Articular Aspergillosis: Case Report

Álvarez, Luis; Calvo, Emílio; Abril, Carlos

doi:10.1093/clinids/20.2.457

Cited by 32 publications

(13 citation statements)

References 14 publications

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“…The literature review yields only 12 reported cases of septic arthritis due to A. fumigatus and only one without systemic infection. Two cases in renal transplant recipients have been reported as arthrocentesis and corticosteroid complications 8 …”

Section: Discussionmentioning

confidence: 99%

Invasive aspergillosis with polyarthritis

Mekan¹,

Saeed²,

Khan

2004

Mycoses

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We report a case of septic arthritis of multiple joints in an 18-year-old male caused by Aspergillus fumigatus. His initial presentation was of low-grade fever followed by involvement of both knee and ankle joints. Later, there was also involvement of metacarpophalangeal joints. Diagnosis was based on biopsy and culture of the skin and joint lesions. The symptoms resolved readily under administration of itraconazole. We recommend that clinicians should be alerted of potential fungal etiology in cases of fever and chronic arthritis, which is unresponsive to conventional medical therapy.

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Section: Discussionmentioning

confidence: 99%

Invasive aspergillosis with polyarthritis

Mekan¹,

Saeed²,

Khan

2004

Mycoses

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“…Post‐operative cases of wound infection [87,138,139,141–143,297], peritonitis [297,298] and renal allograft infection [299] have also been described following solid‐organ transplantation. Although not always apparent, it is possible that some of these patients had occult foci from which the Aspergillus may have disseminated [299–325].…”

Section: Literature Reviewmentioning

confidence: 99%

Post-operative aspergillosis

Pasqualotto

Denning

2006

Clinical Microbiology and Infection

160

173

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While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infection have been reported in immunocompetent individuals. The Medline, LILACS and EMBASE databases were searched for descriptions of cases of post-operative aspergillosis, and references from relevant articles and conference abstracts were reviewed. More than 500 cases of post-operative aspergillosis were found. Cardiac surgery (n = 188), ophthalmological surgery (n > 90) and dental surgery (n > 100) were associated with the majority of cases. Other cases involved wound infections (n = 22), bronchial infections (n = 30), mediastinitis (n = 11), pleural aspergillosis (n = 1), infections following orthopaedic surgery (n = 42), vascular prosthetic surgery (n = 22), breast surgery (n = 5), abdominal surgery (n = 10) and neurosurgery (n = 25). In most patients, the source was presumed to be airborne infection during the surgical procedure. Prevention of these infections requires special care of the ventilation system in the operating room. Successful treatment requires rapid diagnosis, surgical debridement and antifungal therapy, often with voriconazole. In order to improve the outcome, better diagnostic methods are needed, particularly for cases of endocarditis and aortitis.

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“…The published literature concerning FOAIs includes a heterogeneous spectrum of diseases with different prognoses [4][5][6]8,9,12,13,[15][16][17][19][20][21][22][23][24], and there is no standard treatment for patients with FOAIs. More specifically, there is no consensus on the optimum dose and duration of antifungal therapy, the value of combination antifungal therapy, or the timing and extent of adjunctive surgery [3,24].…”

Section: Discussionmentioning

confidence: 99%

“…There is a scarcity of literature concerning FOAIs, particularly in patients with cancer; most studies consist of case reports or small case series [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Therefore, the present study sought to define the characteristics of patients with FOAIs who received care at a comprehensive cancer centre during the past 10 years.…”

mentioning

confidence: 99%

Fungal osteoarticular infections in patients treated at a comprehensive cancer centre: a 10-year retrospective review

Kumashi

Safdar

Chamilos

et al. 2006

Clinical Microbiology and Infection

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This study reviewed retrospectively the clinical characteristics of 28 cancer patients with fungal osteoarticular infections (FOAIs) between 1995 and 2005. Most patients (26; 93%) had haematological malignancies (19 had leukaemia); half (14) were allogeneic stem-cell transplant recipients. Twelve patients (43%) had severe neutropenia (< or = 100/mm3) with a mean duration of 65 days (range 10-500 days), and ten (36%) patients had received a significant dose of corticosteroids. Most (19; 68%) FOAIs were caused by contiguous extension, while nine (32%) were associated with haematogenous spread. Pain, joint instability and local drainage were seen in 28 (100%), six (21%), and seven (25%) patients, respectively. Sixteen (57%) patients had symptoms for < 1 month. The sinuses (ten; 36%) and the vertebral spine (six; 21%) were the most common sites involved. Moulds were the predominant pathogens: Aspergillus fumigatus (two); non-fumigatus Aspergillus spp. (eight); non-specified Aspergillus spp. (three); Fusarium spp. (six); Zygomycetes (five); Scedosporium apiospermum (two); and Exserohilum sp. (one). Candida was the causative pathogen in four cases (including two cases of mixed FOAIs). Arthritis and post-operative FOAIs were both uncommon manifestations, occurring in two patients each. All patients received systemic antifungal therapy (combinations in 20 cases), and 19 cases underwent adjunctive surgery. The crude mortality rates (at 12 weeks) were 44% (9/20) in the patients who underwent surgery and antifungal therapy vs. 33% (2/6) in patients who received antifungal therapy alone (p not significant). FOAI is a rare, yet severe, manifestation of localised or systemic mycoses, caused predominantly by moulds, and is seen typically in patients with haematological malignancies.

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Articular Aspergillosis: Case Report

Cited by 32 publications

References 14 publications

Invasive aspergillosis with polyarthritis

Invasive aspergillosis with polyarthritis

Post-operative aspergillosis

Fungal osteoarticular infections in patients treated at a comprehensive cancer centre: a 10-year retrospective review

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