[Fungal osteoarthritis]

Abstract

Two large groups of bone and joint mycoses should be recognised: fungal osteoarthritis due to blood spread and osteoarthritis due to traumatic inoculation. The authors report data in the literature and the experience of the Mycology unit of the Pasteur Institute. In the first group, one may recognise a category of cosmopolitan, opportunist fungi (Candida, cryptococcus) becoming grafted on a background of iatrogenic factors, in particular, Candida albicans arthritis of the newborn (2 new cases have been added to 12 already described in the literature) and osteoarthritis (17 cases) and candida spondylodiscitis (1 recent case out of 8 described in the literature). Out of 39 cases of cryptococcosis at various levels, in 7 cases we observed bony localisations in recent years. Another category consisted of mycoses due to dimorphic exotic fungi in the first place, african histoplasmosis due to H. Duboisii (73 cases of osteitis out of 179). The group of osteoarthritis by traumatic inoculation consists mainly of fungal mycetomas and actinomycoses, occasionally sporotrichosis; recently we have observed for the first time in the literature an arthritis due to a black fungus similar to Beauveria sp. The immunological reactions (immunoelectrophoresis) may be useful for the diagnosis and assessment of the efficacy of treatment. Present treatment is based on the routine use of antifungal agents: e.g. amphotericin B, 5-fluorocytosine, imidazole derivatives (Ketoconazole) according to the sensitivity of the fungi.