title: Osteomyelitis due to Aspergillus spp. in patients with chronic granulomatous disease: comparison of Aspergillus nidulans and Aspergillus fumigatus.
abstract: OBJECTIVE
  Chronic granulomatous disease (CGD) is a rare inherited disorder of NADPH oxidase in which phagocytes fail to generate reactive antimicrobial oxidants. Invasive fungal infections are an important cause of morbidity and mortality in CGD patients, with Aspergillus spp. being the most frequent fungal pathogens. We reviewed the reported cases of osteomyelitis in CGD patients due to Aspergillus nidulans and compared them with those due to Aspergillus fumigatus.
  
  
  METHODS
  Twenty-four cases of osteomyelitis due to Aspergillus spp. in 22 male CGD patients were found in MEDLINE.
  
  
  RESULTS
  Fourteen cases (58%) were due to Aspergillus nidulans and ten cases to Aspergillus fumigatus. No other aspergilli were reported as causes of osteomyelitis. Osteomyelitis due to Aspergillus nidulans was associated with pulmonary infection and involved 'small bones' more frequently than Aspergillus fumigatus osteomyelitis (p=0.032). Half of the CGD patients with Aspergillus nidulans osteomyelitis died compared with none of those with Aspergillus fumigatus osteomyelitis (p=0.019). In both Aspergillus nidulans and Aspergillus fumigatus cases, cure was achieved by prompt antifungal treatment combined with surgery and immunotherapy.
  
  
  CONCLUSIONS
  Aspergillus nidulans causes osteomyelitis in CGD patients relatively frequently compared with Aspergillus fumigatus and may be accompanied by higher mortality. This contrasts with the low frequency with which Aspergillus nidulans causes osteomyelitis in patients with other types of immunodeficiency.
authors.affiliation: 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Konstantinoupoleos 49, GR 54642, Thessaloniki, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Dotis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D001232:Aspergillus fumigatus / Q000472:pathogenicity*; D001233:Aspergillus nidulans / Q000472:pathogenicity*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000150:complications*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy
chemical_list: D000935:Antifungal Agents