Table 3.
Clinical characteristics and anatomical distribution of osteoarticular infections due to mucormycetes fungi reported in the literature from 1978 to 2014.
| Diagnostic approach | Total N = 34 (%) |
|---|---|
| Clinical manifestation* | |
| Pain/tenderness/swelling | 20 (59) |
| Cellulitis/ulcer/abscess | 8 (24) |
| Neurological deficit | 4 (12) |
| Movement painfully restricted | 21 (62) |
| Fever | 8 (24) |
| Types of infection | |
| Direct inoculation | 19 (56) |
| Hematogenous | 8 (24) |
| Contiguous | 7 (21) |
| Initial presentation of osteoarticular infections | |
| One bone infected | 28 (82) |
| Two bones infected | 4 (12) |
| ≥3 bones infected | 2 (6) |
| Bone involvement | |
| Skull and facial bones | 6 (18) |
| Upper limb | 2 (6) |
| Scapula | 1 (3) |
| Sternum | 1 (3) |
| Vertebra | 3 (9) |
| Femur | 4 (12) |
| Hip osteomyelitis/multiple sites | 4 (12) |
| Tibia | 7 (21) |
| Knee arthritis | 2 (6) |
| Foot | 4 (12) |
| Radiological features* | |
| Osteolytic lesion | 14 (41) |
| Increase of nuclear scan uptake | 8 (23) |
| TC99 m/Ga67 | |
| Bone destruction/erosion | 3 (9) |
| Lucency | 3 (9) |
| Necrosis | 2 (6) |
| Not specified | 7 (21) |
| Inflammatory markers | |
| ESR | |
| Mean ± SD | 74 ± 27 |
| Median (Range) | 69 (40–107) |
| WBC | |
| Mean ± SD | 16,891 ± 8,265 |
| Median (Range) | 16,150 (7,000–29,400) |
| Types of biopsy | N = 32 |
| Open surgical wound | 28 (87) |
| Percutaneous needle biopsy | 3 (9) |
| Arthroscopy | 1 (3) |
| Diagnostic delay (days) | |
| Mean ± SD | 73 ± 47 |
| Median (Range) | 60 (10–180) |
| Treatment | N = 33 |
| (one died before treatment) | |
| Only Amphotericin B | 4 (12) |
| Only Surgery | 1 (3) |
| Amphotericin B + surgery | 28 (85) |
| Duration of medical treatment, | 45 (5–573) |
| median (range) d | |
| Type of surgical intervention (n = 29) | |
| Debridement | 11 (38) |
| Amputation | 5 (17) |
| Bone grafting/multiple procedures/ | 7 (24) |
| Autotransplantation/Fixation | |
| Decompressive laminectomy | 1 (3.5) |
| Excision | 5 (17) |
| Outcome | |
| Complete response | 14 (41) |
| Partial response | 12 (35) |
| Crude mortality | 8 (24) |
| Attributable death | 6 (18) |
*Some cases demonstrate more than one symptom.