Blez Damien, Bronnimann Didier, Rammaert Blandine, Zeller Valérie, Delhaes Laurence, Hustache Laurent, Grenouillet Frédéric, Traversier Nicolas, Bonhomme Julie, Chouaki Taieb, Perpoint Thomas, Persat Florence, Bougnoux Marie Elisabeth, Bayle Sophie, Quaesaet Luc, Nevez Gilles, Boutoille David, Morio Florent, Pougnet Laurence, Queyrel-Moranne Viviane, Heym B Eate, Guillemain Romain, Dannaoui Éric, Roux Antoine, Garcia-Hermoso Dea, Lanternier Fanny
Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France.
Service des pathologies infectieuses et tropicales, Université de Paris, Paris, Île-de-France, France.
Med Mycol. 2023 Mar 2;61(3). doi: 10.1093/mmy/myad023.
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.
关于局限性骨关节炎性足分支霉病（LOS），人们了解甚少。大多数数据来自病例报告和小型病例系列。在此，我们展示了一项针对法国全国性足分支霉病观察研究（SOS）的辅助研究，描述了2005年1月至2017年3月期间连续确诊的15例LOS病例。纳入了在SOS中诊断为LOS且有骨关节炎受累但无远处病灶的成年患者。对15例LOS进行了分析。7例患者有基础疾病。14例患者有先前创伤作为潜在接种途径。临床表现为关节炎（n = 8）、骨炎（n = 5）和胸壁感染（n = 2）。最常见的临床表现是疼痛（n = 9），其次是局部肿胀（n = 7）、皮肤瘘管形成（n = 7）和发热（n = 5）。涉及的菌种有波氏足分支霉（n = 8）、博伊德足分支霉（n = 3）、德霍氏足分支霉（n = 1）和多育裂孢壳霉（n = 3）。除博伊德足分支霉与医疗相关接种有关外，菌种分布无明显异常。13例患者的治疗基于药物和手术治疗。14例患者接受了抗真菌治疗，中位疗程为7个月。随访期间无患者死亡。LOS仅在接种或全身易感因素的情况下发生。它具有非特异性临床表现，并且只要有延长的抗真菌治疗疗程和充分的手术管理，总体临床结局良好。
