title: Osteomyelitis caused by Aspergillus species: a review of 310 reported cases.
abstract: Aspergillus osteomyelitis is a rare infection. We reviewed 310 individual cases reported in the literature from 1936 to 2013. The median age of patients was 43 years (range, 0-86 years), and 59% were males. Comorbidities associated with this infection included chronic granulomatous disease (19%), haematological malignancies (11%), transplantation (11%), diabetes (6%), pulmonary disease (4%), steroid therapy (4%), and human immunodeficiency virus infection (4%). Sites of infection included the spine (49%), base of the skull, paranasal sinuses and jaw (18%), ribs (9%), long bones (9%), sternum (5%), and chest wall (4%). The most common infecting species were Aspergillus fumigatus (55%), Aspergillus flavus (12%), and Aspergillus nidulans (7%). Sixty-two per cent of the individual cases were treated with a combination of an antifungal regimen and surgery. Amphotericin B was the antifungal drug most commonly used, followed by itraconazole and voriconazole. Several combination or sequential therapies were also used experimentally. The overall crude mortality rate was 25%.
authors.affiliation: Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Gabrielli
authors.forename: A W
authors.initials: AW
authors.lastname: Fothergill
authors.forename: L
authors.initials: L
authors.lastname: Brescini
authors.forename: D A
authors.initials: DA
authors.lastname: Sutton
authors.forename: E
authors.initials: E
authors.lastname: Marchionni
authors.forename: E
authors.initials: E
authors.lastname: Orsetti
authors.forename: S
authors.initials: S
authors.lastname: Staffolani
authors.forename: P
authors.initials: P
authors.lastname: Castelli
authors.forename: R
authors.initials: R
authors.lastname: Gesuita
authors.forename: F
authors.initials: F
authors.lastname: Barchiesi
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D001230:Aspergillus / Q000145:classification* / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement; D003710:Demography; D006801:Humans; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents
keywords: Antifungals; aspergillosis; immunosuppressed patients; osteomyelitis; spondylodiscitis