Osteoarticular Mycoses

Area of Science:

• Mycology
• Infectious Diseases
• Rheumatology

Background:

• Osteoarticular mycoses are chronic, debilitating infections requiring prolonged antifungal therapy and potential surgical intervention.
• A comprehensive review of these complex infections was lacking, necessitating a definitive treatise.

Purpose of the Study:

• To provide a comprehensive review of osteoarticular mycoses, covering their history, epidemiology, pathogenesis, clinical features, diagnostics, treatment, and outcomes.
• To consolidate current knowledge on infections caused by various fungi, including Candida, Aspergillus, Mucorales, and endemic mycoses.

Main Methods:

• Systematic review and synthesis of existing literature on osteoarticular mycoses.
• Analysis of etiological agents, including Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic fungi.

Main Results:

• Identified key fungal culprits: Candida, Aspergillus, Mucorales, dematiaceous fungi, non-Aspergillus molds, and endemic fungi (Histoplasma, Blastomyces, Coccidioides).
• Highlighted differences in dissemination (Candida) and inoculation routes (Aspergillus, molds).
• Emphasized high sensitivity of synovial fluid cultures for Candida and Aspergillus arthritis and the risk of relapse with inadequate therapy.

Conclusions:

• Osteoarticular mycoses encompass a diverse range of fungal infections with varying clinical presentations and management strategies.
• Accurate diagnosis, appropriate antifungal therapy duration, and consideration of host factors are critical for successful outcomes.
• This review serves as a definitive resource for clinicians managing these challenging infections.