title: Bone and joint infections by Mucorales, Scedosporium, Fusarium and even rarer fungi.
abstract: Mucorales, Scedosporium and Fusarium species are rarely considered as cause for bone and joint infections. However, these moulds are emerging as important fungal pathogens in immunocompromised and immunocompetent patients. Typical pre-disposing host conditions are immunosuppression and diabetes. Most common causative pathogens are Mucorales followed by Scedosporium and Fusarium. Acremonium and Phialemonium species are rare but some case reports exist. MRI is the gold standard imaging technique. Tissue specimens obtained as aspirates, imaging guided biopsy or open surgery need mycological and histopathological work-up for genus and species identification. Multimodal treatment strategies combine surgical debridement, drainage of joints or abscesses, removal of infected prosthetic joints and systemic antifungals. The treatment of mucormycosis is polyene based and may be combined with either posaconazole or - in rare cases - caspofungin. As Scedosporium species are intrinsically resistant to polyenes and azoles show absence of in vitro activity, voriconazole plus synergistic treatment regimens become the therapeutic standard. In fusariosis, fungal susceptibility is virtually impossible to predict, so that combination treatment of voriconazole and lipid-based amphotericin B should be the first-line strategy while susceptibility results are pending. In the absence of randomized controlled trials, infections due to the above moulds should be registered, e.g. in the registries of the European Confederation of Medical Mycology (ECMM).
authors.affiliation: a Department I of Internal Medicine , University Hospital of Cologne , Cologne , Germany .|b Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne , Cologne , Germany .|c Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne , Cologne , Germany .
authors.forename: Philipp
authors.initials: P
authors.lastname: Koehler
authors.affiliation: a Department I of Internal Medicine , University Hospital of Cologne , Cologne , Germany .|b Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne , Cologne , Germany .
authors.forename: Daniela
authors.initials: D
authors.lastname: Tacke
authors.affiliation: a Department I of Internal Medicine , University Hospital of Cologne , Cologne , Germany .|b Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne , Cologne , Germany .|c Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne , Cologne , Germany .|d Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Medical Faculty, University of Cologne , Cologne , Germany , and.|e German Centre for Infection Research (DZIF), partner site Bonn-Cologne , Cologne , Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
mesh_terms: D001168:Arthritis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D003952:Diagnostic Imaging; D019468:Disease Management; D060585:Fusariosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005670:Fusarium / Q000502:physiology*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D025202:Molecular Diagnostic Techniques; D009090:Mucorales / Q000502:physiology*; D009091:Mucormycosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D010000:Osteitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D021681:Scedosporium / Q000502:physiology*
keywords: Acremonium species; mucor; osteomyelitis; pseudallescheria; rhizopus