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Fungal Osteomyelitis


Presentation

  • In addition, a review of the literature regarding case reports of fungal osteomyelitis after ACL reconstruction is presented.[ncbi.nlm.nih.gov]
  • Miscellaneous manifestations have included endocarditis, keratomycosis, endophthalmitis, peritonitis, various pulmonary presentations, osteomyelitis, rarely disseminated systemic infection (1).[webmedcentral.com]
  • Hayda or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of AO North America; serves as an unpaid consultant to BioIntraface; and serves as a board member, owner, officer, or committee member of the[journals.lww.com]
Fever
  • A 23-year-old man developed fever, swelling and pain of the affected knee from 18 days after arthroscopic ACL reconstruction.[ncbi.nlm.nih.gov]
  • Osteomyelitis Symptom Fever The definition of fever is an elevation in body temperature or a high body temperature.[medicinenet.com]
  • The disease is commonest in children, and causes fever and severe pain at the affected site.[medical-dictionary.thefreedictionary.com]
  • Symptoms of bone infections include Pain in the infected area Chills and fever Swelling, warmth, and redness A blood test or imaging test such as an x-ray can tell if you have a bone infection. Treatment includes antibiotics and often surgery.[medlineplus.gov]
  • Unlike children, adults with osteomyelitis generally have no fever.[medbroadcast.com]
Malaise
  • They include chronic pain, persistent sinus tract or wound drainage, poor wound healing, malaise, and sometimes fever. Diagnosis Acute osteomyelitis in children is primarily a clinical diagnosis based on the rapid onset and localization of symptoms.[aafp.org]
Rigor
  • Expanded coverage and rigorous updates—including 40 online-only chapters—keep you current with the latest advances in cartilage repair and regeneration, allograft and autografts, computer robotics in total knee arthroplasty, and other timely topics.[books.google.com]
Bone Pain
  • A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.[chop.edu]
  • […] had any surgery on a bone a weakened immune system – for example, because of chemotherapy or you have another serious illness had osteomyelitis before diabetes, especially if you also have a foot ulcer Sometimes an infection in the blood affects the bone[nhs.uk]
  • When to see a doctor See your doctor if you experience worsening bone pain along with fever.[mayoclinic.org]
  • pain, tenderness, and draining abscesses around infected bone for long periods of time (months to years).[columbiaspine.org]
Spine Pain
  • . - h/o of unremmiting spine pain at any level is characteristic, & tenderness, spasm, and loss of motion are seen; - initially onset of pain may be insidious; - w/ time, pain may be so severe that jarring the bed may be agonizing; - pain restricts ROM[wheelessonline.com]
Distractibility
  • We report lower extremity salvage by radical bony debridement, free tissue transfer, distraction osteogenesis with bone-docking, and a novel antifungal regimen in a clinical setting of infection with Scedosporium inflatum, historically requiring amputation[ncbi.nlm.nih.gov]
Excitement
  • A, Sagittal T1-weighted (416/19/2 [TR/TE/excitations]) spin-echo image in the midline of the lumbar spine shows minimal hypointensity within the L2, L3, and L4 vertebral bodies ( arrows ).[ajnr.org]
Incontinence
  • The pain had progressed since transplantation, and by 8 months after surgery had become debilitating and associated with fecal and urinary incontinence. In addition, she reported a 30-pound weight loss over the preceding 4 months.[ajnr.org]
Urinary Incontinence
  • The pain had progressed since transplantation, and by 8 months after surgery had become debilitating and associated with fecal and urinary incontinence. In addition, she reported a 30-pound weight loss over the preceding 4 months.[ajnr.org]

Workup

Scedosporium
  • We report lower extremity salvage by radical bony debridement, free tissue transfer, distraction osteogenesis with bone-docking, and a novel antifungal regimen in a clinical setting of infection with Scedosporium inflatum, historically requiring amputation[ncbi.nlm.nih.gov]
  • Host immune response against Scedosporium species. Med Mycol. 2009;47:443–50. CrossRef Google Scholar 38. Ochiai N, Shimazaki C, Uchida R, et al. Disseminated infection due to Scedosporium apiospermum in a patient with acute myelogenous leukemia.[link.springer.com]
Trichophyton Rubrum
  • Trichophyton rubrum osteomyelitis after calcaneus external fixation pin stabilization of a pilon fracture. J Foot Ankle Surg. 2014;53:480–4. PubMed CrossRef Google Scholar 60. Baraboutis I, Belesiotou E, Platsouka E, et al.[link.springer.com]
Fusarium
  • Fusarium osteomyelitis: case report and review of the literature. Scand J Infect Dis. 2005;37:237–40. PubMed CrossRef Google Scholar 45. Wu CY, Chen GS, Lan CC. Onychomycosis caused by Fusarium solani in a woman with diabetes.[link.springer.com]

Treatment

  • Treatment must be aggressive and should include radical local debridement. The quest for effective systemic chemotherapy should continue. Persistent drainage, ascending infection, and a functionless extremity are reasons for considering amputation.[ncbi.nlm.nih.gov]
  • 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.[journals.lww.com]
  • Mycetoma: Current concepts in treatment. Int J Dermatol 30: 387-98.[webmedcentral.com]
  • Treatment Treatment is involved and is not always successful. Expensive anti-fungal drugs have to be given by a vet and repeat tests performed to ensure it is clearing up. See also... Osteosarcoma of the elbow Osteosarcoma of the radius[berryhavenvet.com.au]

Prognosis

  • What is the prognosis for osteomyelitis? With early diagnosis and appropriate treatment, the prognosis for osteomyelitis is good.[medicinenet.com]
  • Post-sternotomy sternal osteomyelitis and mediastinitis by Trichosporon asahii : a rare occurrence with a grave prognosis. Mycoses. 2010;53:272–4. PubMed CrossRef Google Scholar 61. Davies F, Logan S, Johnson E, Klein JL.[link.springer.com]
  • Prognosis Prognosis varies depending on how quickly an infection is identified, and what other underlying conditions exist to complicate the infection.[medical-dictionary.thefreedictionary.com]
  • What is the outlook (prognosis)? If the infection is treated promptly, there is a good chance of a complete cure. The best outcome occurs if you have treatment within 3-5 days of the start of infection.[patient.info]

Etiology

  • In cases of chronic osteomyelitis with draining sinuses occurring in uncommon anatomic locations, fungal etiology should be suspected (3). 1. Silveira F, Nucci M (2001) Emergence of black moulds in fungal disease:Epidemiology and Therapy.[webmedcentral.com]
  • Among them, the most common etiological agent is Fonsecaea pedrosoi. [1] Other rarely reported agents include Exophiala spinifera and Rhinocladiella aquaspersa. [2] E. spinifera belongs to family Herpotrichiellaceae in the fungal order Chaetothyriales[e-ijd.org]
  • "Etiologic diagnosis of chronic osteomyelitis: A prospective study". Archives of Internal Medicine. 166 (1): 95–100. doi : 10.1001/archinte.166.1.95. ISSN 0003-9926. PMID 16401816.[en.wikipedia.org]
  • A swab culture was obtained from the fistula and was found to be positive with Periodic Acid Schiff, which indicated a fungal etiology. Oral antifungals were given for 1 month (Tablet.[ijdr.in]
  • […] or surgery immunocompromised patients illicit IV drug use poor vascular supply systemic conditions such as diabetes and sickle cell peripheral neuropathy Pathophysiology mechanism of spread hematogenous originated or transported by blood most common etiology[orthobullets.com]

Epidemiology

  • Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect. 2014;68:478–93.[link.springer.com]
  • The epidemiology of these fungal infections, their musculoskeletal presentations, and their treatment are considered in this chapter.[musculoskeletalkey.com]
  • Epidemiology and pathogenesis of paranasal sinus mycoses.[ijdr.in]
  • Introduction Overview Infection of bone characterized by progressive inflammatory destruction and apposition of new bone treatment is often a combination of culture-directed antibiotics and surgical debridement of nonviable tissue Epidemiology incidence[orthobullets.com]
  • Epidemiological and laboratory studies traced the potential source of Candida contamination to lemon juice used to dissolve the injected heroin [ 61-64 ].[academic.oup.com]
Sex distribution
Age distribution

Pathophysiology

  • 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.[ncbi.nlm.nih.gov]
  • Pathophysiology Department, Medical School National and Kapodistrian University of Athens Athens Greece 2.[link.springer.com]
  • […] lateral clavicle in IV drug abusers foot and decubitus ulcers in diabetics risk factors recent trauma or surgery immunocompromised patients illicit IV drug use poor vascular supply systemic conditions such as diabetes and sickle cell peripheral neuropathy Pathophysiology[orthobullets.com]
  • "Infectious diseases: pathophysiology and mechanisms of hyperbaric oxygen". Journal of Hyperbaric Medicine. 2 (3): 133–140. Archived from the original on 2009-02-13. Retrieved 2008-05-16.[en.wikipedia.org]

Prevention

  • Osteomyelitis surgery prevents the infection from spreading further or getting so bad that amputation is the only remaining option. Preventing Osteomyelitis The best way to prevent osteomyelitis is to keep things clean.[webmd.com]
  • Prevention Patients with a weakened immune system should: Cleaning and dressing an open wound can prevent infection.[medicalnewstoday.com]
  • Prevention If you've been told that you have an increased risk of infection, talk to your doctor about ways to prevent infections from occurring. Reducing your risk of infection will also help your risk of developing osteomyelitis.[mayoclinic.org]
  • Prevention About the only way to have any impact on the development of osteomyelitis involves excellent care of any wounds or injuries. Resources Periodicals Calhoun, Jason H., et al. "Osteomyelitis: Diagnosis, Staging, Management."[medical-dictionary.thefreedictionary.com]
  • Treatment and Prevention Treatment of osteomyelitis depends on how the infection has spread to the bone and how deeply it has penetrated.[medbroadcast.com]

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