Osteoarticular infections caused by non-Aspergillus filamentous fungi in adult and pediatric patients: A systematic review

Saad J. Taj-Aldeen, Blandine Rammaert, Maria Gamaletsou, Nikolaos V. Sipsas, Valerie Zeller, Emmanuel Roilides, Dimitrios P. Kontoyiannis, Andy O. Miller, Vidmantas Petraitis, Thomas J. Walsh, Olivier Lortholary

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16 Scopus citations


Osteoarticular mycoses due to non-Aspergillus moulds are uncommon and challenging infections. A systematic literature review of non-Aspergillus osteoarticular mycoses was performed using PUBMED and EMBASE databases from 1970 to 2013. Among 145 patients were 111 adults (median age 48.5 [16-92 y]) and 34 pediatric patients (median age 7.5 [3-15 y]); 114 (79.7%) were male and 88 (61.9%) were immunocompromised. Osteomyelitis was due to direct inoculation in 54.5%. Trauma and puncture wounds were more frequent in children (73.5% vs 43.5%; P=0.001). Prior surgery was more frequent in adults (27.7% vs 5.9%; P=0.025). Vertebral (23.2%) and craniofacial osteomyelitis (13.1%) with neurological deficits predominated in adults. Lower limb osteomyelitis (47.7%) and knee arthritis (67.8%) were predominantly seen in children. Hyalohyphomycosis represented 64.8% of documented infections with Scedosporium apiospermum (33.1%) and Lomentospora prolificans (15.8%) as the most common causes. Combined antifungal therapy and surgery was used in 69% of cases with overall response in 85.8%. Median duration of therapy was 115 days (range 5-730). When voriconazole was used as single agent for treatment of hyalohyphomycosis and phaeohyphomycosis, an overall response rate was achieved in 94.1% of cases. Non-Aspergillus osteoarticular mycoses occur most frequently in children after injury and in adults after surgery. Accurate early diagnosis and long-course therapy (median 6 mo) with a combined medicalsurgical approach may result in favorable outcome.

Original languageEnglish (US)
Article number2078
JournalMedicine (United States)
Issue number50
StatePublished - 2015

ASJC Scopus subject areas

  • Medicine(all)


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