Management of Fungal Osteoarticular Infections
Summary
Fungal infections of bone and joint structures are uncommon but carry significant morbidity owing to delayed diagnosis, protracted treatment courses and frequent surgical interventions. They most often arise in immunocompromised hosts, after trauma or around orthopaedic implants, and can involve vertebrae, long bones, small bones of the foot or prosthetic joints. Clinical presentation is typically indolent, with nonspecific pain, swelling and systemic signs that overlap with bacterial osteomyelitis or inflammatory arthritides. Definitive diagnosis relies on imaging modalities such as MRI or CT, histopathology and prolonged culture or molecular identification of fungal species. Management centres on both surgical debridement of necrotic bone and soft tissues and prolonged systemic antifungal therapy guided by in vitro susceptibility. Amphotericin B formulations, azoles (for example fluconazole, voriconazole) and echinocandins (caspofungin, rezafungin) are selected according to organism, site and patient factors. Duration of therapy often spans several months, and novel agents with improved pharmacokinetics and tolerability are under investigation. Multidisciplinary care involving infectious disease specialists, orthopaedic surgeons and clinical microbiologists is key to optimising outcomes and preventing relapse.
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Management of Fungal Osteoarticular Infections publication trend
The graph below shows the total number of articles in management of fungal osteoarticular infections across all publications each year (not limited to Nature Index journals).
Technical terms
Osteomyelitis: Infection of bone marrow and adjacent bone structures often requiring both surgical and medical therapies.
Spondylodiskitis: Concurrent inflammation or infection of the intervertebral disc and adjacent vertebral bodies.
Debridement: Surgical removal of infected, necrotic or foreign material to achieve a clean wound bed.
Azoles: A class of antifungal agents (e.g. fluconazole, voriconazole) that inhibit ergosterol synthesis in fungal cell membranes.
Echinocandins: Antifungal drugs (e.g. caspofungin, rezafungin) that disrupt the fungal cell wall by inhibiting β-1,3-glucan synthesis.
Antifungal susceptibility testing: Laboratory assessment of a fungal isolate’s sensitivity to various antifungal agents to guide therapy choice.
References
- Candida fracture-related infection: a systematic review. Journal of Bone and Joint Infection (2021).
- Talus osteomyelitis by Candida krusei with multiple huge cystic lesions: a case report and review of literatures. BMC Musculoskeletal Disorders (2022).
- Efficacy of rezafungin in a case of Candida spondylodiskitis. Journal of Bone and Joint Infection (2024).
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