title: Bone and joint infections caused by mucormycetes: A challenging osteoarticular mycosis of the twenty-first century.
abstract: Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.
authors.affiliation: Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.|Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Weill Cornell Medicine, Doha, Qatar.
authors.forename: Saad J
authors.initials: SJ
authors.lastname: Taj-Aldeen
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA.|The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Gamaletsou
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA.|The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK.|National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Sipsas
authors.affiliation: Osteoarticular Reference Center, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Zeller
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University, School of Health Sciences, and Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Henry
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA.
authors.forename: Vidmantas
authors.initials: V
authors.lastname: Petraitis
authors.affiliation: Department of Pharmacy, NIH Clinical Center, Bethesda, MD, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Moriyama
authors.affiliation: The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|Université Paris-Descartes, Sorbonne Paris Cité, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, Paris, France.|Institut Pasteur, Mycology Molecular Unit, Paris, France.|Departments of Pediatrics, and Microbiology and Immunology, Weill Cornell Medical Center of Cornell University, New York, NY, USA.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Center for Osteoarticular Mycoses, Hospital for special Surgery, New York, NY, USA.|International Osteoarticular Mycoses Study Consortium, New York, NY, USA and Paris, France.|Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical Center of Cornell University, New York, NY, USA.|Departments of Pediatrics, and Microbiology and Immunology, Weill Cornell Medical Center of Cornell University, New York, NY, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001168:Arthritis / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D010019:Osteomyelitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Mucormycosis; amphotericin B; arthritis; bone infections; osteomyelitis; treatment