Fungal Arthritis
March 15, 2008 by Dr Arun Pal Singh
Filed under Musculoskeletal Infections
Fungi are an unusual and rare cause of chronic monarticular arthritis. Granulomatous articular infection with the endemic dimorphic fungi Coccidioides immitis, Blastomyces dermatitidis, and Histoplasma capsulatum results from hematogenous seeding or direct extension from bony lesions in persons with disseminated disease.
A normal person is quite resistant to fungal infection. Fungal infection occurs when immunity of the person is low due to some reason
Joint involvement is an unusual complication of sporotrichosis among gardeners and other persons who work with soil or sphagnum moss. Articular sporotrichosis is six times more common among men than among women, and alcoholics and other debilitated hosts are at risk polyarticular infection.
Candida infection involving a single joint, usually the knee, hip, or shoulder, results from surgical procedures, intraarticular injections, or among critically ill patients with debilitating illnesses such as diabetes mellitus or hepatic or renal insufficiency and patients receiving immunosuppressive therapy hematogenous spread.
Candida infections in intravenous drug users typically involve the spine, sacroiliac joints, or other fibrocartilaginous joints. Unusual cases of arthritis due to Aspergillus species, Cryptococcus neoformans, Pseudallescheria boydii, and the dematiaceous fungi have also resulted from direct inoculation or disseminated hematogenous infection in immunocompromised persons.
Diagnosis
The synovial fluid in fungal arthritis usually contains 10,000 to 40,000 cells/µL, with about 70 percent neutrophils. Stained specimens and cultures of synovial tissue often confirm the diagnosis of fungal arthritis when studies of synovial fluid give negative results.
Treatment
Treatment consists of drainage and lavage of the joint and systemic administrations of amphotericin B, fluconazole, or itraconazole (the exact drug depending on the species involved). The doses and duration of therapy are the same as for disseminated disease. Intraarticular instillation of amphotericin B has been used in addition to intravenous therapy.
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