Fungal osteomyelitis

Background

Microbiology

• Causative organisms include: Candida and other yeasts, Aspergillus, Mucorales, dematiaceous molds, non-Aspergillus hyaline molds, and endemic mycoses (Histoplasma, Blastomyces, and Coccidioides)

Clinical Manifestations

• Candidal osteomyelitis and septic arthritis has more hematogenous spread than other causes
• Hyaline molds, including Aspergillosis, are commonly after traumatic inoculation

Management

• Duration, regardless of causative organism, is typically in the range of a few months to a few years1
  • Candida: median 90 days (range 7 to 720 days)
  • Aspergillus: median 90 days (range 10 to 772 days)
  • Dimorphic fungi: median 180 days (range 70 to 365 days)
  • Mucormycosis: median 45 days (range 5 to 573 days)
  • Other non-Aspergillus molds: median 115 days (range 5 to 730 dats)

Further Reading

• Osteoarticular mycoses. Clin Microbiol Rev. 2022;35(4):e0008619. doi: 10.1128/cmr.00086-19