Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome.

摘要: Summary Background The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood. Methods Protocol-defined cases published in the English literature were reviewed for comorbidities, microbiology, mechanisms infection, clinical manifestations, radiological findings, inflammatory biomarkers, antifungal therapy, outcome. Results Among 180 evaluable patients, 127 (71%) males. Possible predisposing medical conditions 103 (57%) included pharmacological immunosuppression, primary immunodeficiency, neutropenia. Seventy-three others (41%) had prior open fracture, trauma or surgery. Eighty (44%) followed a hematogenous mechanism, 58 (32%) contiguous infections, 42 (23%) direct inoculation. was first manifestation aspergillosis 77%. Pain tenderness present 80%. most frequently infected sites vertebrae (46%), cranium (23%), ribs (16%), long bones (13%). Patients with vertebral more previous orthopedic surgery (19% vs 0%; P  = 0.02), while those cranial diabetes mellitus (32% 8%;  = 0.002) head/neck (12%  = 0.02). Radiologic findings osteolysis, soft-tissue extension, uptake on T2-weighted images. Vertebral body complicated by spinal-cord compression 47% neurological deficits 41%. Forty-four patients (24%) received only 121 (67%) managed therapy. Overall mortality 25%. Median duration therapy 90 days (range, 10–772 days). There fewer relapses plus comparison to alone (8% 30%;  = 0.006). Conclusions is debilitating infection affecting both immunocompromised immunocompetent patients. common vertebrae, ribs, cranium. Based upon this comprehensive review, optimally includes selective avoid relapse achieve complete response.