Bone and joint infections caused by mucormycetes: A challenging osteoarticular mycosis of the twenty-first century.

Abstract

Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.

• Authors: Saad J Taj-Aldeen, Maria N Gamaletsou, Blandine Rammaert, Nikolaos V Sipsas, Valerie Zeller, Emmanuel Roilides, Dimitrios P Kontoyiannis, Michael Henry, Vidmantas Petraitis, Brad Moriyama, David W Denning, Olivier Lortholary, Thomas J Walsh, International Osteoarticular Mycoses Consortium
• Journal: Medical mycology (Med Mycol) Vol. 55 Issue 7 Pg. 691-704 (Oct 01 2017) ISSN: 1460-2709 [Electronic] England
• PMID: 28053147 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Antifungal Agents

Topics

• Adolescent
• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Arthritis (diagnosis, epidemiology, pathology, therapy)
• Child
• Child, Preschool
• Debridement
• Early Diagnosis
• Female
• Humans
• Infant
• Male
• Middle Aged
• Mucorales (isolation & purification)
• Mucormycosis (diagnosis, epidemiology, pathology, therapy)
• Osteomyelitis (diagnosis, epidemiology, pathology, therapy)
• Surgical Wound Infection (diagnosis, epidemiology, pathology, therapy)
• Wounds and Injuries (complications)
• Young Adult