title: Osteoarticular Infections Caused by Non-Aspergillus Filamentous Fungi in Adult and Pediatric Patients: A Systematic Review.
abstract: Osteoarticular mycoses due to non-Aspergillus moulds are uncommon and challenging infections. A systematic literature review of non-Aspergillus osteoarticular mycoses was performed using PUBMED and EMBASE databases from 1970 to 2013. Among 145 patients were 111 adults (median age 48.5 [16-92 y]) and 34 pediatric patients (median age 7.5 [3-15 y]); 114 (79.7%) were male and 88 (61.9%) were immunocompromised. Osteomyelitis was due to direct inoculation in 54.5%. Trauma and puncture wounds were more frequent in children (73.5% vs 43.5%; P = 0.001). Prior surgery was more frequent in adults (27.7% vs 5.9%; P = 0.025). Vertebral (23.2%) and craniofacial osteomyelitis (13.1%) with neurological deficits predominated in adults. Lower limb osteomyelitis (47.7%) and knee arthritis (67.8%) were predominantly seen in children. Hyalohyphomycosis represented 64.8% of documented infections with Scedosporium apiospermum (33.1%) and Lomentospora prolificans (15.8%) as the most common causes. Combined antifungal therapy and surgery was used in 69% of cases with overall response in 85.8%. Median duration of therapy was 115 days (range 5-730). When voriconazole was used as single agent for treatment of hyalohyphomycosis and phaeohyphomycosis, an overall response rate was achieved in 94.1% of cases. Non-Aspergillus osteoarticular mycoses occur most frequently in children after injury and in adults after surgery. Accurate early diagnosis and long-course therapy (median 6 mo) with a combined medical-surgical approach may result in favorable outcome.
authors.affiliation: From the Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar (SJT-A); Center for Osteoarticular Mycoses, Hospital for Special Surgery (SJT-A, BR, MG, NVS, ER, AOM, VP, TJW, OL); International Osteoarticular Mycoses Study Consortium, NY (SJT-A, BR, MG, NVS, ER, AOM, VP, TJW, OL); Weill Cornell Medical College, Doha, Qatar (SJT-A); Université Paris-Descartes, Sorbonne Paris Cité, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine (BR, OL); Institut Pasteur, Mycology Molecular Unit, Paris, France (BR, OL); Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University (MG, AOM, VP, TJW); Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center of Cornell University, New York, NY (MG, NVS, TJW); National and Kapodistrian University of Athens, Athens, Greece (MG, NVS); Osteoarticular Reference Center, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France (VZ); Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, Aristotle University, School of Health Sciences, and Hippokration Hospital, Thessaloniki, Greece (ER); and MD Anderson Cancer Center, Houston, TX (DPK).
authors.forename: Saad J
authors.initials: SJ
authors.lastname: Taj-Aldeen
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.forename: Maria
authors.initials: M
authors.lastname: Gamaletsou
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Sipsas
authors.forename: Valerie
authors.initials: V
authors.lastname: Zeller
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Andy O
authors.initials: AO
authors.lastname: Miller
authors.forename: Vidmantas
authors.initials: V
authors.lastname: Petraitis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005658:Fungi / Q000145:classification*; D006801:Humans; D016867:Immunocompromised Host; D007592:Joint Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology*; D011183:Postoperative Complications; D012307:Risk Factors; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult
chemical_list: D000935:Antifungal Agents