Mycobacterial and fungal infections of bone and joints

The incidence of tuberculosis of the bone or joint is increasing. The number of Mycobacterium tuberculosis isolates that are resistant to multiple antibiotics is also on the rise. In response to the changing epidemiology, the approach to treatment of tuberculosis has been considerably modified. Laboratory methodology is improving to facilitate diagnosis and management of this disease. A variety of nontuberculous mycobacteria may also cause disease of skeletal structures. Mycobacterium haemophilum is an emerging pathogen in immunosuppressed patients with a proclivity for infecting bones and joints. The availability of the triazoles has substantially altered the therapeutic approach to fungal infections of bone or joint. Itraconazole can now be considered as therapy of blastomycosis, coccidioidosis, histoplasmosis, or sporotrichosis. Fluconazole is useful in cryptococcal infection, but its role in candida osteoarticular infection remains to be defined.