TABLE 7.
Demographic and clinical characteristics and anatomical distribution of cases of osteoarticular infections caused by hyalohyphomycosis and phaeohyphomycosise
| Parameter | Value for group |
P value | |
|---|---|---|---|
| Hyalohyphomycosis (n = 80) | Phaeohyphomycosis (n = 57) | ||
| Mean age (yrs) ± SD | 35.9 ± 21.4 | 35 ± 22.2 | 0.837 |
| No. of male patients (%) | 68 (85) | 41 (74.5) | 0.13 |
| No. of patients with underlying condition (%) | |||
| Diabetes | 16 (20) | 3 (5.6) | 0.019 |
| Trauma | 41 (51.9) | 26/54 (48.1) | 0.671 |
| Prior surgery | 20 (26) | 18 (33.3) | 0.361 |
| Prosthesis | 2/78 (2.6) | 1/54 (1.9) | 0.999 |
| Immunocompromised | 42/80 | 22/55 | 0.153 |
| Solid cancer | 1/76 (1.3) | 2/54 (3.7) | 0.57 |
| Hematological malignancy | 8/78 (10.3) | 2/54 (3.7) | 0.19 |
| Neutropenia (ANCf < 500 cells/mm3) | 5/77 (6.5) | 4/54 (7.4) | 0.999 |
| Solid-organ transplant | 6/78 (7.7) | 3/54 (5.6) | 0.737 |
| Chronic granulomatous disease | 4/78 (5.1) | 1/54 (1.8) | 0.029 |
| HIV/AIDS | 1/76 (1.3) | 3/54 (5.6) | 0.307 |
| Corticosteroid use | 17/77 (22.1) | 7/54 (13) | 0.11 |
| No. of patients with other medical conditions (%) | |||
| Total | 75 | 50 | |
| Road accident | 7 | 0 | 0.029 |
| Penetrating puncture/injection | 22 (29.3) | 16 (32) | 0.751 |
| History of laceration/wound/ulcer | 10 (13.3) | 3 | 0.188 |
| Traumatic injury/fall/fracture | 4 | 10 (20) | 0.011 |
| No. of patients with bone infected (%) | |||
| Total | 58 | 34 | |
| Vertebra | 17 (29.3) | 3 (8.8) | 0.443 |
| Foot | 14 (24.1) | 10 (29.4) | |
| Tibia | 8 (13.8) | 4 (11.8) | |
| Ilium/crest/wing | 1 (1.7) | 2 (5.9) | |
| Fibula | 0 | 2 (5.9) | |
| Femur | 3(5.2) | 4 (11.8) | |
| Cranium | 5 (8.6) | 2 (5.9) | |
| Pterygoid/mandibular (others) | 2 (3.4) | 1 (2.9) | |
| Sternum/ribs | 2 (3.4) | 1 (2.9) | |
| Humerus | 1 (1.7) | 0 | |
| Hand | 2 (3.4) | 3 (8.8) | |
| Ulna | 1 (1.7) | 0 | |
| Multiple bone infections | 1 (1.7) | 1 (2.9) | |
| No. of patients with joint involvement (%) | |||
| Total | 29 | 27 | |
| Knee | 18 (62.1) | 15 (55.5) | 0.443 |
| Osteoarthritis | 5 (17.3) | 5 (18.5) | |
| Othersa | 6 (20.6) | 7 (25.9) | |
| No. of patients with mechanism of infection (%) | |||
| Total | 73 | 48 | |
| Direct inoculation | 39 (53.4) | 30 (62.5) | 0.614 |
| Hematogenous | 21 (28.8) | 11(22.9) | |
| Contiguous | 13 (17.8) | 7 (14.6) | |
| No. of patients with clinical symptom (%)b | |||
| Total | 80 | 57 | |
| Pain/tenderness | 59 (73.7) | 36 (63.1) | 0.185 |
| Swollen | 27 (33.7) | 25 (43.8) | 0.230 |
| Drainage/sinus/abscess | 23 (28.7) | 12 (21) | 0.310 |
| Erythema/cellulitis | 17 (21.25) | 5 (8.77) | 0.050 |
| Restricted movement | 47 (58.8) | 28 (49.1) | 0.265 |
| Warmness | 4 (5) | 2 (3.5) | 0.714 |
| Fatigue/wt loss | 3 (3.7) | 2 (3.5) | 0.962 |
| Neurological deficits | 9 (11.25) | 2 (3.5) | 0.179 |
| Impaired vision/blindness | 1 (1.2) | 1 (1.75) | 0.998 |
| Fever | 24 (30) | 16 (28.1) | 0.807 |
| Mean inflammatory marker value ± SD (no. of patients) | |||
| CRP (mg/dL) | 62.58 ± 76.18 (23) | 58.14 ± 44.218 (15) | 0.840 |
| ESR | 76 ± 34.78 (28) | 86.6 ± 37.65 (17) | 0.340 |
| WBCs (cells/mm3) | 11,025.9 ± 6,491.8 (27) | 8,109 ± 4,042.8 (11) | 0.176 |
| Treatment(s) and outcome | |||
| Total no. of patients | 79 | 57 | |
| No. of patients with type treatment(s) (%) | |||
| Medical and surgical | 50 (63.3) | 43 (75.4) | 0.552 |
| Medical | 20 (25.3) | 11 (19.3) | |
| Surgical | 3 (3.8) | 3 (5.2) | |
| Mean diagnostic delay (days) ± SD | 206.3 ± 301 | 156.3 ± 242.8 | 0.352 |
| Mean duration of treatment (days) ± SD | 189.12 ± 180.7 | 196.46 ± 174.9 | 0.834 |
| No. of patients with complete response/total no. of patients (%) | 56/74 (75.7) | 47/55 (85.5) | 0.171 |
| No. of patients with partial response (%) | 12 (15.6) | 4 (7) | 0.149 |
| Crude mortality [no. of patients (%)] | 6 (5.6) | 4 (7) | 0.898 |
| Attributable mortality [no. of patients (%)] | 3 (3.8) | 1 (1.7) | 0.882 |
| No. of patients administered antifungal agent (%) | |||
| Total | 72 | 53 | |
| Amphotericin B | 29 (40.2) | 19 (35.8) | 0.615 |
| Voriconazole | 20 (27.7) | 15 (28.3) | 0.949 |
| Other azoles | 11 (15.3) | 4 (7.4) | 0.189 |
| Others | 12 (16.66) | 15 (28.3) | 0.118 |
| Drug in association | 16 (20.8) | 22 (39.3) | 0.020 |
| Switch therapy | 19 (26) | 13 (23.6) | 0.814 |
| No. of patients with surgical intervention (%) | |||
| Total | 55 | 45 | |
| Laminectomy/discectomy | 5 (9) | 3 (6.66) | 0.948 |
| Debridement | 16 (29) | 19 (42.22) | |
| Amputation | 9 (16.3) | 4 (8.88) | |
| Drainage | 5 (9) | 5 (11.11) | |
| Excision | 4 (7.27) | 5 (11.11) | |
| Bone grafting/autotransplantation/fixation | 4 (7.27) | 2 (4.44) | |
| Joint proceduresc | 11 (20) | 6 (13.33) | |
| Insertion of prosthesis | 1 (0.2) | 1 (2.22) | |
| No. of patients with radiological feature (%) | |||
| MRI | |||
| Total | 48 | 36 | |
| Osteolytic lesion | 18 (37.5) | 15 | 0.998 |
| Compression | 2 (4.16) | 1 | |
| T1 low intensity | 6 (12.5) | 4 | |
| T2 enhancement | 10 (20.8) | 6 | |
| Effusion/fluid collection | 3 (6.25) | 3 | |
| Abscessd | 7 (14.6) | 5 | |
| Discitis | 1 (2.1) | 1 | |
| Malformation | 1 (2.1) | 1 | |
| Conventional radiography | |||
| Total | 42 | 30 | |
| Osteolytic destruction | 28 (66.7) | 15 (50) | 0.977 |
| Lucency | 4 (9.5) | 4 (13.3) | |
| Soft tissue swelling | 5 (11.9) | 5 (16.7) | |
| “Honeycomb” appearance | 1 (2.4) | 2 (6.6) | |
| Necrosis | 1 (2.4) | 1 (3.3) | |
| Decreased space | 2 (4.8) | 2 (6.6) | |
| Effusion | 1 (2.4) | 1 (3.3) | |
a
Metacarpophalangeal (n = 1), hip (n = 4), ankle (n = 5), cuneiform (n = 1), sternoclavicular (n = 1), and elbow (n = 1).
b
Some cases had more than one symptom.
c
Arthrotomy/synovectomy/arthrocentesis/arthroscopy/aspiration.
d
Epidural, paraspinal, psoas, and paravertebral.
e
See reference 1232. All data are expressed in absolute numbers (percentages) unless otherwise specified. Yates-corrected and Fisher’s exact chi-square tests were applied for low expected frequencies. The total numbers in several categories may be smaller than the total number of cases due to incomplete information in individual published reports.
f
ANC, absolute neutrophil count.