Mycobacterial and fungal infections of bone and joints

The number of cases of tuberculous bone or joint infection reported annually in the United States has been rising, but it decreased slightly in 1993. Management of skeletal tuberculosis is a complex and evolving issue that requires knowledge of the treatment of drug-resistant organisms. Nontuberculous mycobacteria also may cause skeletal infections, which are often located in tenosynovium or osteoarticular components of the hand or wrist but may occur at other skeletal sites, particularly when there is underlying immunosuppression. Identification of the organism and determination of its drug sensitivities are crucial for providing optimal therapy. Fungal infections of bone or joint can be difficult to treat, but the availability of fluconazole and itraconazole has extended our therapeutic options for some mycoses.