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Aspergillosis of bones and joints - a review from 2002 until today
Philipp Koehler1, Daniela Tacke, Oliver A Cornely
11st Department of Internal Medicine, University Hospital of Cologne, Zentrum für Klinische Studien (BMBF 01KN1106), CECAD - Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany.
Abstract:
Poor clinical outcome and complicated neurological complications illustrate the severity of bone and joint infections with Aspergillus species. Host predisposing conditions are immunosuppression, intravenous drug use, a variety of chronic underlying diseases and prior surgical interventions. Nosocomial infections may originate from contaminated air ventilation systems or water pipes. Most common causative pathogen is Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus nidulans. A. niger, A. tubingensis and A. terreus are rare but stress the need of targeted and adapted antimycotic therapy. Diagnosis has to be pursued by means of MRI imaging techniques and tissue specimens. Multimodal treatment strategy is based on a combination of surgical debridement of necrotic bone and cartilage and systemically active antifungal treatment. Voriconazole combines satisfactory systemic antifungal effect, high oral bioavailability and good bone penetration. Development of fungicidal cement spacers still continues and in vitro data show promising results of bioactive cements. Purpose of this review of literature published between 2002 and 2013 was to provide up-to-date information on pathogenesis, diagnostic approach and treatment recommendations. Properly established treatment guidelines and prophylaxis for patients at risk are required as the high mortality rate continues to pose a future challenge.
Insights
Aspergillus bone and joint infections cause severe outcomes, often in immunocompromised patients. Early diagnosis via MRI and tissue samples, combined with surgery and antifungal drugs like voriconazole, is crucial for effective treatment.
Area of Science:
- Mycology
- Infectious Diseases
- Orthopedics
Background:
- Bone and joint infections caused by Aspergillus species present significant clinical challenges, including poor outcomes and neurological complications.
- Predisposing factors include immunosuppression, intravenous drug use, chronic diseases, and prior surgeries. Nosocomial infections can arise from contaminated environmental sources.
- Aspergillus fumigatus is the most common pathogen, with other species like A. flavus, A. nidulans, A. niger, A. tubingensis, and A. terreus also implicated, necessitating tailored antifungal therapies.
Purpose of the Study:
- To provide an updated review of literature from 2002-2013 on Aspergillus bone and joint infections.
- To summarize current knowledge on pathogenesis, diagnostic approaches, and treatment recommendations.
- To highlight the need for established treatment guidelines and prophylaxis strategies.
Main Methods:
- Literature review of scientific articles published between 2002 and 2013.
- Analysis of diagnostic methods, including MRI imaging and tissue specimen analysis.
- Evaluation of treatment strategies, encompassing surgical debridement and systemic antifungal therapy.
Main Results:
- Multimodal treatment involving surgical debridement and systemic antifungals is the standard approach.
- Voriconazole demonstrates efficacy due to its systemic effect, oral bioavailability, and bone penetration.
- Ongoing research into fungicidal cement spacers shows promising in vitro results for bioactive cements.
Conclusions:
- Aspergillus bone and joint infections require a comprehensive diagnostic and therapeutic approach.
- Effective management necessitates a combination of surgical intervention and appropriate systemic antifungal treatment.
- Further development of treatment guidelines and prophylaxis is essential to address the high mortality associated with these infections.
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