Aspergillus fumigatus infection as a delayed manifestation of prosthetic knee arthroplasty and a review of the literature

Abstract

Fungal infection after total joint arthroplasty is a very rare but serious complication and a challenge to the treating and consulting physicians. The literature includes little information about the treatment protocol for Aspergillus infection after total knee arthroplasty, since only 3 cases have been reported. We describe the case of a non-immunocompromised patient who lacked predisposing risk factors and presented with pain and swelling. An aspiration under sterile conditions revealed Aspergillus fumigatus. The patient was treated successfully with a 2-stage exchange reimplantation and 6-week course of liposomal amphotericin B. At 4 y after reimplantation, the patient had no evidence of infection or pain.

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

“…Joint infection can occur as an extension from a focus of Aspergillus osteomyelitis. There are also reported cases of prosthetic joint infections by Aspergillus fumigatus in immunocompetent patients 14,15. It’s thought that in such cases early and delayed infections may be due to organisms introduced at the time of surgery and late infections may occur as a result of hematogenous spread 14,15.…”

“…There are also reported cases of prosthetic joint infections by Aspergillus fumigatus in immunocompetent patients 14,15. It’s thought that in such cases early and delayed infections may be due to organisms introduced at the time of surgery and late infections may occur as a result of hematogenous spread 14,15. Spondylodiskitis is one of the most common type of bone involvement reported in literature 9,16.…”

Prosthetic Joint Infection

“…The individual Candida species may be related to geographic differences, with Candida albicans causing the majority of infections in one multicenter American study (239) and Candida parapsilosis being the most frequently isolated species in a singlecenter experience from Southeast Asia (238). Aspergillus species (239)(240)(241)(242), dimorphic fungi (243,244), pigmented yeast (239), dematiaceous fungi (239), and other filamentous fungi (245) have all been rarely reported in PJIs.…”

“…However, the relative importance of these risk factors compared to those identified in patients with bacterial PJI is unknown. Interestingly, several of the reported cases of Aspergillus PJI have occurred in immunocompetent individuals, unlike pulmonary infection, which occurs more often in immunocompromised subjects (241,242). Fungal PJI typically presents with subacute or chronic pain and joint swelling, with fever being uncommon (239,246,247).…”

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

“…The most common organisms in fungal PJI are Candida species [7]. Aspergillus fumigatus and Aspergillus niger have also been reported in the arthroplasty literature in small numbers [8] but, to the best of our knowledge, there have been none for Aspergillus terreus .…”