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      Periprosthetic hip joint infection with Aspergillus terreus: A clinical case and a review of the literature

      brief-report

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          Abstract

          Fungal periprosthetic joint infections due to Aspergillus species are rare but are associated with significant cost and morbidity. We present a case of Asperigillus terreus prosthetic joint infection of the hip. The patient was successfully treated with a prolonged course of systemic antifungals along with surgical management.

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          Treatment of infections associated with surgical implants.

          Rabih Darouiche (2004)
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            Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology.

            H Ashbee, Rosemary A. Barnes, Elizabeth Johnson … (2014)
            The burden of human disease related to medically important fungal pathogens is substantial. An improved understanding of antifungal pharmacology and antifungal pharmacokinetics-pharmacodynamics has resulted in therapeutic drug monitoring (TDM) becoming a valuable adjunct to the routine administration of some antifungal agents. TDM may increase the probability of a successful outcome, prevent drug-related toxicity and potentially prevent the emergence of antifungal drug resistance. Much of the evidence that supports TDM is circumstantial. This document reviews the available literature and provides a series of recommendations for TDM of antifungal agents.
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              Infections due to Aspergillus terreus: a multicenter retrospective analysis of 83 cases.

              Hasan S. Jafri, Paola Torres, Michail Lionakis … (2004)
              Current in vitro and in vivo data indicate that invasive aspergillosis due to Aspergillus terreus is resistant to treatment with amphotericin B. Because little clinical data are available to guide therapy, we performed a retrospective cohort study of cases of invasive A. terreus infections from 1997-2002 to determine whether the use of voriconazole, compared with use of other antifungal therapies, led to an improved patient outcome. We analyzed a total of 83 cases of proven or probable invasive A. terreus infection (47% and 53%, respectively). A total of 66.3% of patients (55 of 83) died during management of IA, with 55.8% mortality (19 of 34 patients) in the voriconazole group and 73.4% mortality (36 of 49) in the group that received therapy with other antifungals. By use of Cox proportional hazards modeling, decreased mortality at 12 weeks was observed in those patients who received voriconazole (hazard ratio, 0.29; 95% CI, 0.15-0.56). Voriconazole is likely to be a better treatment choice for A. terreus infection than is a polyene.
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                Author and article information

                Contributors
                Rachel Bartash
                Journal
                Journal ID (nlm-ta): Med Mycol Case Rep
                Journal ID (iso-abbrev): Med Mycol Case Rep
                Title: Medical Mycology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2211-7539
                Publication date PMC-release: 25 July 2017
                Publication date Collection: December 2017
                Publication date (Electronic): 25 July 2017
                Volume: 18
                Pages: 24-27
                Affiliations
                [a ]Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
                [b ]Department of Pharmacy, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
                [c ]Department of Orthopedic Surgery, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
                [d ]Microbiology Laboratory, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
                Author notes
                [* ]Corresponding author. rbartash@ 123456montefiore.org
                Article
                Publisher ID: S2211-7539(17)30043-X
                DOI: 10.1016/j.mmcr.2017.07.006
                PMC ID: 5544492
                PubMed ID: 28808616
                SO-VID: f70829c4-3ec5-4b67-bddb-05c8214767db
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 20 April 2017
                Date revision received : 19 July 2017
                Date accepted : 24 July 2017
                Categories
                Subject: Case Report

                Keywords: fungal prosthetic joint infection,aspergillus terreus
                Data availability:
                Keywords: fungal prosthetic joint infection, aspergillus terreus

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