Fungal bone and joint infections

2017 ◽  
Author(s):  
Damien Mack ◽  
Simon Warren ◽  
Shara Palanivel ◽  
Christopher P. Conlon
Keyword(s):  
Fungal Infections ◽  
Vertebral Osteomyelitis ◽  
Invasive Fungal Disease ◽  
Clinical Suspicion ◽  
Dimorphic Fungi ◽  
Joint Infections ◽  
Clinical Presentations ◽  
Direct Inoculation ◽  
Immunosuppressed Patients ◽  
Haematogenous Spread

Although fungal infections of bones and joints are rare, the increasing incidence of invasive fungal disease, along with an increased population of immunosuppressed patients and individuals with multiple comorbidities, means that these infections are also increasing. The most common organisms are Candida and Aspergillus species, although the endemic dimorphic fungi are responsible for significant numbers of cases in some parts of the world. Most infections occur following haematogenous spread, but invasion from contiguous infection occurs, as does direct inoculation after trauma or surgery. Clinical presentations differ somewhat between children and adults, with the latter more likely to have vertebral osteomyelitis. Clinical presentations may be subtle, often without fever or raised inflammatory markers, and diagnosis may be delayed as a consequence. Diagnosis rests on clinical suspicion coupled with the need to obtain tissue for culture and for histology. Appropriate antifungal therapy usually needs to be prolonged and combined with surgical debridement.

Opportunistic Fungal Infections in Small Animals

2018 ◽  
Vol 54 (6) ◽  
pp. 327-337 ◽  
Author(s):  
Andrea Dedeaux ◽  
Amy Grooters ◽  
Nobuko Wakamatsu-Utsuki ◽  
Joseph Taboada
Keyword(s):  
Clinical Presentation ◽  
Fungal Infections ◽  
Small Animal ◽  
Small Animals ◽  
Clinical Presentations ◽  
Number Of Patients ◽  
Causes Of Disease ◽  
Immunosuppressed Patients ◽  
Opportunistic Mycoses ◽  
Hyphal Diameter

ABSTRACT Opportunistic fungal infections have long been recognized as rare causes of disease in immunocompetent dogs and cats. Recently, the escalating use of multiagent immunosuppression protocols (especially those that include cyclosporine) has resulted in an increased number of patients with opportunistic fungal infection encountered by small animal practitioners and has altered the typical case phenotype. Based on histologic and cytologic features such as pigmentation, hyphal diameter, and distribution in tissue, these opportunistic mycoses can be placed into categories such as phaeohyphomycosis, hyalohyphomycosis, and eumycotic mycetoma. This review aims to summarize the clinical presentations, methods for diagnosis, treatment recommendations, and prognosis for both immunocompetent and immunosuppressed patients with opportunistic fungal infections. An example case description is included to illustrate the most common current clinical presentation.

scholarly journals Infection of a sylvian Galassi II arachnoid cyst after craniotomy for resection of a parasagittal meningioma

2021 ◽  
Vol 14 (8) ◽  
pp. e243405
Author(s):  
Ioannis Christodoulides ◽  
Christoforos Syrris ◽  
Jose Pedro Lavrador ◽  
Christopher Chandler
Keyword(s):  
Arachnoid Cyst ◽  
Rare Complication ◽  
Arachnoid Cysts ◽  
Tumour Resection ◽  
High Dose ◽  
Direct Inoculation ◽  
Immunosuppressed Patients ◽  
Haematogenous Spread ◽  
Working Hypotheses ◽  
Parasagittal Meningioma

Arachnoid cysts are CSF-containing entities that rarely are symptomatic or warrant neurosurgical intervention. In addition, infection of these lesions is an even rarer event, with only four reports in the literature capturing this. In this report, we present the case of a 79-year-old man presenting with paraparesis, secondary to a right parasagittal meningioma, with an incidental asymptomatic right sylvian arachnoid cyst (Galassi type II). The initially planned surgery was postponed for 3 months, due to COVID-19 restrictions, and he was kept on high dose of steroids. Following tumour resection, the patient developed bilateral subdural empyemas with involvement of the arachnoid cyst, requiring bilateral craniotomies for evacuation of the empyemas and drainage of the arachnoid cyst. Suppuration of central nervous system arachnoid cysts is a very rare complication following cranial surgery with the main working hypotheses including direct inoculation from surrounding inflamed meninges or haematogenous spread secondary to systemic bacteraemia, potentiated by steroid-induced immunosuppression. Even though being a rarity, infection of arachnoid cysts should be considered in immunosuppressed patients in the presence of risk factors such as previous craniotomy.

scholarly journals Establishment of an interdisciplinary board for bone and joint infections

Infection ◽  
2021 ◽  
Author(s):  
Christina Otto-Lambertz ◽  
Ayla Yagdiran ◽  
Kirsten Schmidt-Hellerau ◽  
Charlotte Meyer-Schwickerath ◽  
Peer Eysel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Vertebral Osteomyelitis ◽  
Study Data ◽  
Suspected Infection ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Clinical Presentations ◽  
Treatment Plans ◽  
Guidelines And Recommendations ◽  
Rule Out

Abstract Purpose The incidence of bone and joint infections is increasing while their treatment remains a challenge. Although guidelines and recommendations exist, evidence is often lacking and treatment complicated by complex clinical presentations and therapeutic options. Interdisciplinary boards shown to improve management of other diseases, seem potentially helpful. We describe the establishment of an osteomyelitis board to show the existing demand for such a platform. Methods All patients discussed in the board for bone and joint infections between October 2014 and September 2020 were included in this retrospective study. Data were extracted from patient records and analyzed descriptively. Results A total of 851 requests related to 563 patients were discussed in the board during the study period. After a run-in period of 3 years, a stable number of cases (> 170/year) were discussed, submitted by nearly all hospital departments (22 of 25). Recommendations were mainly related to antibiotic treatment (43%) and to diagnostics (24%). Periprosthetic joint infections were the most frequent entity (33%), followed by native vertebral osteomyelitis and other osteomyelitis. In 3% of requests, suspected infection could be excluded, in 7% further diagnostics were recommended to confirm or rule out infection. Conclusions A multidisciplinary board for bone and joint infections was successfully established, potentially serving as a template for further boards. Recommendations were mainly related to antibiotic treatment and further diagnostics, highlighting the need for interdisciplinary discussion to individualize and optimize treatment plans based on guidelines. Further research in needed to evaluate impact on morbidity, mortality and costs.

scholarly journals Primary immune deficiencies with defects in neutrophil function

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Mary C. Dinauer
Keyword(s):  
Fungal Infections ◽  
Leukocyte Adhesion ◽  
Genetic Disorders ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Adaptor Protein ◽  
Invasive Fungal Disease ◽  
Neutrophil Function ◽  
Microbial Pathogens ◽  
Immune Deficiencies

Abstract Immune deficiencies resulting from inherited defects in neutrophil function have revealed important features of the innate immune response. Although sharing an increased susceptibility to bacterial and fungal infections, these disorders each have distinctive features in their clinical manifestations and characteristic microbial pathogens. This review provides an update on several genetic disorders with impaired neutrophil function, their pathogenesis, and treatment strategies. These include chronic granulomatous disease, which results from inactivating mutations in the superoxide-generating nicotinamide dinucleotide phosphate oxidase. Superoxide-derived oxidants play an important role in the control of certain bacterial and fungal species, and also contribute to the regulation of inflammation. Also briefly summarized are updates on leukocyte adhesion deficiency, including the severe periodontal disease characteristic of this disorder, and a new immune deficiency associated with defects in caspase recruitment domain–containing protein 9, an adaptor protein that regulates signaling in neutrophils and other myeloid cells, leading to invasive fungal disease.

scholarly journals Laboratory Diagnosis of Porphyria

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1343
Author(s):  
Elena Di Pierro ◽  
Michele De Canio ◽  
Rosa Mercadante ◽  
Maria Savino ◽  
Francesca Granata ◽  
...  
Keyword(s):  
Molecular Analysis ◽  
Diagnostic Testing ◽  
Laboratory Diagnosis ◽  
Clinical Suspicion ◽  
Enzymatic Activities ◽  
Heme Biosynthesis ◽  
Present Review ◽  
Biosynthesis Pathway ◽  
Clinical Presentations

Porphyrias are a group of diseases that are clinically and genetically heterogeneous and originate mostly from inherited dysfunctions of specific enzymes involved in heme biosynthesis. Such dysfunctions result in the excessive production and excretion of the intermediates of the heme biosynthesis pathway in the blood, urine, or feces, and these intermediates are responsible for specific clinical presentations. Porphyrias continue to be underdiagnosed, although laboratory diagnosis based on the measurement of metabolites could be utilized to support clinical suspicion in all symptomatic patients. Moreover, the measurement of enzymatic activities along with a molecular analysis may confirm the diagnosis and are, therefore, crucial for identifying pre-symptomatic carriers. The present review provides an overview of the laboratory assays used most commonly for establishing the diagnosis of porphyria. This would assist the clinicians in prescribing appropriate diagnostic testing and interpreting the testing results.

Results of alemtuzumab-based reduced-intensity allogeneic transplantation for chronic lymphocytic leukemia: a British Society of Blood and Marrow Transplantation Study

Blood ◽  
2006 ◽  
Vol 107 (4) ◽  
pp. 1724-1730 ◽  
Author(s):  
Julio Delgado ◽  
Kirsty Thomson ◽  
Nigel Russell ◽  
Joanne Ewing ◽  
Wendy Stewart ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Fungal Infections ◽  
Allogeneic Transplantation ◽  
Lymphocytic Leukemia ◽  
British Society ◽  
Graft Versus Host ◽  
Blood And Marrow Transplantation ◽  
Immunosuppressed Patients ◽  
Related Mortality

We report results in 41 consecutive patients with chronic lymphocytic leukemia (CLL) who underwent allogeneic hematopoietic cell transplantation (HCT) after fludarabine, melphalan, and alemtuzumab conditioning. Donors were 24 HLA-matched siblings and 17 unrelated volunteers, 4 of them mismatched with recipients. All but 3 patients had initial hematologic recovery, but 5 more patients had secondary graft failure. Median intervals to neutrophil (greater than 0.5 × 109/L) and platelet (greater than 20 × 109/L) recovery were 14 days (range, 9-30 days) and 11 days (range, 8-45 days), respectively. Eleven (27%) patients had relapses and received escalated donor lymphocyte infusions, but only 3 of them had sustained responses. Acute and chronic graft-versus-host disease (GVHD) was observed in 17 (41%) and 13 (33%) patients, respectively. Seventeen (41%) patients have died, 5 of progressive disease. The 2-year overall survival and transplantation-related mortality (TRM) rates were 51% (95% confidence interval [CI], 33%-69%) and 26% (95% CI, 14%-46%), respectively. The alemtuzumabbased regimen was feasible and effective in patients with CLL with a relatively low rate of GVHD. However, TRM remains relatively high as a result of a variety of viral and fungal infections. Studies are ongoing to address the efficacy of reduced doses of alemtuzumab in this group of immunosuppressed patients.

scholarly journals Pulmonary Interleukin-17-Positive Lymphocytes Increase during Pneumocystis murina Infection but Are Not Required for Clearance of Pneumocystis

2017 ◽  
Vol 85 (7) ◽  
Author(s):  
Chiara Ripamonti ◽  
Lisa R. Bishop ◽  
Joseph A. Kovacs
Keyword(s):  
T Cells ◽  
Fungal Infections ◽  
Intracellular Cytokine Staining ◽  
Γδ T Cells ◽  
Interleukin 17 ◽  
Content Type ◽  
Immunosuppressed Patients ◽  
Ifn Γ ◽  
Immunocompetent Mice ◽  
Deficient Mice

ABSTRACT Pneumocystis remains an important pathogen of immunosuppressed patients, causing a potentially life-threatening pneumonia. Despite its medical importance, the immune responses required to control infection, including the role of interleukin-17 (IL-17), which is important in controlling other fungal infections, have not been clearly defined. Using flow cytometry and intracellular cytokine staining after stimulation with phorbol myristate acetate and ionomycin, we examined gamma interferon (IFN-γ), IL-4, IL-5, and IL-17 production by lung lymphocytes in immunocompetent C57BL/6 mice over time following infection with Pneumocystis murina. We also examined the clearance of Pneumocystis infection in IL-17A-deficient mice. The production of both IFN-γ and IL-17 by pulmonary lymphocytes increased during infection, with maximum production at approximately days 35 to 40, coinciding with peak Pneumocystis levels in the lungs, while minimal changes were seen in IL-4- and IL-5-positive cells. The proportion of cells producing IFN-γ was consistently higher than for cells producing IL-17, with peak levels of ∼25 to 30% of CD3+ T cells for the former compared to ∼15% for the latter. Both CD4+ T cells and γδ T cells produced IL-17. Administration of anti-IFN-γ antibody led to a decrease in IFN-γ-positive cells, and an increase in IL-5-positive cells, but did not impact clearance of Pneumocystis infection. Despite the increases in IL-17 production during infection, IL-17A-deficient mice cleared Pneumocystis infection with kinetics similar to C57BL/6 mice. Thus, while IL-17 production in the lungs is increased during Pneumocystis infection in immunocompetent mice, IL-17A is not required for control of Pneumocystis infection.

Difficulties in diagnosing vertebral osteomyelitis in a child

2021 ◽  
Vol 14 (1) ◽  
pp. e236037
Author(s):  
Jonathan Holzmann ◽  
Sunday Pam ◽  
Geoffrey Clark
Keyword(s):  
False Negative ◽  
Vertebral Osteomyelitis ◽  
Delayed Diagnosis ◽  
Abdominal Ultrasound ◽  
Clinical Suspicion ◽  
Thoracic Vertebrae ◽  
Negative Results ◽  
False Negative Results ◽  
The Face ◽  
Initial Imaging

Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.

Bone and joint infections in children

2013 ◽  
pp. 753-763
Author(s):  
Alasdair Munro ◽  
Julia Clark ◽  
Saul N. Faust
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Chronic Infection ◽  
Laboratory Tests ◽  
Oral Treatment ◽  
Timely Initiation ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Wide Range ◽  
Direct Inoculation

Bone and joint infections in children are uncommon, but they affect all ages and there is a wide range of disease. The mode of infection may be haematogenous or by direct inoculation from a wound. The child may present acutely unwell or with a chronic infection. Clinical features include fever, reluctance to move the affected limb, pain, and swelling. Laboratory tests and medical imaging are used to confirm diagnosis. Medical treatment is with initial intravenous antibiotic therapy, usually followed by oral treatment. Surgical treatment may be necessary if abscess or joint collection is present. In general prognosis is good with timely initiation of treatment, although complications such as pathological fracture are occasionally seen.

scholarly journals Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

2019 ◽  
Vol 5 (3) ◽  
pp. 67 ◽  
Author(s):  
Friedman ◽  
Schwartz
Keyword(s):  
North America ◽  
Fungal Pathogens ◽  
Fungal Infections ◽  
Trichophyton Mentagrophytes ◽  
Invasive Fungal Disease ◽  
Multidrug Resistant ◽  
Antifungal Prophylaxis ◽  
Candida Spp ◽  
Sporothrix Brasiliensis ◽  
Emerging Fungal Infections

: The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus Aspergillus species, Mucorales, and Scedosporium/Lomentospora spp. The agricultural application of triazole pesticides has driven an emergence of azole-resistant A. fumigatus in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in Trichophyton mentagrophytes causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including Emergomyces, which cause disseminated mycoses globally, primarily in HIV infected patients, and Blastomyces helicus and B. percursus, causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as an important disease of felines and people.

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