Fungal periprosthetic joint infection: Rare but challenging problem

Area of Science:

• Orthopedics
• Infectious Diseases
• Mycology

Background:

• Periprosthetic joint infection (PJI) is a major complication of total joint arthroplasty, predominantly caused by bacteria.
• Fungal PJI, though rare (1-2%), presents significant diagnostic and therapeutic challenges due to slow organism isolation and lack of standardized treatment algorithms.
• Culture-negative PJIs can be attributed to fungal pathogens, complicating diagnosis.

Purpose of the Study:

• To provide an up-to-date review on the diagnosis and treatment of fungal PJI.
• To offer clear guidance for clinicians, researchers, and surgeons managing this complex condition.

Main Methods:

• Review of current literature on fungal PJI diagnosis and treatment.
• Highlighting the role of next-generation sequencing in identifying causative agents in culture-negative cases.
• Summarizing consensus-based treatment strategies, including surgical and pharmacological interventions.

Main Results:

• Fungal PJI diagnosis is often delayed due to traditional culture limitations.
• Next-generation sequencing aids in identifying fungi in culture-negative PJI.
• Two-stage revision surgery is the preferred surgical approach for chronic fungal PJI.
• Prolonged antifungal therapy, combined with antibiotics for potential bacterial superinfections, is essential.

Conclusions:

• Fungal PJI requires a multidisciplinary approach for effective management.
• Early and accurate diagnosis, potentially aided by advanced molecular techniques, is crucial.
• Adherence to established treatment protocols, including surgical intervention and long-term antifungal therapy, improves outcomes.