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播散性真菌感染的肌肉骨骼表现

Musculoskeletal Manifestations of Disseminated Fungal Infections.

作者信息

Koul Akash, Traversone John, Light Jonathan J, Chaturvedi Sudha, Daniel Jency, Rosenbaum Andrew

机构信息

Albany Medical College, Albany, New York.

Department of Orthopaedic Surgery, Albany Medical College, Albany, New York.

出版信息

JB JS Open Access. 2025 Sep 17;10(3). doi: 10.2106/JBJS.OA.25.00095. eCollection 2025 Jul-Sep.

Abstract

» Disseminated musculoskeletal fungal infections, though rare, present significant diagnostic and therapeutic challenges, affecting both immunocompromised and previously healthy individuals. » Ubiquitous species (spp.) such as , , and contrast with dimorphic fungi, including , spp., and spp., which are endemic to specific regions. » These infections typically present insidiously, with non-specific symptoms such as fever, joint pain, and swelling that mimic autoimmune, bacterial, or viral diseases, often leading to delayed diagnosis. » Initial evaluation often includes radiographs, which may reveal lytic bone lesions, particularly in the metaphyses of long bones, as well as in less conspicuous sites such as the talus and cuboid. Even with this information, a definitive diagnosis still requires histological or microbiological evidence prior to initiating some antifungal treatments. » This review synthesizes current knowledge on disseminated musculoskeletal fungal infections, emphasizing their epidemiology, pathogenesis, clinical manifestations, diagnostic strategies, and treatment.

摘要

播散性肌肉骨骼真菌感染虽然罕见,但会给诊断和治疗带来重大挑战,影响免疫功能低下者和既往健康的个体。无处不在的菌种,如曲霉属、念珠菌属和毛霉属,与双相真菌形成对比,双相真菌包括组织胞浆菌属、球孢子菌属菌种和芽生菌属菌种,它们在特定地区流行。这些感染通常隐匿出现,伴有发热、关节疼痛和肿胀等非特异性症状,这些症状与自身免疫性、细菌性或病毒性疾病相似,常常导致诊断延迟。初步评估通常包括X光片,X光片可能显示溶骨性骨病变,特别是在长骨的干骺端,以及在距骨和骰骨等不太明显的部位。即使有这些信息,在开始某些抗真菌治疗之前,明确诊断仍需要组织学或微生物学证据。本综述综合了关于播散性肌肉骨骼真菌感染的现有知识,重点介绍了它们的流行病学、发病机制、临床表现、诊断策略和治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba94/12431750/4976c13ae7a1/jbjsoa-10-e25.00095-g001.jpg

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