Aspergillus Osteomyelitis of the Scapula

Hébert-Seropian, Sarah; Pelet, Stéphane

doi:10.2106/jbjs.cc.19.00343

Cited by 8 publications

(17 citation statements)

References 19 publications

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“…Our institution is a tertiary diagnosis and treatment centre that specializes in the diagnosis, treatment, and research of spinal diseases. The inclusion criteria were as follows: (1) patients with spinal infections with typical imaging characteristics and (2) patients with biopsy-and cultureconfirmed Aspergillus infection. The exclusion criteria were as follows: (1) patients with other types of spinal infections and (2) patients with incomplete clinical data or who were lost to follow-up.…”

Section: Methodsmentioning

confidence: 99%

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Aspergillus spondylitis: case series and literature review

Dai

Wang

Yin

et al. 2020

BMC Musculoskelet Disord

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Background: Spinal fungal infections, especially spinal Aspergillus infections, are rare in the clinic. Here, we introduce the clinical features, diagnosis, treatment, and prognoses of 6 cases of Aspergillus spondylitis. Methods: We retrospectively analysed the complete clinical data of patients with Aspergillus spondylitis treated in our hospital from January 2013 to January 2020. Results: Aspergillus fumigatus was isolated in 4 cases, and Aspergillus spp. and Aspergillus niger were isolated in 1 case each. All six patients reported varying degrees of focal spinal pain; one patient reported radiating pain, one patient experienced bowel dysfunction and numbness in both lower limbs, and three patients had fever symptoms. One case involved the thoracic spine, one case involved the thoracolumbar junction, and 4 cases involved the lumbar spine. Three patients were already in an immunosuppressed state, and three patients entered an immunosuppressed state after spinal surgery. All six patients were successfully cured, and five required surgery. Of the 5 patients who underwent surgical treatment, 2 had spinal cord compression symptoms, and 3 had spinal instability. At the end of follow-up, 1 patient reported left back pain and 1 patient reported left limb numbness. Conclusion: The clinical manifestations of Aspergillus spondylitis are non-specific, and the diagnosis depends on typical imaging findings and microbiological and histopathological examination results. When there is no spinal instability, spinal nerve compression symptoms, or progressive deterioration, antifungal therapy alone may be considered. If spinal instability, spinal nerve compression, or epidural abscess formation is present, surgery combined with antifungal therapy is recommended.

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Section: Methodsmentioning

confidence: 99%

“…Aspergillus is a saprophytic fungus that mainly inhabits soil and plants [1]. Aspergillosis is an opportunistic infection that mainly affects the respiratory tract and can be spread through blood contact [2].…”

Section: Introductionmentioning

confidence: 99%

Aspergillus spondylitis: case series and literature review

Dai

Wang

Yin

et al. 2020

BMC Musculoskelet Disord

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“…Fungal osteoarticular infections represent a severe invasive disease caused by hematogenous dissemination, but also by direct inoculation, or direct extension from a nearby infection focus [ 1 , 2 , 3 ]. Hematogenous spread is the most frequent cause of osseous infection, while direct inoculation is mainly associated with prosthesis implantation or instrumentation.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, they also may more rarely affect immunocompetent patients as well [ 2 ]. The main predisposing factors for fungal osteomyelitis are immunosuppression by disease or medications, substance abuse, presence of an indwelling catheter, parenteral hyperalimentation, diabetes mellitus, long-term use of broad-spectrum antimicrobials, HIV infection, and organ transplantation [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Osseous Infections Caused by Aspergillus Species

et al. 2022

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Background: Osteomyelitis caused by Aspergillus spp. is a severe, but rare, clinical entity. However, clear guidelines regarding the most effective medical management have not yet been established. The present study is a literature review of all such cases, in an effort to elucidate epidemiology, as well as the therapeutic management and the infection’s outcome. Methods: A thorough review of all reports of osteomyelitis of the appendicular and the axial skeleton, without the skull and the spine, caused by Aspergillus spp. was undertaken. Data about demographics, imaging techniques facilitating diagnosis, causative Aspergillus, method of mold isolation, antifungal treatment (AFT), surgical treatment, as well as the infection’s outcome were recorded and evaluated. Results: A total of 63 cases of osseous infection due to Aspergillus spp. were identified. The studied population’s mean age was 37.9 years. The most commonly affected site was the rib cage (36.8%). Most hosts suffered immunosuppressive conditions (76.2%). Regarding imaging methods indicating diagnosis, computer tomography (CT) was performed in most cases (42.9%), followed by plain X-ray (41.3%) and magnetic resonance imaging (MRI) (34.9%). The most frequent isolated mold was Aspergillus fumigatus (49.2%). Cultures and/or histopathology were used for definite diagnosis in all cases, while galactomannan antigen test was additionally used in seven cases (11.1%), polymerase chain reaction (PCR) in four cases (6.3%), and beta-d-glucan testing in three cases (4.8%). Regarding AFT, the preferred antifungal was voriconazole (61.9%). Most patients underwent surgical debridement (63.5%). The outcome was successful in 77.5%. Discussion: Osteomyelitis due to Aspergillus spp. represents a severe infection. The available data suggest that prolonged AFT in combination with surgical debridement is the preferred management of this infection, while identification of the responsible mold is of paramount importance.

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Prednisone/tacrolimus

2021

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Aspergillus Osteomyelitis of the Scapula

Cited by 8 publications

References 19 publications

Aspergillus spondylitis: case series and literature review

Aspergillus spondylitis: case series and literature review

Osseous Infections Caused by Aspergillus Species

Prednisone/tacrolimus

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