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World J Orthop. Feb 18, 2023; 14(2): 55-63
Published online Feb 18, 2023. doi: 10.5312/wjo.v14.i2.55
Fungal arthritis: A challenging clinical entity
Anjali Mishra, Deven Juneja
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
Author contributions: Mishra A and Juneja D performed the writing, prepared the tables, performed data accusation, and reviewed the manuscript.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deven Juneja, DNB, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1 Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: November 19, 2022
Peer-review started: November 19, 2022
First decision: December 13, 2022
Revised: December 22, 2022
Accepted: January 19, 2023
Article in press: January 19, 2023
Published online: February 18, 2023
Processing time: 90 Days and 8.4 Hours
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.

Keywords: Aspergillus; Candida; Fungal arthritis; Invasive fungal infections; Osteomyelitis

Core Tip: Fungal arthritis and osteomyelitis are rare diseases, but their incidence is increasing with the rising prevalence of predisposing factors. Most infections are secondary to Candida spp., especially Candida albicans, but patients rarely develop infections secondary to other fungi, including Aspergillus, Histoplasma, Cryptococcus and Coccidioides. Fungal biomarkers may aid in rapid diagnosis in high-risk patients, but definitive diagnosis requires bone or synovial culture or biopsy. Surgical intervention and prolonged antifungal therapy form the mainstay of therapy, with azoles and echinocandins providing a safe and effective therapeutic option.