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[Fungal osteoarthritis]
Abstract:
Two large groups of bone and joint mycoses should be recognised: fungal osteoarthritis due to blood spread and osteoarthritis due to traumatic inoculation. The authors report data in the literature and the experience of the Mycology unit of the Pasteur Institute. In the first group, one may recognise a category of cosmopolitan, opportunist fungi (Candida, cryptococcus) becoming grafted on a background of iatrogenic factors, in particular, Candida albicans arthritis of the newborn (2 new cases have been added to 12 already described in the literature) and osteoarthritis (17 cases) and candida spondylodiscitis (1 recent case out of 8 described in the literature). Out of 39 cases of cryptococcosis at various levels, in 7 cases we observed bony localisations in recent years. Another category consisted of mycoses due to dimorphic exotic fungi in the first place, african histoplasmosis due to H. Duboisii (73 cases of osteitis out of 179). The group of osteoarthritis by traumatic inoculation consists mainly of fungal mycetomas and actinomycoses, occasionally sporotrichosis; recently we have observed for the first time in the literature an arthritis due to a black fungus similar to Beauveria sp. The immunological reactions (immunoelectrophoresis) may be useful for the diagnosis and assessment of the efficacy of treatment. Present treatment is based on the routine use of antifungal agents: e.g. amphotericin B, 5-fluorocytosine, imidazole derivatives (Ketoconazole) according to the sensitivity of the fungi.
Insights
Bone and joint fungal infections (mycoses) are categorized into those from blood spread and traumatic inoculation. Opportunistic fungi like Candida and Cryptococcus, and exotic fungi such as Histoplasma, cause these infections, requiring targeted antifungal treatments.
Area of Science:
- Mycology
- Infectious Diseases
- Rheumatology
Context:
- Bone and joint mycoses present diagnostic and therapeutic challenges.
- Understanding the routes of fungal infection is crucial for effective management.
- The Pasteur Institute's Mycology unit contributes significant clinical experience.
Purpose:
- To classify bone and joint mycoses into two main groups: hematogenous spread and traumatic inoculation.
- To review the literature and present clinical experience with various fungal pathogens affecting bones and joints.
- To highlight the role of immunological reactions and current antifungal therapies.
Summary:
- Fungal osteoarthritis can arise from bloodstream infections (e.g., Candida, Cryptococcus) or direct inoculation (e.g., mycetomas, actinomycoses).
- Specific examples include Candida albicans arthritis in newborns, cryptococcosis with bone involvement, and African histoplasmosis.
- Traumatic inoculation can lead to fungal mycetomas, actinomycoses, sporotrichosis, and rare cases like Beauveria sp. arthritis.
- Immunoelectrophoresis aids diagnosis and treatment monitoring.
- Antifungal agents such as amphotericin B, 5-fluorocytosine, and ketoconazole are standard treatments.
Impact:
- Provides a framework for understanding and diagnosing diverse fungal bone and joint infections.
- Emphasizes the importance of considering fungal etiologies in bone and joint pathology.
- Informs clinical practice regarding diagnostic tools and therapeutic strategies for mycoses affecting the musculoskeletal system.