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.

Fungi as causative agents of healthcare-associated infections

“…Zakażenie najczęściej następowało przez bezpośrednie wprowadzenie patogenu, a także rozsiew drogą krwionośną. Wśród czynników etiologicznych dominowały rodzaje Rhizopus i Apophysomyces [45].…”

Two cases of Osteoarticular Mucor menace: A diagnostic and management conundrum

“…Diagnosis of this rare manifestation is challenging in a setting with high burden of tuberculosis, like ours. Biopsy is the mainstay of diagnosis as imaging features are non-specific (4).…”

“…Osteoarticular mucormycosis (excluding extension following rhinosinusitis) is a rare manifestation of this disease. In a systematic review, 34 reported cases were identified between 1978 and 2014 (4). We reported a case of long bone mucormycosis and Mycobacterium abscessus infection recently (5).…”

Successful Treatment of Saksenaea sp. Osteomyelitis by Conservative Surgery and Intradiaphyseal Incorporation of Amphotericin B Cement Beads

“…That review reported a mortality rate of 24% for patients with osteoarticular mucormycosis. However, accurate early diagnosis and long-course therapy with a combined medical-surgical approach may result in favorable outcomes (1). Recent guidelines proposed a multimodal approach for management of posttraumatic Mucorales bone and joint infections, including surgical debridement (to clear margins) (12) and long-term antifungal treatment using Here we report the first successful conservative orthopedic treatment of Saksenaea sp.…”

“…M ucorales osteomyelitis still presents diagnostic and therapeutic challenges and is associated with high mortality rates despite a combined therapeutic strategy involving antifungal treatment and surgery (1). Members of the order Mucorales are present in soil and plant debris and could be responsible for osteoarticular mucormycosis as a consequence of contamination through disrupted cutaneous barriers after traumatic injury (2).…”