Epidemiology of Fungal Osteomyelitis

Fungal osteomyelitis is a severe and debilitating disease, affecting both immunocompetent and immunocompromised patients. Recent comprehensive reviews showed that the burden of fungal osteoarticular infections is steadily increasing due to the growing number of patients at risk. Candida osteomyelitis frequently affects non-immunosuppressed pediatric and adult patients. C. albicans and C. tropicalis are the predominant recovered species. Vertebral osteomyelitis is most common in adults, whereas femoral and humeral bones are typically infected in pediatric patients. Aspergillus osteomyelitis may develop in both immunocompromised and immunocompetent patients; the vertebral bodies and ribs are most frequently involved. Dimorphic osteoarticular infections occur in endemic areas. Some dimorphic fungi affect immunocompetent patients, while others develop in immune-impaired patients. Osteoarticular mucormycosis and fusariosis also principally develop in immunocompromised patients. Scedosporium bone infections may emerge in immunocompetent hosts with mycetoma or in immunocompromised patients with hematogenous dissemination. Cryptococcal osteomyelitis occurs in patients with predominantly impaired cellular immunity.