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1
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Kong YX, Kong KO. Fungal arthritis. Best Pract Res Clin Rheumatol 2025:102058. [PMID: 40087103 DOI: 10.1016/j.berh.2025.102058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/02/2025] [Accepted: 03/04/2025] [Indexed: 03/16/2025]
Abstract
Fungal arthritis is a rare infection with a global distribution that affects neonates, the elderly, and immunocompromised individuals, resulting in severe outcomes. It presents a challenge for healthcare professionals due to its rarity, lack of characteristic features, and difficulty isolating and identifying responsible organisms. Studies on their pathophysiology and treatment have been limited, and evidence-based treatment options are lacking. The pathogens infect through direct inoculation, extension from adjacent infective foci, or distant dissemination via the bloodstream. Typically, it manifests as either monoarthritis or oligoarthritis, with the knee joint being the most common target. Systemic disease is often absent, while pulmonary and cutaneous diseases are the most frequent extra-articular manifestations. Diagnosis frequently necessitates the direct visualisation of the organism in specimens and cultures of synovial fluid and membranes. A combination of medical (antifungal) and surgical treatments is often required.
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Affiliation(s)
- Ying Xi Kong
- General Internal Medicine, Perth Royal Infirmary, PH11NX, Scotland, Perth, United Kingdom.
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433, Singapore.
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2
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Ni Mhiochain de Grae M, Davey MS, Hoey C, Kearns S. Coccidiomycosis: ankle septic arthritis with an extended incubation period requiring aggressive multidisciplinary surgical intervention. BMJ Case Rep 2024; 17:e262472. [PMID: 39631906 DOI: 10.1136/bcr-2024-262472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
Coccidiomycosis is a regional disease with global importance, with both an expanding endemic area and population, as well as increasing travel. Although unusual, it should be considered in patients with a travel history to endemic areas, even when immunocompetent and outside the usual incubation period. We present a case of isolated ankle septic arthritis which required an aggressive multidisciplinary surgical approach as well as antibiotic therapy.
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Affiliation(s)
| | - Martin S Davey
- Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
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3
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Tancer S, Ressler A, Miceli MH, Wallace BI. Coccidiomycosis septic arthritis presenting as ankle monoarthritis in a patient with presumed psoriatic arthritis. BMJ Case Rep 2024; 17:e261809. [PMID: 39289033 DOI: 10.1136/bcr-2024-261809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
A man in his 50s with a history of psoriasis was evaluated for acute on chronic left ankle pain. His symptoms were attributed to psoriatic arthritis, and he tried several immunosuppressive regimens without improvement. Further diagnostic workup confirmed Coccidioides immitis/posadasii septic monarthritis thought secondary to a known remote history of Valley fever while residing in Arizona and subsequent reactivation in the setting of immunosuppression. The patient ultimately required prolonged anti-fungal therapy and multiple surgical debridements.Although psoriatic arthritis can present as monarthritis, it is uncommon, with more likely differential considerations including crystal arthropathies, trauma and both typical and atypical infections. Acute monarthritis should always prompt concern for a septic joint, even in a patient with autoimmune disease. The specific history elicited from the patient, including residence in an endemic region, and known prior Coccidioides infection, increased suspicion for Coccidioides and led to the correct diagnosis and management.
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Affiliation(s)
- Stephanie Tancer
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Adam Ressler
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marisa H Miceli
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Beth I Wallace
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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4
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Gonçalves JRR, Tres KE, Narciso LS, Corrêa R, Perez RD. Fungal Osteomyelitis of the Hip with Septic Arthritis: Case Report. Rev Bras Ortop 2024; 59:e49-e51. [PMID: 39027186 PMCID: PMC11254441 DOI: 10.1055/s-0042-1742604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022] Open
Abstract
Fungal osteomyelitis, especially associated with septic arthritis, is uncommon in Brazil; therefore, sometimes it is difficult to diagnose and treat it. We report the case of a young patient, with no immunosuppressive risk factor, with osteomyelitis leading to septic arthritis of the hip. The diagnosis was performed after surgical drainage and visualization of Cryptococcus neoformans at pathological anatomy. Antifungal treatment resulted in complete remission of the symptoms. Since there is no consensus on the treatment of fungal osteomyelitis, this case report aims to inform orthopedists about the importance of hip arthritis differential diagnosis and the good evolution of clinical treatment after drainage and pathogen isolation.
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Affiliation(s)
- João Rodolfo Radtke Gonçalves
- Divisão em Cirurgia do Quadril, Instituto de Ortopedia e Traumatologia, Blumenau, SC, Brasil
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
| | | | | | - Ricardo Corrêa
- Departamento de Ortopedia e Traumatologia, Hospital Santa Isabel (HSI), Blumenau, SC, Brasil
- Departamento de Ortopedia da Universidade Regional Blumenau (FURB), Blumenau, SC, Brasil
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5
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Li Y, Berianu F, Brumble L, Calamia KT. Synovitis due to Histoplasma capsulatum: a case series and literature review. Rheumatol Int 2023; 43:763-769. [PMID: 34164701 DOI: 10.1007/s00296-021-04912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
Musculoskeletal manifestations of Histoplasma capsulatum infection are uncommon but can mimic inflammatory arthritis. Early diagnosis of this complication is of critical importance in the era of potent immunosuppression for rheumatologic diseases. We conducted a retrospective chart review for patients with histoplasmosis and tenosynovitis, synovitis, or arthritis, diagnosed and treated at our institution between January 1, 2000, and December 31, 2019. We also reviewed the relevant literature. Four patients with biopsy-proven, culture-proven histoplasma tenosynovitis were identified at our institution. All four patients had wrist or hand involvement in an asymmetric pattern, and one patient had lower extremity involvement as well. Two patients were not immunocompromised at baseline. One patient underwent a lengthy evaluation and received immunosuppression for 4 years without improvement prior to the diagnosis of histoplasmosis. Histoplasma serologic tests varied among patients with localized infection. Pathologic findings revealed non-caseating granulomatous inflammation. Three patients recovered after 6-12 months of antifungal treatment. One patient still had recurrent infection despite 20 months of treatment. Histoplasma tenosynovitis and synovitis are rare causes of inflammatory arthritis. Infectious causes should be considered and carefully evaluated when patients present with asymmetric oligoarthritis. Early recognition is crucial for successful treatment, especially in patients with concomitant rheumatologic diseases receiving immunosuppressive treatment.
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Affiliation(s)
- Yan Li
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Florentina Berianu
- Division of Rheumatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Lisa Brumble
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Kenneth T Calamia
- Division of Rheumatology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
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6
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Mishra A, Juneja D. Fungal arthritis: A challenging clinical entity. World J Orthop 2023; 14:55-63. [PMID: 36844378 PMCID: PMC9945246 DOI: 10.5312/wjo.v14.i2.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
There has been an increasing incidence of fungal infections in recent years. Rarely joints are also affected by fungal infections. Mainly, these infections develop in prosthetic joints, but sometimes native joints are also involved. Candida infections are mostly reported, but patients may also develop infections secondary to non-Candida fungi, especially Aspergillus. Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy. Despite this, these infections are associated with high morbidity and mortality. This review described the clinical features, risk factors, and therapeutic interventions required to manage fungal arthritis.
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Affiliation(s)
- Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Specialty Hospital, Saket, New Delhi 110017, India
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7
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Yan YY, Peh WCG. Mimics of Synovial Tumors Due to Chronic Infection. MEDICAL RADIOLOGY 2023:241-266. [DOI: 10.1007/174_2023_428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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8
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Hijikata H, Mochizuki T, Tanifuji O, Kawashima H. Analyzing Different Elution Profiles of Echinocandins In Vitro from the Antibiotic-Loaded Bone Cement Comprising Apatite or Polymethylmethacrylate. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Rutjanawech S, Mejia-Chew C, Ayres C, Spec A. A Canker Barking at the Wrong Knee: Thyronectria austroamericana Septic Arthritis. Open Forum Infect Dis 2021; 8:ofab381. [PMID: 34458393 PMCID: PMC8387459 DOI: 10.1093/ofid/ofab381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
The mold Thyronectria austroamericana is a plant pathogen that causes canker in honey locust trees. We describe the first case of this mold causing septic arthritis in humans.
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Affiliation(s)
- Sasinuch Rutjanawech
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Chapelle Ayres
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Andrej Spec
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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10
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Ingegnoli F, Coletto LA, Scotti I, Compagnoni R, Randelli PS, Caporali R. The Crucial Questions on Synovial Biopsy: When, Why, Who, What, Where, and How? Front Med (Lausanne) 2021; 8:705382. [PMID: 34422862 PMCID: PMC8377390 DOI: 10.3389/fmed.2021.705382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
In the majority of joint diseases, changes in the organization of the synovial architecture appear early. Synovial tissue analysis might provide useful information for the diagnosis, especially in atypical and rare joint disorders, and might have a value in case of undifferentiated inflammatory arthritis, by improving disease classification. After patient selection, it is crucial to address the dialogue between the clinician and the pathologist for adequately handling the sample, allowing identifying histological patterns depending on the clinical suspicion. Moreover, synovial tissue analysis gives insight into disease progression helping patient stratification, by working as an actionable and mechanistic biomarker. Finally, it contributes to an understanding of joint disease pathogenesis holding promise for identifying new synovial biomarkers and developing new therapeutic strategies. All of the indications mentioned above are not so far from being investigated in everyday clinical practice in tertiary referral hospitals, thanks to the great feasibility and safety of old and more recent techniques such as ultrasound-guided needle biopsy and needle arthroscopy. Thus, even in rheumatology clinical practice, pathobiology might be a key component in the management and treatment decision-making process. This review aims to examine some essential and crucial points regarding why, when, where, and how to perform a synovial biopsy in clinical practice and research settings and what information you might expect after a proper patient selection.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Isabella Scotti
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
| | - Riccardo Compagnoni
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Pietro Simone Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milano, Italy
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11
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Maniar AR, Bhatnagar N, Mishra A, Vinchurkar K, Jain D. Rare Fungal Infection in Arthritic Knee After Stem Cell Injection Managed by Novel Staged Primary Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00070. [PMID: 33989236 DOI: 10.2106/jbjs.cc.20.00354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 72-year-old man with bilateral knee osteoarthritis treated elsewhere with bilateral intraarticular stem cell injections (SCIs) presented to us 2 months later with signs of infection in his left knee. Aspiration culture grew fungus Penicillium sp. First-stage total knee arthroplasty (TKA) included thorough joint debridement, lavage, standard bone cuts, and insertion of antibiotic-impregnated cement spacer. Second stage included spacer removal and final implantation. At the 1.5-year follow-up, he has a satisfactory clinical outcome without evidence of infection. CONCLUSION As far as we know, this is the first reported case of infective fungal arthritis secondary to intraarticular SCI successfully managed by a staged primary TKA.
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Affiliation(s)
- Adit R Maniar
- Department of Orthopaedics, Joint Replacement Fellow, Lilavati Hospital and Research Centre, Mumbai, India
| | - Nishit Bhatnagar
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Abhinav Mishra
- Department of Orthopaedics, Joint Replacement Fellow, Lilavati Hospital and Research Centre, Mumbai, India
| | - Kshitija Vinchurkar
- Department of Radiology, SRM Medical College and Research Centre, Tamil Nadu, India
| | - Ditesh Jain
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, India
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12
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Nasrawi F, Heidari A, Aljashamy T, Mangat N, Bhaika J, Kaur S, Kuran R, Johnson R. Disseminated Coccidioidomycosis Presenting as Polyarticular Septic Arthritis: A Case Report. J Investig Med High Impact Case Rep 2020; 8:2324709620974894. [PMID: 33238746 PMCID: PMC7705290 DOI: 10.1177/2324709620974894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coccidioidomycosis a fungal infection endemic to southwestern United States. It is caused by inhalation of spores of Coccidioides immitis. Sixty percent of infections are asymptomatic; the remaining 40% are primarily pulmonary disease. In <1% of infections, dissemination can occur. Dissemination usually affects those with impaired cellular immunity and pregnant women, and can involve bones, joints, meninges, and skin. We present the case of a 29-year-old Hispanic male who presented to the emergency department (ED) complaining of pain and swelling of right wrist and ankle as well as left knee for 2 months. He was referred to rheumatology clinic but returned to the ED as he developed spontaneous purulent drainage from his wrist. In the ED, an arthrocentesis of 2 of the joints showed total nucleated cells of 520 000/cm2 and 90 000/cm2 with 61% and 93% neutrophils, respectively. Fungal culture eventually grew Coccidioides immitis from his wrist and knee. Coccidioidomycosis complement fixation titer came back >1:512. Bone scan showed uptake of adjacent bones in the affected joints. Superimposed bacterial infection of the wrist complicated the treatment course and delayed the start of liposomal amphotericin B. Eventually patient received 12 weeks of intravenous liposomal amphotericin-B with slow clinical improvement and then switched to oral isavuconazonium for maintenance therapy. This case shows that although disseminated polyarthritis coccidioidomycosis is very rare, clinicians should keep the diagnosis of disseminated synovial coccidioidomycosis in mind in patients with risk factors.
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13
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Murray T. Tubercular monoarthritis of the glenohumeral joint in a non-endemic region: Vancouver, Canada. BMJ Case Rep 2020; 13:13/11/e239844. [PMID: 33148565 DOI: 10.1136/bcr-2020-239844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tyler Murray
- Department of Internal Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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14
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Ranjit E, Roxborough J, Davis D, Sapra A, Bhandari P. Clavicular Osteomyelitis Secondary to Candida Parapsilosis Infection. Cureus 2020; 12:e8699. [PMID: 32699695 PMCID: PMC7370671 DOI: 10.7759/cureus.8699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Candida parapsilosis osteomyelitis is a rare diagnosis. Candidal infection can occur via hematogenous or local spread. A localized swelling around a bony structure should raise clinical suspicion. Diagnosis is made by a combination of imaging modalities and biopsy. Anecdotal case reports have been reported in medical literature and treatment guidelines are very limited. Treatment modality includes a combination of surgical debridement and antifungal therapy.
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15
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van Egmond JC, Hunfeld NGM, Rijnders BJA, Verhaar JAN. Persistent candida arthritis successfully treated with micafungin instillation and surgery. A case report. Med Mycol Case Rep 2020; 27:29-31. [PMID: 32123657 PMCID: PMC7036544 DOI: 10.1016/j.mmcr.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022] Open
Abstract
We report a rare case of C. krusei knee arthritis treated with instillation of micafungin and arthroscopy. A 49-year-old man hospitalized for treatment of Acute Myeloid Leukemia developed knee arthritis with C. krusei. He was treated with a combination of arthroscopic debridement, intravenous as well as intra-articular micafungin. Serum and intra-articular concentrations of micafungin were determined. After instillation of micafungin in the knee and arthroscopic debridement, the patient completely recovered.
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Affiliation(s)
- Jeroen C van Egmond
- Department of Orthopaedics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Nicole G M Hunfeld
- Department of Pharmacy, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Bart J A Rijnders
- Department of Infectious Diseases, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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16
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[Synovial fluid cytodiagnosis]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 53:100-112. [PMID: 32199591 DOI: 10.1016/j.patol.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/05/2019] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
Synovial fluid samples represent only a very small percentage of routine work in a cytology laboratory. However, its microscopic examination allows us to observe different types of cells, particles and structures that, due to their morphological characteristics, may provide relevant data for cytodiagnosis. We present certain aspects related to arthrocentesis, the relationship between the gross appearance of synovial fluid and certain pathological processes, as well as the different techniques for processing and staining the smears. Furthermore, we describe the main cytological findings in various pathological conditions of the synovial joints, such as infections (bacterial and fungal), non-infectious inflammatory type (osteoarthrosis, rheumatoid arthritis, connective tissue diseases) and tumoral, distinguishing between primary and metastatic, both solid and haematological neoplasms.
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17
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Compton J, Vander Voort W, Willey M, Sekar P. A case of Histoplasma capsulatum variety capsulatum septic arthritis successfully treated with surgery, systemic antifungals, and local amphotericin cement beads. Int J Infect Dis 2018; 77:23-25. [PMID: 30273649 DOI: 10.1016/j.ijid.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022] Open
Abstract
Histoplasma capsulatum variety capsulatum (H. capsulatum) is a thermally dimorphic fungus that is endemic to the Mississippi River and Ohio River valley regions. Of the hundreds of thousands of patients exposed to this fungus, less than 1% develop a severe illness most commonly manifesting as pulmonary disease. Septic arthritis from hematogenous seeding with H. capsulatum or from direct inoculation has been reported only rarely in the literature. The first case of septic arthritis of the shoulder due to H. capsulatum occurring in an immunocompromised patient, treated successfully with irrigation and debridement, systemic antifungals, and local delivery of amphotericin B with cement beads, is reported here. Importantly, the addition of local amphotericin B delivery by cement beads to conventional treatment likely led to clinical cure in this patient.
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Affiliation(s)
- Jocelyn Compton
- Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Michael Willey
- Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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18
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Abstract
Juvenile arthritis with unknown disease etiology is also known as juvenile idiopathic arthritis. Symptoms include joint pain, swelling, and stiffness, and standard treatment involves immunosuppressant medication. Here we present a case of juvenile idiopathic arthritis with severe malnutrition and worsening of symptoms, which restrained a nine-year-old girl to a wheelchair with minimal movement capacity and low energy during standard immunosuppressant therapies over the course of three years. Our innovative Pathogen Blood Test combining cytology-based microscopy and genetic analysis using a pan-fungal primer assay and sequencing identified a systemic fungal infection with Sagenomella species, closely related to Aspergillus, and a soil-dwelling highly pathogenic fungus, which had previously been linked to a fatal veterinary case of arthritis and malnutrition. Our test results encouraged a radical change of the patient's treatment plan, including cessation of the regular immunosuppressants, including steroids, over six months. The patient made a progressive recovery, including complete reversion of the previously swollen and painful joints, development of a good appetite, and return to liveliness. Within the year of change from immunosuppressants to immune-supportive integrative nutritional therapies, including regular intravenous vitamin C, and oral vitamin D, as well as gentle aqua- and physiotherapy, the patient started to gain weight including muscle mass and regained strength and movement in the hands, arms, and legs. She was able to walk again within 18 months. Her mood and energy levels continued to improve and she was able to return to school full-time.
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Affiliation(s)
- Karin Ried
- NIIM Research, National Institute of Integrative Medicine, Melbourne, AUS
| | - Peter Fakler
- NIIM Research, National Institute of Integrative Medicine, Melbourne, AUS
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19
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A rare case of Candida parapsilosis osteomyelitis: a literature review and proposed treatment algorithm. Patient Saf Surg 2017; 11:31. [PMID: 29296122 PMCID: PMC5740595 DOI: 10.1186/s13037-017-0146-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Candida parapsilosis is a rare opportunistic pathogen that can be found in immunosuppressed patients. There are seldom-reported cases of fungal osteomyelitis surrounding orthopedic implants. Case presentation This is a case of chronic Candida parapsilosis osteomyelitis in an immunocompromised patient with a prior open reduction and internal fixation for a closed bimalleolar ankle fracture that went on to neglected wound complications. The patient underwent series of treatments including removal of hardware, serial irrigation and debridements, negative pressure wound therapy, and intravenous antifungal therapy. Our case illustrates the possibility of this rare pathogen involved in orthopedic surgery particularly in immunocompromised hosts. Conclusion Fungal and atypical pathogens should always be considered in such patients or if another diagnosis is not clear. Protracted time to culture specimens should be considered for at least four weeks in such situations. This article outlines a review of the literature and treatment algorithm to guide physicians when managing patients with this rare infection.
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21
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van Weelden M, Viola GR, Kozu KT, Aikawa NE, Ivo CM, Silva CA. Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:479-482. [PMID: 29037320 DOI: 10.1016/j.rbre.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/20/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Marlon van Weelden
- Vrije University, Medical Faculty, Amsterdam, The Netherlands; Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, Brazil
| | - Gabriela R Viola
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia, São Paulo, Brazil
| | - Katia T Kozu
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, Brazil
| | - Nadia E Aikawa
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, Brazil; Universidade de São Paulo, Faculdade de Medicina, Divisão de Reumatologia, São Paulo, Brazil
| | - Claudia M Ivo
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Infectologia Pediátrica, São Paulo, Brazil
| | - Clovis A Silva
- Universidade de São Paulo, Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, Brazil; Universidade de São Paulo, Faculdade de Medicina, Divisão de Reumatologia, São Paulo, Brazil.
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22
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Headley SA, Mota FCD, Lindsay S, de Oliveira LM, Medeiros AA, Pretto-Giordano LG, Saut JPE, Krockenberger M. Cryptococcus neoformans var. grubii-Induced Arthritis with Encephalitic Dissemination in a Dog and Review of Published Literature. Mycopathologia 2016; 181:595-601. [PMID: 27126588 DOI: 10.1007/s11046-016-0009-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/17/2016] [Indexed: 01/12/2023]
Abstract
This article describes the clinical, pathological, and immunohistochemical findings associated with Cryptococcus neoformans var. grubii in a 4-year-old female Boxer dog from Uberlândia, Minas Gerais, Southeastern Brazil. Clinically, there was a swelling at the right metatarsal region and the hock joint with enlargement of regional lymph nodes. Radiographical evaluation revealed lysis of the tarsal bone; cytology demonstrated cryptococcal intralesional organisms at the swollen joint. Despite empirical antifungals therapeutic, the animal developed neurological cryptococcosis and died spontaneously. Significant pathological alterations included arthritis, lymphadenitis, and encephalitic cryptococcomas associated with numerous intralesional narrow-necked budding encapsulated yeasts. Immunohistochemistry utilising monoclonal antibodies that label C. neoformans sp. complex capsule, characterised the yeasts as C. neoformans var. grubii. Collectively, the pathological and immunohistochemical findings of this dog indicate that the intralesional organisms observed within the articular surface of the hock joint, lymph nodes, and the brain were C. neoformans var. grubii, confirming the participation of this fungal pathogen in the development of cryptococcal arthritis. In this case, the most likely pathogenesis was percutaneous inoculation with resultant abscess-like lesion, which resulted in the draining sinus, swelling of the right hind limb with progression to the articular disease. Thereafter, the fungal pathogen probably compromised the adjacent lymph nodes with subsequent haematogenous distribution to the brain, terminating with cryptococcal arthritis, lymphadenitis, and encephalitis.
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Affiliation(s)
- Selwyn Arlington Headley
- Laboratory of Animal Pathology, Department of Veterinary Preventive Medicine, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, PR 445 Km 380, Campus Universitário, PO Box 10.011, Londrina, Paraná, 86057-970, Brazil.
| | - Francisco Claudio D Mota
- Faculty of Veterinary Medicine, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Scott Lindsay
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Sydney, Sydney, Australia
| | - Luiza M de Oliveira
- Laboratory of Mycology, Department of Veterinary Preventive Medicine, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | | | - Lucienne Garcia Pretto-Giordano
- Laboratory of Mycology, Department of Veterinary Preventive Medicine, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - João Paulo Elsen Saut
- Faculty of Veterinary Medicine, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Mark Krockenberger
- Department of Veterinary Pathology, Faculty of Veterinary Science, University of Sydney, Sydney, Australia
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Case report: Eumycetoma and mycotic arthritis of the knee caused by Arthrographis kalrae. J Orthop 2016; 12:S140-4. [PMID: 26719609 DOI: 10.1016/j.jor.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/07/2013] [Indexed: 11/21/2022] Open
Abstract
A 33-year-old male presents following a penetrating injury to his right knee. Clinically he demonstrated pain, an effusion and fevers. At diagnostic arthroscopy, no microbiological growth was cultured. Delayed growth yielded the fungus Arthrographis kalrae. He was treated with a three-stage total knee arthroplasty. The first stage consisted of soft tissue debridement. The second stage involved femoral and tibial osteotomies and insertion of antifungal-impregnated cement spacers. Definitive total knee joint prosthesis were implanted during stage three. At 2 years follow up, he demonstrated a pain free range of motion and has returned to competitive tennis. To the authors' knowledge this is the first report implicating A. kalrae as an invasive pathogen of the knee in an immunocompetent host.
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Abstract
Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.
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Affiliation(s)
- Mukesh Kumar
- Department of Orthopedics, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India,Address for correspondence: Dr. Mukesh Kumar, Department of Orthopedics, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India. E-mail:
| | - Jai Thilak
- Department of Orthopedics, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
| | - Adnan Zahoor
- Department of Orthopedics, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
| | - Arun Jyothi
- Department of Orthopedics, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
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Martirosyan NL, Skoch JM, Zaninovich O, Zoccali C, Galgiani JN, Baaj AA. A paradigm for the evaluation and management of spinal coccidioidomycosis. Surg Neurol Int 2015; 6:107. [PMID: 26167359 PMCID: PMC4483783 DOI: 10.4103/2152-7806.158979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. Methods: The electronic literature search of National Library of Medicine for publications from 1964 to 2014 was performed using the following keywords: Coccidioidomycosis and spine. The search yielded 24 papers. Treatment strategies were summarized into a treatment protocol. Results: A total of 164 cases of spinal coccidioidomycosis were identified, ranging in age from <10 to >80 years. Males (n = 131) and African-Americans (n = 79) were strikingly over-represented. Medical therapy: Once a diagnosis of spinal coccidioidomycosis is established, antifungal therapy should always be started. Antifungal therapy with amphotericin B or azoles like fluconazole. Medical therapy needs to be continued for many years and sometimes indefinitely to reduce disease recurrence or progression. Surgical management is indicated in cases with mechanical instability, neurologic deficit, medically intractable pain, or progression of infection despite antifungal therapy. Conclusions: This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization.
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Affiliation(s)
| | - Jesse M Skoch
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Orel Zaninovich
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Carmine Zoccali
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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Septic arthritis in immunocompetent and immunosuppressed hosts. Best Pract Res Clin Rheumatol 2015; 29:275-89. [PMID: 26362744 DOI: 10.1016/j.berh.2015.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/08/2015] [Indexed: 12/12/2022]
Abstract
Septic arthritis has long been considered an orthopedic emergency. Historically, Neisseria gonorrhoeae and Staphylococcus aureus have been the most common causes of septic arthritis worldwide but in the modern era of biological therapy and extensive use of prosthetic joint replacements, the spectrum of microbiological causes of septic arthritis has widened considerably. There are also new approaches to diagnosis but therapy remains a challenge, with a need for careful consideration of a combined medical and surgical approach in most cases.
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Abstract
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
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Affiliation(s)
- Ashish Jacob Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
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28
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[Septic arthritis in adults]. Z Rheumatol 2015; 73:623-33; quiz 634-5. [PMID: 25115141 DOI: 10.1007/s00393-014-1463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Septic arthritis is a true rheumatological emergency requiring immediate and thoughtful effort for rapid diagnosis establishment and treatment initiation. Children and elderly persons as well as immunocompromised individuals, patients with pre-existing joint damage and with inflammatory rheumatic joint diseases are preferentially affected. Bacteremia, joint surgery and intra-articular injections pose risk situations for the development of joint infections. The most frequent causative organism is Staphylococcus aureus but other relevant pathogens include coagulase-negative staphylococci, streptococci and mycobacteria. Synovial fluid analysis (e.g. appearance, cell count and microbiological examination) is the most important step to establish the diagnosis. The two main components of therapy consist of joint drainage and antibiotic treatment. The approach to periprosthetic joint infections depends on the duration of symptoms, causative organism and individual factors.
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29
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van Weelden M, Viola GR, Kozu KT, Aikawa NE, Ivo CM, Silva CA. [Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 57:S0482-5004(15)00028-5. [PMID: 25802128 DOI: 10.1016/j.rbr.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/06/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systemic histoplasmosis is an invasive fungal infection that may mimic primary vasculitis, particularly granulomatosis with polyangiitis (GPA), and was rarely described in adult patients. We reported an immunocompetent patient with disseminated histoplasmosis mimicking GPA who fulfilled European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) validated classification criteria. CASE REPORT A 6-year old boy presented acute migratory polyarthritis with spontaneous improvement, sinus inflammation, fever, headache and abdominal pain. Serologic test for hepatitis, cytomegalovirus, human immunodeficiency virus, Epstein-Barr virus, toxoplasmosis, dengue virus and antistreptolysin O were all negative. Magnetic resonance imaging (MRI) showed moderate ascites in pelvis and pansinusitis. Antineutrophil cytoplasmic antibodies (c-ANCA) were positive. He had spontaneous remission of the symptoms including fever. At the age of 11 years and 11 months, he had sinusitis, pneumonia and epididymitis. A month later, he was hospitalized and MRI showed left eye proptosis. Cerebrospinal fluid was normal and indirect tests of fungi were negative. Two months later, he had lumbar pain and computer tomography showed a mass in the right kidney and pulmonary nodule in the right lung. He fulfilled EULAR/PRINTO/PRES criteria for GPA, however the renal biopsy showed a focal granulomatous interstitial nephritis with yeast fungal cells compatible with Histoplasma sp. He was treated with liposomal amphotericin B and itraconazole with improvement of signs and symptoms. CONCLUSION We reported a progressive disseminated histoplasmosis case mimicking GPA. Histoplasmosis infection should be considered in immunocompetent subjects with uncommon clinical manifestations, such as arthritis, nephritis and epididymitis.
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Affiliation(s)
- Marlon van Weelden
- Faculdade de Medicina, Universidade de Vrije, Amsterdã, Holanda; Departamento de Pedriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Gabriela R Viola
- Unidade de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Katia T Kozu
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nadia E Aikawa
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Claudia M Ivo
- Unidade de Infectologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Robier C, Stettin M, Neubauer M. Fungal contamination of hyaluronidase solution mimicking fungal joint infection: a preanalytical pitfall in synovial fluid analysis. ACTA ACUST UNITED AC 2015; 53:e231-2. [DOI: 10.1515/cclm-2014-1113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/25/2014] [Indexed: 11/15/2022]
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Imamura H, Iwamoto T, Momohara S. Unusual case of an elbow mass caused by Candida arthritis in a patient with systemic lupus erythematosus. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2014; 19:409-11. [PMID: 25155708 DOI: 10.1142/s0218810414720265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 45-year-old woman with systemic lupus erythematosus presented with a painless bulky mass on her elbow. Joint fluid analysis showed the presence of a yeast-like organism. Surgical debridement was performed and specimens obtained at surgery showed growth of Candida albicans. Although Candida species are an uncommon cause of infectious arthritis, fungal arthritis should be considered in the patient with predisposing factors.
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Affiliation(s)
- Hitoshi Imamura
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
Management of fungal osteomyelitis and fungal septic arthritis is challenging, especially in the setting of immunodeficiency and conditions that require immunosuppression. Because fungal osteomyelitis and fungal septic arthritis are rare conditions, study of their pathophysiology and treatment has been limited. In the literature, evidence-based treatment is lacking and, historically, outcomes have been poor. The most common offending organisms are Candida and Aspergillus, which are widely distributed in humans and soil. However, some fungal pathogens, such as Histoplasma, Blastomyces, Coccidioides, Cryptococcus, and Sporothrix, have more focal areas of endemicity. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. These infections may be difficult to diagnose and eradicate, especially in the setting of total joint arthroplasty. Although there is no clear consensus on treatment, guidelines are available for management of many of these pathogens.
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Vecchiarelli A, Pericolini E, Gabrielli E, Kenno S, Perito S, Cenci E, Monari C. Elucidating the immunological function of the Cryptococcus neoformans capsule. Future Microbiol 2014; 8:1107-16. [PMID: 24020739 DOI: 10.2217/fmb.13.84] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The encapsulated fungal pathogen Cryptococcus neoformans represents a significant agent of life-threatening infections in immunocompromised subjects. A unique characteristic of Cryptococcus species is the presence of a polysaccharide capsule, which is essential for virulence and endows Cryptococcus with potent immunoregulatory properties. This review provides an overview of the immunological properties of the principal components of C. neoformans capsule.
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Affiliation(s)
- Anna Vecchiarelli
- Department of Experimental Medicine, Microbiology Section, University of Perugia, Perugia, 06132, Italy
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Li YC, Calvert G, Hanrahan CJ, Jones KB, Randall RL. Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports. BMC Med Imaging 2014; 14:8. [PMID: 24548622 PMCID: PMC3939934 DOI: 10.1186/1471-2342-14-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 02/14/2014] [Indexed: 11/15/2022] Open
Abstract
Background Coccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms. Case Presentation The first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist’s interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis. Conclusions Though history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging.
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Affiliation(s)
| | | | | | | | - Robert Lor Randall
- Sarcoma Services, Department of Orthopaedics, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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36
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Abstract
Fungal arthritis is an uncommon yet serious disorder in the newborn. Delay in diagnosis and management can lead to significant morbidity. We report our experience with management of two such cases. Two preterm neonates with multifocal arthritis caused by Candida were studied. Diagnosis was made by clinical examination, laboratory investigations, radiological investigations and culture. Both were treated by aspiration, arthrotomy and antifungal therapy. One patient recovered fully from the infection while the other had growth disturbances resulting in limb length inequality at recent followup. Prompt and expeditious evacuation of pus from joints and antifungal therapy is imperative for treatment. Associated osteomyelitis leads to further difficulty in treatment.
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Affiliation(s)
- Saurabh Sharma
- Department of Orthopaedics, Peoples College of Medical Sciences, Bhopal, Madhya Pradesh, India,Address for correspondence: Dr. Saurabh Sharma, E-26, 45 Bungalows, North T. T. Nagar, Near New Market, Bhopal - 462 003, Madhya Pradesh, India. E-mail:
| | - Kapil Gangwal
- Department of Orthopaedics, Santokba Durlabhji Memorial Hospital Cum Research Institute, Jaipur, Rajasthan, India
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37
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[Fungal osteoarticular infection: report of 5 cases]. Med Clin (Barc) 2013; 141:412-4. [PMID: 23566626 DOI: 10.1016/j.medcli.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 11/20/2022]
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38
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Successful management of Candida krusei monoarthritis after allo-SCT. Bone Marrow Transplant 2013; 48:1585-6. [PMID: 23892331 DOI: 10.1038/bmt.2013.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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Rheumatologic manifestations of histoplasmosis: a review. Rheumatol Int 2013; 33:2963-5. [DOI: 10.1007/s00296-013-2816-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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40
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Lu H, Marengo MF, Mihu CN, Garcia-Manero G, Suarez-Almazor ME. Rare case of septic arthritis caused by Candida krusei: case report and literature review. J Rheumatol 2012; 39:1308-9. [PMID: 22661427 DOI: 10.3899/jrheum.111348] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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41
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Ramos Martínez A, Orden Martínez B, Polo Laborda J, García Magallón B, Fernández Castro M, Ortega Sánchez C, Gil Navarro M. Artritis séptica por Scedosporium apiospermum de lenta instauración tras infiltración periarticular. Rev Iberoam Micol 2012; 29:241-4. [DOI: 10.1016/j.riam.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/17/2012] [Accepted: 02/09/2012] [Indexed: 11/16/2022] Open
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42
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El Abd OH, Fusco HN, Gomba L, Lew M, Jenis L. Coccidioidomycosis Infection Presenting With Thoracic Spinal Pain. PM R 2012; 4:450-5. [DOI: 10.1016/j.pmrj.2012.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
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43
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Vecchiarelli A, Monari C. Capsular Material of Cryptococcus neoformans: Virulence and Much More. Mycopathologia 2012; 173:375-386. [PMID: 22314939 DOI: 10.1007/s11046-011-9513-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/28/2011] [Indexed: 01/08/2023]
Abstract
The capsule is generally considered one of the more powerful virulence factors of microorganisms, driving research in the field of microbial pathogenesis and in the development of vaccines. Cryptococcus neoformans is unique among the most common human fungal pathogens in that it possesses a complex polysaccharide capsule. This review focuses on the Cryptococcus neoformans capsule from the viewpoint of fungal pathogenesis, and the effective immune response target of the capsule's main component, glucuronoxylomannan.
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Affiliation(s)
- A Vecchiarelli
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Via del Giochetto, 06126, Perugia, Italy,
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44
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Tenosynovitis Caused by a Pseudallescheria boydii Infection and Symptoms of Reflex Sympathetic Dystrophy After a Dog Bite. J Clin Rheumatol 2011; 17:363-4. [DOI: 10.1097/rhu.0b013e31823279dd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Mycobacterial, brucellar, fungal, and parasitic arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Choi SW, Lee TJ, Kim MK, Lee M, Jung JH. A case of fungal arthritis caused by Hansenula anomala. Clin Orthop Surg 2010; 2:59-62. [PMID: 20191003 PMCID: PMC2824097 DOI: 10.4055/cios.2010.2.1.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 10/08/2008] [Indexed: 11/06/2022] Open
Abstract
Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.
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Affiliation(s)
- Sung-Wook Choi
- Department of Orthopedic Surgery, Cheju National University Hospital, Jeju, Korea
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Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect 2006; 12:309-14. [PMID: 16524406 DOI: 10.1111/j.1469-0691.2006.01366.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An infection of native joints leads generally to suppurative arthritis, which may be of one joint (monarticular) or several joints (oligoarticular). Bacteria that produce symptoms in multiple joints during bacteraemia, such as Neisseria gonorrhoeae, may also induce inflammation in the neighbouring tendon sheaths. Viral infections frequently involve multiple joints and produce inflammation without suppuration. Chronic granulomatous monarticular arthritis may occur because of infection with either mycobacteria or fungi, which must be differentiated from other causes of chronic monarticular arthritis. A sterile arthritis may occur early in infection (as with hepatitis B), or later (as with a post-infectious arthritis). Any patient presenting with an inflamed joint should have infection as a diagnostic possibility and appropriate cultures must be performed.
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Affiliation(s)
- J W Smith
- University of Texas Southwestern Medical Center Dallas, Department of Medicine, Division of Infectious Diseases, Dallas, TX, USA.
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Abstract
Over the last few decades, the incidence of invasive candidal infections in neonatal intensive care units has increased dramatically. Various complications, such as arthritis, endocarditis, meningitis, and endophthalmitis, have been reviewed. We present the case of a premature infant with systemic candidemia. Arthritis was discovered 6 months after completion of amphotericin B therapy, and was successfully treated with oral fluconazole for 6 weeks. We conclude that long-term follow-up is particularly important in patients with treated candidemia. To prevent complications, prolonged treatment with high-dose amphotericin B is suggested for systemic fungal infection, and oral fluconazole is an effective alternative for candidal arthritis.
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Affiliation(s)
- Wen-Bin Hsieh
- Division of Neonatology, Department of Pediatrics, Far Eastern Memorial Hospital, Panchiao, Taipei, Taiwan, ROC
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