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Osteomyelitis caused by Aspergillus species: a review of 310 reported cases

E Gabrielli1, A W Fothergill, L Brescini

  • 1Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|December 6, 2013
PubMed

Insights

Aspergillus osteomyelitis is a rare fungal bone infection. This review of 310 cases highlights spine involvement and common use of combination antifungal and surgical treatments, with a 25% mortality rate.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Orthopedic Surgery

Background:

  • Aspergillus osteomyelitis is an uncommon but serious invasive fungal infection.
  • Characterized by significant morbidity and mortality, it often affects immunocompromised individuals.

Purpose of the Study:

  • To comprehensively review and analyze reported cases of Aspergillus osteomyelitis.
  • To identify epidemiological features, common sites of infection, causative species, treatment modalities, and outcomes.

Main Methods:

  • Systematic literature review of 310 individual cases of Aspergillus osteomyelitis published between 1936 and 2013.
  • Data extraction included patient demographics, comorbidities, infection sites, fungal species, treatments, and mortality.

Main Results:

  • The median patient age was 43 years, with a male predominance (59%).
  • Common comorbidities included chronic granulomatous disease (19%) and hematological malignancies (11%). The spine was the most frequent site of infection (49%).
  • Aspergillus fumigatus was the most common species (55%). Treatment typically involved combined antifungal therapy (Amphotericin B most common) and surgery (62%). The crude mortality rate was 25%.

Conclusions:

  • Aspergillus osteomyelitis predominantly affects immunocompromised patients, with the spine being the most common site.
  • Combined antifungal and surgical treatment is the standard approach, though mortality remains high.
  • Further research into optimal therapeutic strategies is warranted to improve patient outcomes.
Keywords:
Antifungalsaspergillosisimmunosuppressed patientsosteomyelitisspondylodiscitis

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