Fungal osteomyelitis and soft tissue infections: Simple solutions to uncommon scenarios

  • Ravi Chavan P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Aditya Menon P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Rajeev Soman P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Camilla Rodrigues P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Anjali Shetty P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Ravi Bhadiyadra P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
  • Vikas M Agashe P.D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
Keywords: fungal osteomyelitis, mycosis, fungal soft tissue infections, open fractures, mucormycosis, candida osteomyelitis

Abstract

Introduction: Fungal osteoarticular/soft tissue infections (FOaSI) are an uncommon entity with protracted course due to variability in clinical picture, slow progression; resulting in misdiagnosis with empirical therapy. Recent studies have shown an alarming emergence of FOaSI in immunocompetent individuals with high mortality rates. This study recommends a protocol for managing these complex and confusing scenarios.

Methodology: We have retrospectively analysed patients with FOaSI between January 2014 and December 2016, with a minimum 12 months follow up.

Results: 8 cases (6 male, 2 female) with a mean age of 42.88 years (26-53) presented to us 45 days (3-365) after initial symptoms. They underwent mean 3 procedures before being diagnosed with a fungal infection. Deep tissue cultures grew 9 fungi and 6 bacteria, commonest fungus being Candida sp (n = 4), treated with appropriate antifungals and antibiotics. Infection remission was achieved in 7/8 (87.5%) cases at 27.1 months (19-45) follow-up with 1 mortality. Excellent functional results as per our criteria were seen in 5 cases (62.5%) with 1 talus excision, 1 ray amputation and 1 mortality.

Conclusions: This study highlights the significance of implementing a simple rule such as obtaining fungal cultures in every case of bone and soft tissue infections. Standardisation of treatment may not be the ideal solution, since different fungi have different growth patterns and invasiveness. A simple protocol of customising the medico- surgical treatment with an open ended discussion between the surgeons, microbiologists, pathologists and infectious disease specialists forms the cornerstone to success.

Published
2020-09-30
How to Cite
1.
Chavan R, Menon A, Soman R, Rodrigues C, Shetty A, Bhadiyadra R, Agashe VM (2020) Fungal osteomyelitis and soft tissue infections: Simple solutions to uncommon scenarios. J Infect Dev Ctries 14:1033-1039. doi: 10.3855/jidc.11449
Section
Original Articles