Aspergillus PJI - A systematic analysis of all known cases and report of a new one

Fungi resemble less than one percent of all periprosthetic joint infections (PJI). While Candida PJI is well described, Aspergillus PJI has only been reported in a few cases without any systematic analysis present at this point. This review aims to systematically summarize and describe all cases of Aspergillus PJI. The systematic review used PubMed and Cochrane Library to identify case reports and studies eligible for inclusion. One additional case was reported by the authors. T-, Mann-Whitney U- and Fisher-exact tests were used for calculations. Overall, 11 cases of Aspergillus PJI were identified, and ten could be included for a detailed analysis (four hip, four knee, one elbow, one PIP-arthroplasty infection). A. fumigatus was identified in four, A. terreus in three, and A. niger in two cases. The average patient age at time of Aspergillus spp. diagnosis was 64.1 years (32-83) and the mean time from primary implantation to Aspergillus PJI 5.2 years (1-16). The calculated CCI was 2.7 (0-6). Surgery included one-, two-, three-stage-, and spacer-exchange, debridement and resection arthroplasty. Four patients were treated with a triazole for an average of three months, three with amphotericin (mean eight weeks), one with both amphotericin (six weeks) and triazole (seven months). In one patient, reinfection with Coagulase Negative Staphylococci following Aspergillus PJI treatment was noted after four years. A. terreus (p = .048) was associated with failed prosthesis reimplantation (n = 4). To give a resume, Aspergillus PJI is a rare, yet severe complication, with heterogeneous clinical presentation. Complete prosthesis removal is the treatment of choice.