As a Rare Site of Invasive Fungal Infection, Chronic Granulomatous Aspergillus Synovitis: A Case Report

Ayhan, Aylin Canbolat; Özkan, Korhan; Timur, Çetin; Aktaş, Birol; Ceyran, Ayse Bahar

doi:10.4084/mjhid.2013.043

Cited by 3 publications

(2 citation statements)

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“…Typically, in the chronic phase of a fungal infection, the number of polymorphonuclear leukocytes do not increase and the granuloma is the main histopathological manifestation ( 23 ). In the present study, the polymorphonuclear leukocyte count was normal in three of the cases in which the pathogen was a fungus only, which is consistent with previous reports ( 21 , 22 ). Therefore, it is not possible to exclude the diagnosis of fungal PJI if the histological frozen tissue section or permanent tissue section has a normal polymorphonuclear leukocyte count.…”

Section: Discussionsupporting

confidence: 93%

“…The infection site included meninges, epidural, peripheral joint and injection site and the histopathological features included suppurative and granulomatous meningitis and vasculitis. Ayhan et al ( 22 ) reported the incidence of chronic granulomatous Aspergillus synovitis in a 5-year-old girl with acute lymphoblastic leukemia undergoing chemotherapy, in which the main histopathological characteristic was a chronic granuloma. Typically, in the chronic phase of a fungal infection, the number of polymorphonuclear leukocytes do not increase and the granuloma is the main histopathological manifestation ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

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Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases

Geng

et al. 2016

Experimental and Therapeutic Medicine

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Fungal prosthetic joint infections (PJI) and reports of their clinical investigation are rare. In addition, there has been little evidence regarding the outcome of the two-stage exchange protocol for the treatment of fungal PJI. In order to investigate the risk factors and clinical, microbiological and pathological features of fungal PJIs, as well as the effects of the two-stage exchange protocol on their outcome, the present study analyzed eight retrospective fungal PJI cases, involving four cases affecting the hips and four affecting the knees, between May 2000 and March 2012. In all cases, a cemented spacer saturated with antimicrobials was used during the two-stage exchange protocol, and systematic antifungal agents were administrated during the interim period. The average follow-up duration was 4.4 years. Of the eight cases, six had undergone additional surgery on the infected joint prior to infection with the fungus. Following histological analyses, it was determined that the average number of polymorphonuclear cells in the three patients infected with a fungus was only <5/high power field (HPF; magnification, ×400), and that of the five patients with a hybrid infection was >5/HPF. The average Harris Hip scores or Hospital for Special Surgery knee scores were 43.6 preoperatively and 86 at the last follow-up. The two-stage exchange protocol was performed eight times in seven cases, with a failure rate of 12.5%. The remaining case was successfully treated by resection arthroplasty. The average duration of antifungal agent administration during the interim period in five of the eight cases was 1.5 months. For three of the patients, the duration of antifungal agent administration was prolonged until the c-reactive protein levels were decreased to normal. The average duration of spacer implantation into the joint was 4.3 months. The results of the present study suggested that undergoing surgery on a prosthetic joint may be a potential risk factor for the development of fungal PJI. In addition, infiltration of polymorphonuclear leukocytes into the site of the infection may not occur at the same rate as bacterial PJI. Therefore, a two-stage exchange protocol with implantation of a cement spacer saturated with antimicrobials may be considered an effective therapeutic strategy for the treatment of fungal PJI.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases

Geng

et al. 2016

Experimental and Therapeutic Medicine

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Dexamethasone/mercaptopurine/methotrexate

2015

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Aspergillusspp. osteoarticular infections: an updated systematic review on the diagnosis, treatment and outcomes of 186 confirmed cases

et al. 2022

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Background 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. Methods 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. Results 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). Conclusions 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.

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As a Rare Site of Invasive Fungal Infection, Chronic Granulomatous Aspergillus Synovitis: A Case Report

Cited by 3 publications

References 16 publications

Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases

Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases

Dexamethasone/mercaptopurine/methotrexate

Aspergillusspp. osteoarticular infections: an updated systematic review on the diagnosis, treatment and outcomes of 186 confirmed cases

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