xiong C, Huang W, Hu N, Hu X. Prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections. Bone Res 2024; 12:28. [PMID: 38744863 PMCID: PMC11094017 DOI: 10.1038/s41413-024-00332-w] [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] [Received: 12/06/2023] [Revised: 03/08/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
Osteomyelitis is a devastating disease caused by microbial infection in deep bone tissue. Its high recurrence rate and impaired restoration of bone deficiencies are major challenges in treatment. Microbes have evolved numerous mechanisms to effectively evade host intrinsic and adaptive immune attacks to persistently localize in the host, such as drug-resistant bacteria, biofilms, persister cells, intracellular bacteria, and small colony variants (SCVs). Moreover, microbial-mediated dysregulation of the bone immune microenvironment impedes the bone regeneration process, leading to impaired bone defect repair. Despite advances in surgical strategies and drug applications for the treatment of bone infections within the last decade, challenges remain in clinical management. The development and application of tissue engineering materials have provided new strategies for the treatment of bone infections, but a comprehensive review of their research progress is lacking. This review discusses the critical pathogenic mechanisms of microbes in the skeletal system and their immunomodulatory effects on bone regeneration, and highlights the prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections. It will inform the development and translation of antimicrobial and bone repair tissue engineering materials for the management of bone infections.
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Affiliation(s)
- Leilei Qin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Shuhao Yang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Chen Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Jianye Yang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Feilong Li
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Zhenghao Xu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Yaji Yang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Haotian Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Kainan Li
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, 610081, China
| | - Chengdong Xiong
- University of Chinese Academy of Sciences, Bei Jing, 101408, China
| | - Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Ning Hu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China.
| | - Xulin Hu
- Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, 610081, China.
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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11
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Bewersdorf TN, Hofmann J, Findeisen S, Schamberger C, Lingner T, Sommer U, Schmidmaier G, Grossner T. Impact of Anti-Mycotic Drugs on the Osteogenic Response of Bone Marrow Mesenchymal Stem Cells In Vitro. Antibiotics (Basel) 2024; 13:186. [PMID: 38391572 PMCID: PMC10886247 DOI: 10.3390/antibiotics13020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
The treatment of fungal bone infections and infected non-unions is a huge challenge in modern trauma and orthopedics, which normally contain the local and systemic administration of anti-fungal drugs. Although frequently used, little is known about the impact of systemic and locally administered fungicides on the osteogenic regenerative capabilities of infected bone tissue, especially upon the osteogenesis of human bone marrow mesenchymal stem cells (BM-hMSCs). This study evaluates the effects of the three most common fungicides for the systemic treatment of bone infections, Voriconazole (VOR), liposomal Amphotericin B (LAMB), and Fluconazole (FLU), as well as the effects of VOR and LAMB-loaded Polymethylmethacrylate (PMMA) cement chips in different concentrations upon the osteogenic response of BM-hMSCs in vitro. Within this study, we compared the ability of BM-hMSC to differentiate into osteoblast-like cells and synthesize hydroxyapatite as assessed by radioactive 99mTechnetium-Hydroxydiphosphonate (99mTc-HDP) labeling, cell proliferation, and analyses of supernatants upon various osteogenic parameters. Our results revealed that VOR added to the cell culture medium affects the osteogenic potential of BM-hMSC negatively, while there were no detectable effects of LAMB and FLU. Moreover, we showed dose-dependent negative effects of high- and extended-dose fungicide-loaded PMMA cement due to cytotoxicity, with a higher cytotoxic potential of VOR than LAMB, while low-dose fungicide-loaded PMMA had no significant effect on the osteogenic potential of BM-hMSC in vitro.
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Affiliation(s)
- Tim Niklas Bewersdorf
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jakob Hofmann
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Sebastian Findeisen
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Thomas Lingner
- Genevention GmbH, Rudolf-Wissell-Str. 28A, 37079 Göttingen, Germany
| | - Ulrike Sommer
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Tobias Grossner
- Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
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12
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Afaque SF, Agrawal U, Shankhwar DK, Chand S, Verma V. A Rare Case of Fungal Osteomyelitis of the Distal Tibia in a Pediatric Patient. Cureus 2024; 16:e54648. [PMID: 38524028 PMCID: PMC10959727 DOI: 10.7759/cureus.54648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Staphylococcus aureus infection is the most common cause of osteomyelitis. Over 100,000 fungal species have been described; only 150 are pathogenic to humans. These opportunistic infections frequently enter the body due to a decrease in host defense or through an invasive gateway, such as a dental extraction or skin discontinuity due to trauma. Symptoms and radiological examination often mimic those of other etiologies, which can lead to substantial delays in treatment. Our case is a 13-year-old healthy boy with no history of immune incompetency who presented to us with complaints of pain and swelling over his left ankle and leg with an on-and-off history of fever for 15 days. Based on his history and examination, he is diagnosed as having sub-acute osteomyelitis of the distal tibia with septic arthritis. The bacterial culture has no growth; however, the potassium hydroxide mount came positive for fungal elements having hyphae and pseudohyphae, and the fungal culture came positive for Candida. Management of fungal infections is challenging as they have infrequent involvement in bones. Fungal osteomyelitis is considered a rare entity in the literature, and the current case is studied for the management and diagnosis of a rare variant of osteomyelitis in the pediatric population. The treatment guidelines vary based on the identified organism and the duration of treatment. Debridement of fungal osteomyelitis or septic arthritis includes removing sinus tracts, evaluation for squamous cell carcinoma, bony and soft-tissue debridement, and antibiotic or antifungal bead placement. The spectrum of osteomyelitis ranges from Staphylococcus aureus organisms to tumors; therefore, it is necessary to investigate every spectrum of the disease, and fungal infections should be considered differential even though they are a rare entity. Early diagnosis, surgical debridement, and proper antifungal treatment based on fungal species lead to better clinical outcomes and results.
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Affiliation(s)
| | - Udit Agrawal
- Paediatric Orthopaedics, King George's Medical University, Lucknow, IND
| | | | - Suresh Chand
- Paediatric Orthopaedics, King George's Medical University, Lucknow, IND
| | - Vikas Verma
- Paediatric Orthopaedics, King George's Medical University, Lucknow, IND
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13
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Konya P, Konya MN, Yilmaz BK, Kaga E, Kaga S, Çetinkol Y. Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue. Cureus 2023; 15:e46487. [PMID: 37800164 PMCID: PMC10550264 DOI: 10.7759/cureus.46487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Abstract
Background Local antibiotic applications have been used in chronic osteomyelitis and have been defined as an adjunctive treatment method. Biodegradable materials are also used for the same purpose by adding antibiotics. The fact that it does not require additional surgery to be removed is an important advantage. In this study, we intended to develop a new biodegradable drug-loaded polymeric scaffold with good antibiotic release and compare the microbiological results with antibiotic-impregnated bone cement. Methodology A tissue scaffold containing poly(2-hydroxyethyl methacrylate) (PHEMA) was prepared in our laboratory and loaded with ertapenem and daptomycin antibiotics. The surface morphology and pore geometries of drug-loaded and unloaded scaffolds were analyzed by a scanning electron microscope under vacuum. The dose-dependent antiproliferative effects of PHEMA scaffold, drug-loaded scaffold, cement, and drug-loaded cement on osteoblast cells were investigated. To evaluate drug release kinetics, the absorbance values of the scaffold loaded with ertapenem and daptomycin were measured with the spectrometer. For microbiological tests, ertapenem and daptomycin-impregnated cement and scaffold, as well as the control scaffold and cement samples, were investigated for their antibacterial activities on Staphylococcus aureus and Klebsiella pneumoniae strains using the disc diffusion method. These microorganisms are one of the most common microorganisms in osteomyelitis. Results The efficacy of antibiotic-impregnated scaffold and cement on both gram-negative and gram-positive microorganisms was investigated. The daptomycin zone diameter in S. aureus ATCC 29233 strain was 17 mm, whereas it was 24 mm for scaffold and 22 mm for cement. Scaffold was found to be more effective than cement against S. aureus strain. The K. pneumoniae ATCC BAA-2814 strain was found to be resistant to ertapenem, but the zone diameter was 21 mm for scaffold and 20 mm for cement. Ertapenem-loaded scaffold was found to be more effective than cement. It was found that the antimicrobial activity of the scaffold was higher than cement. When we evaluated the release profiles, for the daptomycin-loaded cement group, 98% of daptomycin was cumulatively released within 30 minutes, and for the daptomycin-loaded scaffold group, 100% of daptomycin was cumulatively released in six days. To compare ertapenem-loaded cement and scaffold, 98% of ertapenem was cumulatively released within 10 minutes in the cement group. For the scaffold group, 100% of ertapenem was cumulatively released in 17 days. We found that the scaffold released the antibiotic more slowly and for a longer duration. Therefore, it was thought that the scaffold would be more effective on biofilm and the treatment of osteomyelitis would be more successful. Conclusions The produced scaffold was compared with cement, and it was concluded that the scaffold had better release and antimicrobial efficacy. Scaffold is more advantageous than cement because it is bioeliminable. Thus, there is no need for a second surgical intervention with the likely prevention of mortality and morbidity. Because of all these features, the scaffold seems promising in the local treatment of osteomyelitis.
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Affiliation(s)
- Petek Konya
- Infectious Diseases, Afyonkarahisar Health Science University, Afyonkarahisar, TUR
| | - Mehmet N Konya
- Orthopeadics and Traumatology, Afyonkarahisar Health Science University, Afyonkarahisar, TUR
| | - Bilge Kagan Yilmaz
- Orthopaedics and Traumatology, Afyonkarahisar State Hospital, Afyonkarahisar, TUR
| | - Elif Kaga
- Medical Services and Technique, Afyonkarahisar Health Science University, Afyonkarahisar, TUR
| | - Sadık Kaga
- Biomedical Engineering, Afyon Kocatepe University, Afyonkarahisar, TUR
| | - Yeliz Çetinkol
- Medical Microbiology, Afyonkarahisar Health Science University, Afyonkarahisar, TUR
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14
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Taskin E, Yavuz U, Akbaba D, Afacan MY, Ozsahin MK, Kaynak G, Seker A. Aspergillus fumigatus Septic Arthritis of the Wrist: A Report of a Rare Case in an Immunocompromised Patient. Cureus 2023; 15:e43622. [PMID: 37719571 PMCID: PMC10504690 DOI: 10.7759/cureus.43622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Aspergillus fumigatus is a saprophytic fungus encountered as a pathogen in airborne lung infections. Although it commonly causes pulmonary infectious diseases, when disseminated, it may cause a systemic infection termed invasive aspergillosis, which is associated with high mortality and morbidity. Virtually, all organ systems may be involved. However, the musculoskeletal system is relatively uncommon. Here, we present a case of invasive aspergillosis in an immunocompromised patient involving the wrist joint, an exceedingly rare site. Our treatment choice is serial open debridement, irrigation, and intravenous antibiotics. This case study exemplifies the potential challenges in the identification and treatment of such an uncommon clinical condition. A thorough clinical and microbiological evaluation is essential for accurate diagnosis of fungal septic arthritis of the wrist. Aggressive early surgical treatment combined with appropriate early intravenous antibiotics is crucial for eradicating joint infection.
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Affiliation(s)
- Ersin Taskin
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Ulas Yavuz
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Derya Akbaba
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Muhammed Yusuf Afacan
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Mahmut Kursat Ozsahin
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Gokhan Kaynak
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
| | - Ali Seker
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, TUR
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15
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Asperges E, Albi G, Truffelli F, Salvaderi A, Puci F, Sangani A, Zuccaro V, Scotti V, Orsolini P, Brunetti E, Bruno R. Fungal Osteomyelitis: A Systematic Review of Reported Cases. Microorganisms 2023; 11:1828. [PMID: 37513000 PMCID: PMC10383745 DOI: 10.3390/microorganisms11071828] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Fungal osteomyelitis is considered a rare disease, and the published literature mainly comprises case reports, case series and narrative reviews. A systematic review was undertaken to provide a practice-based global perspective on this disease, focusing on epidemiology and treatment strategies. We searched MEDLINE, EMBASE and Cochrane Library between the 3rd and 8th of March 2023 using a predefined search string. We included studies with at least one patient with a diagnosis of fungal osteomyelitis published before the 1st of January 2023. We included all study designs except for reviews, and we excluded non-English languages and grey literature. After exclusion, 678 studies, mostly case reports, were included. Descriptive analysis was performed on 1072 patients. The most common aetiological agent was Aspergillus (26.5%), followed by Candida (20.7%) and Mucor (16.8%), and the bones most frequently involved were the vertebrae. We described the characteristics of patients divided by site of infection, and we found that diabetes mellitus, disseminated fungal infection, surgery and local lesion were major risk factors. We also successfully associated duration of treatment with outcome. We provided a general overview of this rare disease, and we highlighted the need for high-quality investigations on the subject.
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Affiliation(s)
- Erika Asperges
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giuseppe Albi
- Department of Electrical, Computer and Biomedical Engineering, Università di Pavia, 27100 Pavia, Italy
| | - Francesco Truffelli
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Andrea Salvaderi
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Flavia Puci
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Aurelia Sangani
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
| | - Valentina Zuccaro
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Valeria Scotti
- UOSD Grant Office, TTO e Documentazione Scientifica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paolo Orsolini
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Raffaele Bruno
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche-Università di Pavia, 27100 Pavia, Italy
- S.C. Malattie Infettive I Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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16
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Ranade AS, Gandhi S. Fungal Osteomyelitis of the Proximal Tibial Epiphysis and Septic Arthritis Secondary to an Open Wound: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00055. [PMID: 37590557 DOI: 10.2106/jbjs.cc.23.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 9-year-old boy presented with a painful, swollen knee. He had a wound on the knee 2 months ago after a fall in contaminated water. At another hospital, this was treated with debridement twice, and the patient received several antibiotics. Imaging showed septic arthritis and epiphyseal osteomyelitis involving the proximal medial tibia. Surgical debridement and joint washout were performed. Fungal cultures grew Scedosporium boydii. Antifungal treatment with voriconazole was given. At a 5-year follow-up, we noticed favorable outcomes without any complications. CONCLUSIONS Fungal osteomyelitis because of direct inoculation should be considered a rare differential diagnosis while treating epiphyseal osteomyelitis.
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Affiliation(s)
- Ashish S Ranade
- Blooming Buds Centre for Pediatric Orthopaedics, Deenanath Mangeshkar Hospital, Pune, India
| | - Shreyans Gandhi
- Department of Orthopaedics, Deenanath Mangeshkar Hospital, Pune, India
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17
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Papadakis SA, Gourtzelidis G, Pallis D, Ampadiotaki MM, Tatakis F, Tsivelekas K, Georgousi K, Kokkinis C, Diamantopoulou K, Lelekis M. Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature. J Med Case Rep 2023; 17:188. [PMID: 37149631 PMCID: PMC10164329 DOI: 10.1186/s13256-023-03925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Osteomyelitis is a bone inflammation that can be related to various infectious agents. As with any other type of inflammation, the prevailing symptoms and signs may include redness, swelling, pain, and heat. Fungal osteomyelitis is rare and usually found in immune-compromised patients. CASE PRESENTATION A non-human immunodeficiency virus immunocompromised Greek female patient, 82 years old, visited the emergency department due to a 3 day pain located mainly over the left tibia's anterior surface, accompanied by swelling and redness. There was also a subcutaneous lesion of her left breast. Medical history revealed that the patient had an unmasked close contact with pigeons, a main host of the disease. Initial x-ray imaging showed an osteolytic area in the upper third of the tibial diaphysis. The patient was admitted and underwent a computed tomography-guided biopsy. The specimen revealed a Cryptococcus neoformans infection of the bone and the breast. She was treated with 400 mg fluconazole twice a day for 3 weeks while in hospital and 200 mg twice a day upon discharge for 9 months. After that, she underwent surgical debridement because of lasting local irritation. She was closely monitored in our outpatient office, and in her last visit, 1 year after the initial admission, inflammatory signs had regressed vastly. CONCLUSIONS To our knowledge, this is the ninth cryptococcal osteomyelitis of the tibia to be recorded since 1974, and the most unusual finding was the bifocal nature of the infection, affecting both the tibia and the breast.
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Affiliation(s)
- Stamatios A Papadakis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece.
| | - Georgios Gourtzelidis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | | | - Fotios Tatakis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
| | - Konstantinos Tsivelekas
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | - Kleoniki Georgousi
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
| | | | | | - Moyssis Lelekis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
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18
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Campbell AP, Qiu L, Dillman JR, Trout AT, Szabo S, Lopez-Nunez OF, Pugmire BS, Schapiro AH. Endemic mycoses in children in North America: a review of radiologic findings. Pediatr Radiol 2023; 53:984-1004. [PMID: 36922418 PMCID: PMC10017348 DOI: 10.1007/s00247-023-05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.
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Affiliation(s)
- Abraham P Campbell
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Lisa Qiu
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Szabo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Oscar F Lopez-Nunez
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian S Pugmire
- Department of Radiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Andrew H Schapiro
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Mishra A, Juneja D. Fungal arthritis: A challenging clinical entity. World J Orthop 2023; 14:55-63. [PMID: 36844378 PMCID: PMC9945246 DOI: 10.5312/wjo.v14.i2.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
There has been an increasing incidence of fungal infections in recent years. Rarely joints are also affected by fungal infections. Mainly, these infections develop in prosthetic joints, but sometimes native joints are also involved. Candida infections are mostly reported, but patients may also develop infections secondary to non-Candida fungi, especially Aspergillus. Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy. Despite this, these infections are associated with high morbidity and mortality. This review described the clinical features, risk factors, and therapeutic interventions required to manage fungal arthritis.
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Affiliation(s)
- Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Specialty Hospital, Saket, New Delhi 110017, India
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20
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Henry MW, Miller AO. Management of Fungal Osteoarticular Infections. CURRENT FUNGAL INFECTION REPORTS 2023. [DOI: 10.1007/s12281-023-00453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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21
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Kitaya S, Kanamori H, Baba H, Oshima K, Takei K, Seike I, Katsumi M, Katori Y, Tokuda K. Clinical and Epidemiological Characteristics of Persistent Bacteremia: A Decadal Observational Study. Pathogens 2023; 12:pathogens12020212. [PMID: 36839484 PMCID: PMC9960527 DOI: 10.3390/pathogens12020212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Background: Bloodstream infections (BSIs), including persistent bacteremia (PB), are a leading source of morbidity and mortality globally. PB has a higher mortality rate than non- PB, but the clinical aspects of PB in terms of the causative pathogens and the presence of clearance of PB are not well elucidated. Therefore, this study aimed to describe the clinical and epidemiological characteristics of PB in a real-world clinical setting. Methods: We performed a retrospective observational survey of patients who underwent blood culture between January 2012 and December 2021 at Tohoku University Hospital. Cases of PB were divided into three groups depending on the causative pathogen: gram-positive cocci (GPC), gram-negative rods (GNRs), and Candida spp. For each group, we examined the clinical and epidemiological characteristics of PB, including differences in clinical features depending on the clearance of PB. The main outcome variable was mortality, assessed as early (30-day), late (30-90 day), and 90-day mortality. Results: Overall, we identified 31,591 cases of single bacteremia; in 6709 (21.2%) cases, the first blood culture was positive, and in 3124 (46.6%) cases, a follow-up blood culture (FUBC) was performed. Of the cases with FUBCs, 414 (13.2%) were confirmed to be PB. The proportion of PB cases caused by Candida spp. was significantly higher (29.6%, 67/226 episodes) than that for GPC (11.1%, 220/1974 episodes, p < 0.001) and GNRs (12.1%, 100/824 episodes, p < 0.001). The Candida spp. group also had the highest late (30-90 day) and 90-day mortality rates. In all three pathogen groups, the subgroup without the clearance of PB tended to have a higher mortality rate than the subgroup with clearance. Conclusions: Patients with PB due to Candida spp. have a higher late (30-90 day) and 90-day mortality rate than patients with PB due to GPC or GNRs. In patients with PB, FUBCs and confirming the clearance of PB are useful to improve the survival rate.
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Affiliation(s)
- Shiori Kitaya
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Correspondence: (S.K.); (H.K.)
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Correspondence: (S.K.); (H.K.)
| | - Hiroaki Baba
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kengo Oshima
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kentarou Takei
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Issei Seike
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
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22
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MLV SK, Chauhan N, Mittal R, Chattopadhyay A. Fungal Infection Post Arthroscopic Meniscal Repair: A Rare Complication. Cureus 2023. [DOI: https:/doi.org/10.7759/cureus.33342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
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23
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Yan YY, Peh WCG. Mimics of Synovial Tumors Due to Chronic Infection. MEDICAL RADIOLOGY 2023:241-266. [DOI: 10.1007/174_2023_428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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24
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Muacevic A, Adler JR, Mittal R, Chattopadhyay A. Fungal Infection Post Arthroscopic Meniscal Repair: A Rare Complication. Cureus 2023; 15:e33342. [PMID: 36741675 PMCID: PMC9896428 DOI: 10.7759/cureus.33342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Infections after arthroscopic procedures are rare. Infection due to fungal organisms is rarer and difficult to diagnose due to its insidious nature and chronic presentation but when neglected has devastating consequences. We present a 23-year-old immunocompetent adult post-arthroscopic meniscal repair with fungal surgical site infection. The patient underwent open debridement and was started on antifungals. His surgical wound healed and with physiotherapy he regained his full range of movement.
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25
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Mello López A, da Silva Neto LA, de Oliveira VF, de Carvalho VC, de Oliveira PRD, Lima ALLM. Orthopedic infections due to Trichosporon species: Case series and literature review. Med Mycol 2022; 61:6969423. [PMID: 36610725 DOI: 10.1093/mmy/myad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Reports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality.
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Affiliation(s)
- Andrés Mello López
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Alves da Silva Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vítor Falcão de Oliveira
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vladimir Cordeiro de Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ana Lúcia Lei Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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26
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Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms 2022; 11:microorganisms11010084. [PMID: 36677376 PMCID: PMC9864285 DOI: 10.3390/microorganisms11010084] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
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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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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28
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Devascularized Bone Surface Culture: A Novel Strategy for Identifying Osteomyelitis-Related Pathogens. J Pers Med 2022; 12:jpm12122050. [PMID: 36556270 PMCID: PMC9781165 DOI: 10.3390/jpm12122050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The gold standard for identifying pathogens causing osteomyelitis (OM) is intraoperative tissue sampling culture (TSC). However, its positive rate remains inadequate. Here, we evaluated the efficiency of a novel strategy, known as devitalized bone surface culture (BSC), for detecting OM-related microorganisms and compared it to TSC. Between December 2021 and July 2022, patients diagnosed with OM and received both methods for bacterial identification were screened for analysis. In total, 51 cases were finally recruited for analysis. The mean age was 43.6 years, with the tibia as the top infection site. The positive rate of BSC was relatively higher than that of TSC (74.5% vs. 58.8%, p = 0.093), though no statistical difference was achieved. Both BSC and TSC detected definite pathogens in 29 patients, and their results were in accordance with each other. The most frequent microorganism identified by the BSC method was Staphylococcus aureus. Moreover, BSC took a significantly shorter median culture time than TSC (1.0 days vs. 3.0 days, p < 0.001). In summary, BSC may be superior to TSC for identifying OM-associated pathogens, with a higher detectable rate and a shorter culture time.
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29
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He S, Luo T, Xie Y, Zhu X, Lei J, Cai L, Deng Z. Pubis Cryptococcal Osteomyelitis in an Immunocompetent Patient: A Case Report and Recent Literature Review. Infect Drug Resist 2022; 15:7369-7375. [DOI: 10.2147/idr.s390881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
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Costello JP, Markowitz MI, Luxenburg D, Rizzo MG, Mahmoud RH, Barnhill SW, Vilella-Hernandez FE. Effects of immunocompromised status on diagnostic criteria in septic arthritis. J Orthop 2022; 34:80-83. [PMID: 36035198 PMCID: PMC9411066 DOI: 10.1016/j.jor.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Septic arthritis is an orthopaedic emergency, with permanent cartilage damage possible within hours of the onset of symptoms. Diagnostic criteria for septic arthritis in immunocompetent patients are well established, however, there is a paucity of literature evaluating diagnostic criteria in immunocompromised patients. The purpose of this retrospective case-control study was to evaluate the laboratory and clinical information of immunocompromised patients with septic arthritis and compare them to immunocompetent patients with septic arthritis to enable physicians to diagnose septic arthritis more accurately in this population. Methods All patients at our institution, a level I trauma center, with a clinical diagnosis of septic arthritis between January 1, 2006 and November 1, 2021 were identified and reviewed retrospectively. Patients 18 years old or older were screened for immunocompromised status and those meeting criteria were included for review. The control cohort was matched by the joint affected and age. Data were analyzed using the Shapiro-Wilk test, Turkey's test, Mann-Whitney U test, independent sample t-test, and chi-square analysis. A p-value of <0.05 was considered significant. Results A total of 36 patients with positive joint aspirate cultures were compared (18 immunocompetent and 18 immunocompromised). The immunocompromised group had a significantly longer length of hospital stay than the immunocompetent group (p = 0.044). There was no significant difference in erythrocyte sedimentation rate (ESR) (p = 0.852), peripheral white blood cell count (pWBC) (p = 0.696), joint aspirate white blood cell count (aWBC) (p = 0.901), polymorphonuclear cell percentage (PMN%) (p = 0.325), or total operations performed per patient (p = 0.365). Conclusion At our institution, immunocompromised patients with septic arthritis did not have significantly different diagnostic laboratory values when compared to immunocompetent patients. This suggests that immunocompromised patients with suspicion of septic arthritis can be assessed with similar diagnostic criteria as immunocompetent individuals; however, a larger cohort study is needed to assess the difference more precisely in laboratory values.
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Affiliation(s)
- Joseph P. Costello
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Moses I. Markowitz
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Dylan Luxenburg
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Michael G. Rizzo
- University of Miami Department of Orthopaedic Surgery, 1611 NW 12th Ave, Miami, FL 33136, USA
| | - Rami H. Mahmoud
- University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Spencer W. Barnhill
- University of Miami Department of Orthopaedic Surgery, 1611 NW 12th Ave, Miami, FL 33136, USA
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Co CM, Mulgaonkar A, Zhou N, Harris S, Öz OK, Tang L, Sun X. PET Imaging of Active Invasive Fungal Infections with d-[5- 11C]-Glutamine. ACS Infect Dis 2022; 8:1663-1673. [PMID: 35869564 DOI: 10.1021/acsinfecdis.2c00249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The increasing prevalence and severity of invasive fungal infections (IFIs), especially in immunocompromised populations, has amplified the need for rapid diagnosis of fungal pathogens. Radiotracers derived from d-amino acids (DAAs) show promise as bacterial-specific positron emission tomography (PET) imaging agents due to their preferential consumption by bacteria and largely nonutilization by hosts. Unlike mammals, fungi can utilize external DAAs including d-glutamine for their growth by rapidly upregulating DAA oxidases. Additionally, glutamine is essential for fungal nitrogen assimilation, survival, and virulence. We previously validated d-[5-11C]-glutamine (d-[5-11C]-Gln) as an efficient radiotracer targeting live bacterial soft-tissue infections. Here, we further expanded this investigation to evaluate its translational potential for PET imaging of IFIs in immunocompetent mouse models subcutaneously (SubQ) and intramuscularly (IM) infected with Candida albicans (C. albicans), using its l-isomer counterpart (l-[5-11C]-Gln) as a control. Comparative studies between pathogens showed significantly (p < 0.05) higher uptake in fungi (C. albicans and C. tropicalis) versus tested bacterial species for d-[5-11C]-Gln, suggesting that it could potentially serve as a more sensitive radiotracer for detection of fungal infections. Additionally, comparative PET imaging studies in immunocompetent infected mice demonstrated significantly higher infection-to-background ratios for d- versus l-[5-11C]-Gln in both SubQ (ratio = 1.97, p = 0.043) and IM (ratio = 1.97, p = 0.028) infections. Fungal infection imaging specificity was confirmed with no significant difference observed between localized inflammation sites versus untreated muscle background (heat-killed injection site/untreated muscle: ∼1.1). Taken together, this work demonstrates the translational potential of d-[5-11C]-Gln for noninvasive PET imaging of IFIs.
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Affiliation(s)
- Cynthia M Co
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas 76019, United States
| | - Aditi Mulgaonkar
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Ning Zhou
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Shelby Harris
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Orhan K Öz
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Liping Tang
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas 76019, United States
| | - Xiankai Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
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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: 0.7] [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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Sanderford J, Krumrey J, Campaigniac E, Lin J, Tsai P, Pipitone O. The Utility of Acid-Fast Bacillus (AFB) and Fungal Cultures in Orthopaedic Infections. Cureus 2022; 14:e26639. [PMID: 35949753 PMCID: PMC9357251 DOI: 10.7759/cureus.26639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction When diagnosing suspected orthopaedic-related infections, fungal and acid-fast bacilli (AFB) cultures are often obtained intraoperatively. These cultures are difficult and time-consuming to grow and increase healthcare costs. This study aimed to quantify the rate of positive AFB and fungal cultures in orthopaedic infections and to compare potential risk factors for a positive result. Methods Orthopaedic surgical cases for suspected infection at one institution from March 2013 through December 2019 were included. Data were collected on patient demographics and procedure characteristics for patients with surgical AFB or fungal lab tests ordered on the day of surgery. Results Of the 813 patients for whom intraoperative AFB or fungal cultures were ordered, 3.8% (N=31) had a positive result. Of the 31 positive results, 30 were from fungal cultures and one was from AFB cultures. Patients with a positive versus negative culture result did not differ significantly by age, sex, American Society of Anesthesiologists (ASA) score, diabetes, obesity, or HIV/AIDS. In both unadjusted and adjusted analyses, peripheral vascular disease (PVD) was associated with higher odds of a positive fungal culture result (adjusted OR (aOR)=3.5, 95%CI=1.3-8.4). Likewise, in both unadjusted and adjusted models, a hand/foot operating region was associated with higher odds of a positive fungal culture result compared with all other regions (aOR=4.2, 95%CI=1.9-9.8). Conclusion Intraoperative fungal and AFB cultures may not need to be obtained except in orthopaedic surgical cases for hand or foot infections or in patients with PVD.
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Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use. J Clin Med 2022; 11:jcm11123481. [PMID: 35743551 PMCID: PMC9224689 DOI: 10.3390/jcm11123481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens. VO can be devastating, as infection can result in pathogenic biofilms on instrumentation that is dangerous to remove. New techniques, such as kyphoplasty and novel vertebroplasty methods, could amplify the potential of ABC in spine surgery. However, caution should be exercised when using ABC as there is some evidence of toxicity to patients and surgeons, antibiotic allergies, bone cement structural impairment, and possible development of antibiotic resistance. The purpose of this article is to describe the basic science of antibiotic cement utilization and review its usage in spine surgery.
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Sahoo RR, Wakhlu A, Agarwal V. Neglected tropical rheumatic diseases. Clin Rheumatol 2022; 41:1293-1304. [PMID: 35142903 DOI: 10.1007/s10067-022-06090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
The complexities of dealing with rheumatic diseases in tropical countries are diverse and likely due to limited health care infrastructure, lack of diagnostic and therapeutic facilities, impact of dominant prevailing diseases, and the challenges of differentiating from infectious and non-infectious disease mimics. Several tropical diseases present with musculoskeletal and rheumatic manifestations and often pose a diagnostic dilemma to rheumatologists. The diagnosis is often delayed or the disease is misdiagnosed, leading to poor patient outcomes. Endemic tropical diseases like tuberculosis and leprosy have myriad rheumatic presentations and remain important differentials to consider in patients with rheumatic manifestations. Infection with human immunodeficiency virus is a great masquerade and can mimic manifestations of multiple diseases. The role of viral infections in triggering and perpetuating autoimmunity is well known and chikungunya arthritis is a classic example of the same. This review highlights the rheumatic manifestations of tropical diseases and aims to create awareness among the caregivers. Key Points • It is crucial to be aware and identify infectious diseases presenting with rheumatic manifestations in the tropics. • Presentations akin to classic rheumatic syndromes such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and vasculitis are common.
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Affiliation(s)
- Rasmi Ranjan Sahoo
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
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d’Humières C, Gaïa N, Gueye S, de Lastours V, Leflon-Guibout V, Maataoui N, Duprilot M, Lecronier M, Rousseau MA, Gamany N, Lescure FX, Senard O, Deconinck L, Dollat M, Isernia V, Le Hur AC, Petitjean M, Nazimoudine A, Le Gac S, Chalal S, Ferreira S, Lazarevic V, Guigon G, Gervasi G, Armand-Lefèvre L, Schrenzel J, Ruppé E. Contribution of Clinical Metagenomics to the Diagnosis of Bone and Joint Infections. Front Microbiol 2022; 13:863777. [PMID: 35531285 PMCID: PMC9069157 DOI: 10.3389/fmicb.2022.863777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Bone and joint infections (BJIs) are complex infections that require precise microbiological documentation to optimize antibiotic therapy. Currently, diagnosis is based on microbiological culture, sometimes complemented by amplification and sequencing of the 16S rDNA gene. Clinical metagenomics (CMg), that is, the sequencing of the entire nucleic acids in a sample, was previously shown to identify bacteria not detected by conventional methods, but its actual contribution to the diagnosis remains to be assessed, especially with regard to 16S rDNA sequencing. In the present study, we tested the performance of CMg in 34 patients (94 samples) with suspected BJIs, as compared to culture and 16S rDNA sequencing. A total of 94 samples from 34 patients with suspicion of BJIs, recruited from two sites, were analyzed by (i) conventional culture, (ii) 16S rDNA sequencing (Sanger method), and (iii) CMg (Illumina Technology). Two negative controls were also sequenced by CMg for contamination assessment. Based on the sequencing results of negative controls, 414 out of 539 (76.7%) bacterial species detected by CMg were considered as contaminants and 125 (23.2%) as truly present. For monomicrobial infections (13 patients), the sensitivity of CMg was 83.3% as compared to culture, and 100% as compared to 16S rDNA. For polymicrobial infections (13 patients), the sensitivity of CMg was 50% compared to culture, and 100% compared to 16S rDNA. For samples negative in culture (8 patients, 21 samples), CMg detected 11 bacteria in 10 samples from 5 different patients. In 5/34 patients, CMg brought a microbiological diagnosis where conventional methods failed, and in 16/34 patients, CMg provided additional information. Finally, 99 antibiotic resistance genes were detected in 24 patients (56 samples). Provided sufficient genome coverage (87.5%), a correct inference of antibiotic susceptibility was achieved in 8/8 bacteria (100%). In conclusion, our study demonstrated that the CMg provides complementary and potentially valuable data to conventional methods of BJIs diagnosis.
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Affiliation(s)
- Camille d’Humières
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
- *Correspondence: Camille d’Humières,
| | - Nadia Gaïa
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Signara Gueye
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
| | - Victoire de Lastours
- INSERM, Université de Paris Cité, IAME, Paris, France
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | | | - Naouale Maataoui
- AP-HP, Hôpital Beaujon, Laboratoire de Bactériologie, Paris, France
| | - Marion Duprilot
- AP-HP, Hôpital Beaujon, Laboratoire de Bactériologie, Paris, France
| | - Marie Lecronier
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | | | - Naura Gamany
- AP-HP, Hôpital Beaujon, Service de Médecine Interne, Paris, France
| | - François-Xavier Lescure
- INSERM, Université de Paris Cité, IAME, Paris, France
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Olivia Senard
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Laurène Deconinck
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Marion Dollat
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | - Valentina Isernia
- AP-HP, Hôpital Bichat, Service de Maladies Infectieuses, Site Bichat, Paris, France
| | | | | | | | - Sylvie Le Gac
- AP-HP, Hôpital Bichat, Département d’Epidémiologie Biostatistique et Recherche Clinique, Paris, France
| | - Solaya Chalal
- AP-HP, Hôpital Bichat, Département d’Epidémiologie Biostatistique et Recherche Clinique, Paris, France
| | | | - Vladimir Lazarevic
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | | | | | - Laurence Armand-Lefèvre
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
| | - Jacques Schrenzel
- Laboratoire de Recherche Génomique, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Etienne Ruppé
- AP-HP, Hôpital Bichat, Service de Bactériologie, Paris, France
- INSERM, Université de Paris Cité, IAME, Paris, France
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Rodriguez-Materon S, Trynz S, SanGiovanni TP. Fungal Osteomyelitis due to Phaeoacremonium venezuelense: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00024. [PMID: 36099497 DOI: 10.2106/jbjs.cc.22.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 56-year-old immunosuppressed man presented with pain and swelling in the medial and anterior right foot with accompanied numbness in the second and third toes 1 month after a puncture wound by a Sylvester palm tree thorn. An intraoperative culture/biopsy returned positive for septic arthritis of the naviculocuneiform joint and fungal osteomyelitis of the navicular, medial, and intermediate cuneiforms due to Phaeoacremonium venezuelense. CONCLUSION Fungal osteomyelitis is extremely rare. Only 5 cases by Phaeoacremonium venezuelense have been reported previously in the literature. To the best of our knowledge, this is the first case of osteomyelitis by this strain.
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Affiliation(s)
- Solangel Rodriguez-Materon
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida - Orthopaedic Surgeon. Foot and Ankle Research Fellow, Coral Gables, Florida
| | - Samantha Trynz
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Thomas P SanGiovanni
- Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida - Foot and Ankle Specialist, Orthopedic Surgeon, Coral Gables, Florida
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Unnikrishnan V, Venugopal A, Sivadasan SB, Boniface Fernandez F, Arumugam S, P R HV, Parayanthala Valappil M. Cellular and sub-chronic toxicity of hydroxyapatite porous beads loaded with antibiotic in rabbits, indented for chronic osteomyelitis. Int J Pharm 2022; 616:121535. [PMID: 35124118 DOI: 10.1016/j.ijpharm.2022.121535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/14/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
Bioceramics have emerged as a hopeful remedy for site-specific drug delivery in orthopaedic complications, especially in chronic osteomyelitis. The bioresorbable nature of bioceramic materials shaped them into a versatile class of local antibiotic delivery systems in the treatment of chronic osteomyelitis. Hydroxyapatite (HA) based bioceramics with natural bone mimicking chemical composition are of particular interest due to their excellent biocompatibility, better osteoconductive and osteointegrative properties. Although HA has been widely recognized as an efficient tool for local delivery of antibiotics, information regarding its subchronic systemic toxicity have not been explored yet. Moreover, a detailed investigation of in vivo subchronic systemic toxicity of HA is critical for understanding its biocompatibility and futuristic clinical applications of these materials as novel therapeutic system in its long haul. Evaluation of biocompatibility and sub-chronic systemic toxicity are significant determinants in ensuring biomedical device's long-term functionality and success. Sub-chronic systemic toxicity allows assessing the potential adverse effects caused by leachable and nanosized wear particles from the device materials under permissible human exposure to the distant organs that are not in direct contact with the devices. In this context, the present study evaluates the sub-chronic systemic toxicity of in-house developed Hydroxyapatite porous beads (HAPB), gentamicin-loaded HAPB (HAPB + G) and vancomycin- loaded HAPB (HAPB + V) through 4 and 26-week muscle implantation in New Zealand white rabbits, as per ISO 10993-6 and ISO 10993-11. Analysis of cellular responses of HAPB towards Human Osteosarcoma (HOS) cell line through MTT assay, direct contact cytotoxicity, live/dead assay based on Imaging Flow Cytometry (IFC) showed its non-cytotoxic behaviour. Histopathological analysis of muscle tissue, organs like heart, lungs, liver, kidney, spleen, adrenals, intestine, testes, ovaries, and uterus did not reveal any abnormal biological responses. Our study concludes that the HAPB, gentamicin-loaded HAPB (HAPB + G) and vancomycin-loaded HAPB (HAPB + V) are biocompatible and did not induce sub-chronic systemic toxicity and hence satisfies the criteria for regulatory approval of HAs as a plausible candidate for clinical applications.
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Affiliation(s)
- Vandana Unnikrishnan
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Akhil Venugopal
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Suresh Babu Sivadasan
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Francis Boniface Fernandez
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Sabareeswaran Arumugam
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Harikrishna Varma P R
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - Mohanan Parayanthala Valappil
- Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India.
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Rayens E, Norris KA. Prevalence and Healthcare Burden of Fungal Infections in the United States, 2018. Open Forum Infect Dis 2022; 9:ofab593. [PMID: 35036461 PMCID: PMC8754384 DOI: 10.1093/ofid/ofab593] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background Fungal infections are responsible for >1.5 million deaths globally per year, primarily in those with compromised immune function. This is concerning as the number of immunocompromised patients, especially in those without human immunodeficiency virus (HIV), has risen in the past decade. The purpose of this analysis was to provide the current prevalence and impact of fungal disease in the United States. Methods We analyzed hospital discharge data from the most recent (2018) Healthcare Cost and Utilization Project National Inpatient Sample, and outpatient visit data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Costs are presented in 2018 United States (US) dollars. Results In the 35.5 million inpatient visits documented in 2018 in the US, approximately 666 235 fungal infections were diagnosed, with an estimated attributable cost of $6.7 billion. Aspergillus, Pneumocystis, and Candida infections accounted for 76.3% of fungal infections diagnosed, and 81.1% of associated costs. Most fungal disease occurred in patients with elevated risk of infection. The visit costs, lengths of stay, and risks of mortality in this population were more than twice that of those without fungal diagnoses. A further 6.6 million fungal infections were diagnosed during outpatient visits. Conclusions Fungal disease is a serious clinical concern with substantial healthcare costs and significant increases in morbidity and mortality, particularly among predisposed patients. Increased surveillance, standardized treatment guidelines, and improvement in diagnostics and therapeutics are needed to support the rising numbers of at-risk patients.
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Affiliation(s)
- Emily Rayens
- Center for Vaccines and Immunology, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Karen A Norris
- Center for Vaccines and Immunology, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Royle LN, Muthee BW, Rosenbaum DG. Inflammatory conditions of the pediatric hand and non-inflammatory mimics. Pediatr Radiol 2022; 52:104-121. [PMID: 34415360 DOI: 10.1007/s00247-021-05162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.
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Affiliation(s)
- Leanne N Royle
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Bernadette W Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
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Palasseril AS, Gopinath SV, Thanikachalam R, Prabhu SA, Rajamanoharan V, Shahul MR. "Debaryomyces subglobosus" - Management of a rare case of fungal septic arthritis post arthroscopic rotator cuff repair - a case report. SICOT J 2021; 7:60. [PMID: 34851263 PMCID: PMC8634897 DOI: 10.1051/sicotj/2021057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Fungal septic arthritis of the shoulder is extremely rare in post arthroscopic rotator cuff repair patients. We report our experience in successfully identifying and managing a rare case of fungal septic arthritis with Debaryomyces subglobosus in an uncontrolled diabetic patient who underwent arthroscopic rotator cuff repair in 2019. Our patient had complete resolution of symptoms and a reasonable functional recovery within 2 months of debridement and initiation of the specific anti-fungal. This case highlights the importance of high clinical suspicion for atypical fungal infections, and the use of culture-independent modern diagnostic tools like DNA-PCR as adjuncts to successfully identify rare pathogens in immunodeficient patients presenting with vague, nonspecific symptoms of infection.
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Affiliation(s)
| | | | | | - Sanjoo Anto Prabhu
- Department of Orthopaedics, Parvathy Ortho Hospital, Chennai 600044, India
| | - Vivek Rajamanoharan
- Department of Plastic Surgery, Parvathy Ortho Hospital, Chennai 600044, India
| | - Mymoonah Risha Shahul
- Department of Microbiology, Sree Balaji Medical College & Hospital, Chennai 600044, India
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Rutjanawech S, Mejia-Chew C, Ayres C, Spec A. A Canker Barking at the Wrong Knee: Thyronectria austroamericana Septic Arthritis. Open Forum Infect Dis 2021; 8:ofab381. [PMID: 34458393 PMCID: PMC8387459 DOI: 10.1093/ofid/ofab381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
The mold Thyronectria austroamericana is a plant pathogen that causes canker in honey locust trees. We describe the first case of this mold causing septic arthritis in humans.
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Affiliation(s)
- Sasinuch Rutjanawech
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Chapelle Ayres
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Ruckle DE, Rajfer R, Johnson JP. Diffuse Recalcitrant Osteomyelitis and Joint Septicemia Because of Bowel Perforation Secondary to Gunshot Injury: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00096. [PMID: 34101666 DOI: 10.2106/jbjs.cc.20.00689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A previously healthy 22-year-old man was brought into the emergency department after sustaining a low-velocity, civilian gunshot wound to the abdomen that perforated the bowel. Over the next 300 days, he would be admitted and discharged multiple times, requiring a total of 48 debridements, 23 different antimicrobials in 81 unique combinations, and had 18 different microbes cultured from various sites in bone, joint, and blood. Multiorganism bacteremia and fungemia culminated in above-knee amputation because of progression of infection, all in a nonimmunocompromised host. CONCLUSION Despite following clinical guidelines, patients can still fail evidence-based treatment algorithms. A humbling reminder is that medicine is never one-size-fits-all.
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Affiliation(s)
- David E Ruckle
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, California
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Candida Albicans Osteomyelitis after Chest Wall Blunt Trauma: A Case Report. Case Rep Surg 2021; 2021:9987317. [PMID: 34188968 PMCID: PMC8192213 DOI: 10.1155/2021/9987317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Fungal osteomyelitis is a rare disease that can occur in immunocompromised patients. We report a case of a patient with a primary rib osteomyelitis after a blunt trauma of the chest wall. Aggressive surgical debridement along with antifungal therapy was the cornerstone of the disease management in this patient.
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Tanner MC, Heller RA, Grimm A, Zimmermann S, Pilz M, Jurytko L, Miska M, Helbig L, Schmidmaier G, Haubruck P. The Influence of an Occult Infection on the Outcome of Autologous Bone Grafting During Surgical Bone Reconstruction: A Large Single-Center Case-Control Study. J Inflamm Res 2021; 14:995-1005. [PMID: 33790615 PMCID: PMC7997588 DOI: 10.2147/jir.s297329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Occult infections (OI) lack typical inflammatory signs, making them challenging to diagnose. Uncertainty remains regarding OI’s influence on the outcome of autologous bone grafting (ABG), and evidence-based recommendations regarding an appropriate course of action are missing. Thus, we sought to determine the incidence of an OI in patients receiving ABG, evaluate whether it influences the outcome of ABG and whether associated risk factors have a further negative influence. Methods This study was designed as a large size single-center case-control study investigating patients treated between 01/01/2010 and 31/12/2016 with a minimum follow-up of 12 months. Patients ≥18 years presenting with a recalcitrant non-union of the lower limb receiving surgical bone reconstruction, including bone grafting, were included. A total of 625 patients were recruited, and 509 patients included in the current study. All patients received surgical non-union therapy based on the “diamond concept” including bone reconstruction using ABG. Additionally, multiple tissue samples were harvested and microbiologically analyzed. Tissue samples were microbiologically evaluated regarding an OI. Bone healing was analyzed using clinical and radiological parameters, patient characteristics and comorbidities investigated and ultimately results correlated. Results Forty-six out of 509 cases with OI resulted in an incidence of 9.04%. Overall consolidation time was increased by 15.08 weeks and radiological outcome slightly impaired (79.38% vs 71.42%), differences were at a non-significant extent. Diabetes mellitus had a significant negative influence on consolidation time (p=0.0313), while age (p=0.0339), smoking status (p=0.0337), diabetes mellitus (p=0.0400) and increased BMI (p=0.0315) showed a significant negative influence on the outcome of bone grafting. Conclusion Surgeons treating recalcitrant non-unions should be aware that an OI is common. If an OI is diagnosed subsequent to ABG the majority of patients does not need immediate revision surgery. However, special attention needs to be paid to high-risk patients.
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Affiliation(s)
- Michael C Tanner
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Raban Arved Heller
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany.,Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität Zu Berlin, Berlin Institute of Health, Berlin, D-13353, Germany.,Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Andreas Grimm
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Stefan Zimmermann
- Division Bacteriology, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Louisa Jurytko
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Matthias Miska
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Lars Helbig
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Gerhard Schmidmaier
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany
| | - Patrick Haubruck
- HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany.,Raymond Purves Bone and Joint Research Laboratory, Institute of Bone and Joint Research, Kolling Institute, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, A-2068, Australia
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Di Pietro GM, Borzani IM, Aleo S, Bosis S, Marchisio P, Tagliabue C. Pediatric Septic Arthritis of the Knee Due to a Multi-Sensitive Streptococcus pyogenes Strain Responsive to Clindamycin-A Case Report. CHILDREN-BASEL 2021; 8:children8030189. [PMID: 33802408 PMCID: PMC8001213 DOI: 10.3390/children8030189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022]
Abstract
Septic arthritis is an inflammatory process usually generated by a bacterial infection. The knee is one of the most frequently involved joints. The etiology varies depending on age, and hematogenous spread remains the primary cause in children. Herein, we report a case of a previously healthy three-year-old female who was referred to our institution for acute swelling of her right knee. After a clinical and radiological diagnosis of septic arthritis, an empirical treatment with a combination of cefotaxime and clindamycin was initiated. The isolation of a multi-sensitive Streptococcus pyogenes strain from the joint’s effusion prompted the discontinuation of clindamycin and the usage of cefotaxime alone. One week later, an ultrasound was executed due to worsening in the patient’s clinical conditions, and an organized corpuscular intra-articular effusion with diffuse synovial thickening was revealed. Cefotaxime was therefore replaced with clindamycin, which improved the symptoms. Despite the antibiotic sensitivity test having revealed a microorganism with sensitivity to both cephalosporin and clindamycin, clinical resistance to cefotaxime was encountered and a shift in the antimicrobial treatment was necessary to ensure a full recovery. This case study confirms that an antibiotic regimen based solely on a susceptibility test may be ineffective for such cases.
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Affiliation(s)
- Giada Maria Di Pietro
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Correspondence:
| | - Irene Maria Borzani
- Radiology Unit, Pediatric Division, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Sebastiano Aleo
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Samantha Bosis
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Claudia Tagliabue
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
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47
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Cain KS, Shetty AK, Strowd L, Sangueza O, Potisek NM. Unremitting Pain and Fever in a 15-Year-Old Boy With Osteomyelitis. Pediatrics 2021; 147:e2020012260. [PMID: 33563770 DOI: 10.1542/peds.2020-012260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.
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Affiliation(s)
- Kathryn S Cain
- Departments of Pediatrics
- Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and
| | - Avinash K Shetty
- Departments of Pediatrics
- Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and
| | | | - Omar Sangueza
- Dermatology, and
- Pathology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Nicholas M Potisek
- Departments of Pediatrics,
- Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and
- Department of Pediatrics, Prisma Health Children's Hospital and School of Medicine, University of South Carolina, Greenville, South Carolina
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Alraiyes T, Petis S, Drosdowech D, LeBel ME. Chronic, persistent fungal shoulder arthropathy secondary to genetic mutation: a case report. J Shoulder Elbow Surg 2021; 30:e69-e75. [PMID: 33010436 DOI: 10.1016/j.jse.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Thamer Alraiyes
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Stephen Petis
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Darren Drosdowech
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Marie-Eve LeBel
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada.
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49
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Huang H, Pan J, Yang W, Lin J, Han Y, Lan K, Zeng L, Liang G, Liu J. First case report of Cryptococcus laurentii knee infection in a previously healthy patient. BMC Infect Dis 2020; 20:681. [PMID: 32943003 PMCID: PMC7500548 DOI: 10.1186/s12879-020-05401-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.
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Affiliation(s)
- Hetao Huang
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianke Pan
- Department of Sports Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Weiyi Yang
- Department of Sports Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jiongtong Lin
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanhong Han
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kai Lan
- Department of Clinical Laboratory, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lingfeng Zeng
- Department of Sports Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guihong Liang
- Department of Sports Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jun Liu
- Department of Sports Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
- Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
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50
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Chung SL, Papanikitas J, Johnstone D, McKean D. Septic arthritis caused by Candida albicans: post intra-articular steroid injection in a native joint. BMJ Case Rep 2020; 13:13/8/e233841. [PMID: 32843447 DOI: 10.1136/bcr-2019-233841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intra-articular steroid injections are widely prescribed for management of osteoarthritis when oral medication or physiotherapy treatment fails to relieve patient's pain. Septic arthritis is an uncommon side effect of steroid injection. Common causal micro-organisms are bacterial with Staphylococcus aureus being the most frequent. Fungal septic arthritis is rare and does not usually present beyond the neonatal period. We present a rare case of septic arthritis secondary to fungal infection.
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Affiliation(s)
- Siok Li Chung
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - David Johnstone
- Orthopaedic, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - David McKean
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
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