Treatment of Prosthetic Joint Infections Associated With Coccidioidomycosis

Kuberski, Tim; Ianas, Voichita; Ferguson, T. Bruce; Nomura, Jim; Johnson, Royce H.

doi:10.1097/ipc.0b013e31820fc869

Cited by 10 publications

(8 citation statements)

References 3 publications

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“…2 of 10 patients were excluded in a group of fungal PJI patients because the infected joint was unclear ( Garcia-Oltra et al 2011 ). From 1 study, 4 of 6 patients were excluded, as fungal native joint infection before arthroplasty was proven or strongly suspected ( Kuberski et al 2011 ). 1 article described 10 patients, 6 of which had already been reported ( Phelan et al 2002 ).…”

Section: Methodsmentioning

confidence: 99%

2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections

et al. 2013

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Background and purposeFungal prosthetic joint infections are rare and difficult to treat. This systematic review was conducted to determine outcome and to give treatment recommendations.Patients and methodsAfter an extensive search of the literature, 164 patients treated for fungal hip or knee prosthetic joint infection (PJI) were reviewed. This included 8 patients from our own institutions.ResultsMost patients presented with pain (78%) and swelling (65%). In 68% of the patients, 1 or more risk factors for fungal PJI were found. In 51% of the patients, radiographs showed signs of loosening of the arthroplasty. Candida species were cultured from most patients (88%). In 21% of all patients, fungal culture results were first considered to be contamination. There was co-infection with bacteria in 33% of the patients. For outcome analysis, 119 patients had an adequate follow-up of at least 2 years. Staged revision was the treatment performed most often, with the highest success rate (85%).InterpretationFungal PJI resembles chronic bacterial PJI. For diagnosis, multiple samples and prolonged culturing are essential. Fungal species should be considered to be pathogens. Co-infection with bacteria should be treated with additional antibacterial agents.We found no evidence that 1-stage revision, debridement, antibiotics, irrigation, and retention (DAIR) or antifungal therapy without surgical treatment adequately controls fungal PJI. Thus, staged revision should be the standard treatment for fungal PJI. After resection of the prosthesis, we recommend systemic antifungal treatment for at least 6 weeks—and until there are no clinical signs of infection and blood infection markers have normalized. Then reimplantation can be performed.

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Section: Methodsmentioning

confidence: 99%

2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections

et al. 2013

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“…In review of the radiological findings in each case, it can be noted that preoperative imaging may or may not be useful to rule out alternative diagnoses, as these diseases can mimic common diseases. Advanced imaging techniques including computed tomography, MRI, and positron emission tomography scans can be used to establish a diagnosis but are often nonspecific [1,2,4,6,8].…”

Section: Discussionmentioning

confidence: 99%

“…Given the rarity of total joint infections with coccidioidomycosis, a treatment algorithm has yet to be established. Kuberski et al provided some insight and suggestions based on a case series of 6 patients and a review of the literature [8]. Their review found that a 2-staged revision with a prolonged antifungal regimen is the most appropriate algorithm when the patient is able to tolerate the treatment.…”

Section: Discussionmentioning

confidence: 99%

Coccidioidomycosis in Joint Replacement: A Review of the Literature With Case Presentations

Giordani¹,

Kiernan²,

Giordani³

et al. 2023

Arthroplasty Today

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“…Current literature suggests lifelong azole therapy, if possible, given the high risk of relapse seen in patients who stopped their azole treatment, especially in patients with a periprosthetic joint infection [ 5 , 14 ]. Serial coccidioides complement fixation is a useful tool for monitoring therapeutic response [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Herein, we present a report of a patient with reactivation of Coccidioides immitis knee prosthetic joint infection (PJI) three months after initiation of ibrutinib for CLL/SLL after a 50-year latency period. There are only a few case reports [ 4 , 5 ] regarding reactivation of articular infection; however, none are described with such a prolonged latency period. We further present relevant literature available thus far on the topic and discuss immunologic mechanisms that may be involved in the fungal pathogenesis in such patients.…”

Section: Introductionmentioning

confidence: 99%

Reactivation of Coccidioides immitis in a Prosthetic Knee after Initiation of Chemotherapy

Ciochetto

Georgen

Hadro

et al. 2021

Case Reports in Hematology

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Coccidioides is an endemic fungus in the Southwestern United States and Central and South America. Coccidioidomycosis primary infections are typically of the lung with an asymptomatic or self-limiting course. Some infections disseminate to other parts of the body and a few can remain latent for many years. Reactivation of latent fungal disease can occur following an insult to the host immune system. Here, we describe a case of a 76-year-old Caucasian male patient who moved from California to Wisconsin with a history of coccidioidomycosis infection of the left knee that reactivated decades later in his prosthetic knee shortly after being initiated on ibrutinib (Imbruvica), a Bruton tyrosine kinase (BTK) inhibitor, for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). There have been some case reports regarding coccidioidomycosis infections after initiating ibrutinib therapy but none with a 50 year latency period before reactivation. Readers will learn the immunological effects of ibrutinib on the hosts’ innate and adaptive immunity and its role in putting the host at risk for invasive fungal infections. We also review the literature and data on treatment regimens and recommendations based on current guidelines.

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Treatment of Prosthetic Joint Infections Associated With Coccidioidomycosis

Cited by 10 publications

References 3 publications

2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections

2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections

Coccidioidomycosis in Joint Replacement: A Review of the Literature With Case Presentations

Reactivation of Coccidioides immitis in a Prosthetic Knee after Initiation of Chemotherapy

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