Diagnosis and Management of Fungal Periprosthetic Joint Infections

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Mycology

Background:

• Fungal periprosthetic joint infection (PJI) presents significant diagnostic and therapeutic challenges.
• Immunosuppression, comorbidities, and prior surgeries increase risk.
• Mycotic biofilms complicate infection eradication.

Purpose of the Study:

• To highlight the importance of increased awareness and prompt diagnosis of fungal PJI.
• To outline current surgical and medical management strategies.
• To emphasize the need for standardized guidelines.

Main Methods:

• Review of diagnostic markers including serum and synovial fluid.
• Discussion of surgical options: débridement with antibiotics and implant retention (DAIR), one-stage exchange, prosthetic articulating spacers, and two-stage exchange.
• Emphasis on adjunctive local and systemic antifungal therapy.

Main Results:

• Fungal PJI diagnosis relies on clinical suspicion and laboratory markers.
• DAIR and one-stage revisions may have limited utility due to biofilm formation.
• Thorough irrigation, débridement, and tailored antifungal therapy are essential.

Conclusions:

• A systematic approach is vital for managing fungal PJI.
• Early diagnosis and appropriate antifungal treatment are critical.
• Further research is needed to establish standardized management guidelines.