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

Abstract

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.

Diagnostic difficulty identifying Apophysomyces trapeziformis septic arthritis in a patient with multiple myeloma

“…Only five of those cases were caused by mucoraceous moulds. Of the 28 cases, only two were classified as septic arthritis (Kumashi et al , 2006). There have been a few case reports of mucoraceous mould causing septic arthritis.…”

The role of surgical debridement in different clinical manifestations of invasive aspergillosis

“…Drainage should be performed to gain synovial fluid for diagnostic methods. While debridement and drainage are indicated in Aspergillus arthritis, joint replacement can only be recommended in selected cases . Steinfeld et al .…”

“…While debridement and drainage are indicated in Aspergillus arthritis, joint replacement can only be recommended in selected cases. [92][93][94][94][95][96][97][98][99][100] Steinfeld et al [99] reported of two cases of Aspergillus arthritis of the knee that were managed by surgical intervention after the poor response to antifungal therapy alone. Arthroscopic debridement with a motorised shaver was performed and both patients showed good response.…”

Aspergillus vertebral osteomyelitis and ureteral obstruction after liver transplantation

“…Fungi reported as causative agents of osteomyelitis include Candida species, Aspergillus species, Cryptococcus species , Fusarium species , Pseudallescheria boydii, Zygomycetes , and endemic dimorphic fungi, including Histoplasma capsulatum, Blastomyces dermatitidis , and Coccidioides species (1). Aspergillus osteomyelitis has been noted as a result of dissemination in solid organ transplant recipients.…”