https://orcid.org/0000-0003-1117-9360
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Damien Blez, Didier Bronnimann, Blandine Rammaert, Valérie Zeller, Laurence Delhaes, Laurent Hustache, Frédéric Grenouillet, Nicolas Traversier, Julie Bonhomme, Taieb Chouaki, Thomas Perpoint, Florence Persat, Marie Elisabeth Bougnoux, Sophie Bayle, Luc Quaesaet, Gilles Nevez, David Boutoille, Florent Morio, Laurence Pougnet, Viviane Queyrel-Moranne, B́eate Heym, Romain Guillemain, Éric Dannaoui, Antoine Roux, Dea Garcia-Hermoso, Fanny Lanternier, Invasive bone and joint infections from the French Scedosporiosis/lomentosporiosis Observational Study (SOS) cohort: no mortality with long-term antifungal treatment and surgery, Medical Mycology, Volume 61, Issue 3, March 2023, myad023, https://doi.org/10.1093/mmy/myad023
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Abstract
Little is known about localized osteoarticular Scedosporiosis (LOS). Most data come from case reports and small case series. Here we present an ancillary study of the nationwide French Scedosporiosis Observational Study (SOS), describing 15 consecutive cases of LOS diagnosed between January 2005 and March 2017. Adult patients diagnosed with LOS defined by osteoarticular involvement without distant foci reported in SOS were included. Fifteen LOS were analyzed. Seven patients had underlying disease. Fourteen patients had prior trauma as potential inoculation. Clinical presentation was arthritis (n = 8), osteitis (n = 5), and thoracic wall infection (n = 2). The most common clinical manifestation was pain (n = 9), followed by localized swelling (n = 7), cutaneous fistulization (n = 7), and fever (n = 5). The species involved were Scedosporium apiospermum (n = 8), S. boydii (n = 3), S. dehoogii (n = 1), and Lomentospora prolificans (n = 3). The species distribution was unremarkable except for S. boydii, which was associated with healthcare-related inoculations. Management was based on medical and surgical treatment for 13 patients. Fourteen patients received antifungal treatment for a median duration of 7 months. No patients died during follow-up. LOS exclusively occurred in the context of inoculation or systemic predisposing factors. It has a non-specific clinical presentation and is associated with an overall good clinical outcome, provided there is a prolonged course of antifungal therapy and adequate surgical management.
Lay Summary
Localized osteoarticular scedosporiosis mostly occurs following direct inoculation. Management was most often based on voriconazole therapy and concomitant surgery. Unlike other invasive scedosporiosis, no patient died during follow-up.
