Dimorphic fungal osteoarticular infections.

Area of Science:

• Mycology
• Infectious Diseases
• Rheumatology

Background:

• Osteoarticular infections caused by dimorphic fungi are rare but can lead to significant morbidity.
• Understanding their clinical spectrum, diagnosis, and management is crucial for patient outcomes.

Purpose of the Study:

• To review the clinical manifestations, management strategies, and outcomes of osteoarticular infections caused by dimorphic fungi.
• To analyze factors influencing diagnosis, treatment, and prognosis in a large cohort of patients.

Main Methods:

• Exhaustive literature review of bone and joint infections caused by dimorphic fungi (1970-2012).
• Analysis of 222 evaluable cases, including underlying conditions, microbiological and histological data, clinical presentation, therapy, and outcomes.
• Evaluation of diagnostic methods, time to diagnosis, and adherence to Infectious Diseases Society of America (IDSA) guidelines.

Main Results:

• Dimorphic osteoarticular infections predominantly affect immunocompetent patients (73%).
• Sporothrix schenckii was the most common pathogen, followed by Coccidioides immitis and Blastomyces dermatitidis.
• Disseminated disease occurred in 55% of cases, with arthritis (58%) and osteomyelitis (42%) being common. Median diagnostic time was 175 days.
• Successful initial medical strategy was observed in 84% of cases, with an overall mortality of 6% (highest for Penicillium marneffei at 38.5%).

Conclusions:

• Dimorphic osteoarticular infections present distinct clinical features and frequently occur in immunocompetent individuals, often during disseminated disease.
• Diagnosis can be delayed, and management typically requires systemic antifungal agents, often in conjunction with surgical intervention.
• Adherence to IDSA guidelines contributes to successful treatment outcomes, though mortality varies significantly by fungal species.