Fungal arthritis

• Alternative Names

  Mycotic arthritis

• Causes, incidence, and risk factors

  Fungal arthritis, also called mycotic arthritis, is a very rare condition. It can be caused by any of the invasive types of fungi. These organisms may affect bone or joint tissue. One or more joints may be affected, most often the large, weight-bearing joints, especially the knees.

  Conditions that can cause fungal arthritis include:

  • Blastomycosis
  • Candidiasis
  • Coccidioidomycosis
  • Cryptococcosis
  • Histoplasmosis
  • Sporotrichosis

  The infection sometimes occurs as a result of an infection in another organ such as the lungs, and tends to get worse very slowly. The large joints are most often affected. People with weakened immune systems who travel or live in endemic areas are more susceptible to most causes of fungal arthritis.

• Symptoms
  • Arthritis
  • Fever
  • Joint pain
  • Joint stiffness
  • Joint swelling
  • Swelling of the ankles, feet, and legs
• Signs and tests
  • Culture of joint fluid that grows fungus
  • Joint x-ray showing joint changes
  • Positive antibody test (serology) for fungal disease
  • Synovial biopsy showing fungus
• Treatment

  The goal of treatment is to cure the infection using antifungal drugs. The most commonly used antifungal drugs are amphotericin B or medications in the azole family (fluconazole, ketoconazole, or itraconazole).

  Chronic or advanced bone or joint infection may require surgery (debridement) to remove the infected tissue.

• Expectations (prognosis)

  What happens depends on the underlying cause of the infection and the patient's overall health. A weakened immune system, cancer, and certain medications can affect the outcome.

• Complications

  Joint damage can occur if the infection is not treated promptly.

• Calling your health care provider

  Call for an appointment with your health care provider if you have any symptoms of fungal arthritis.

• Prevention

  Thorough treatment of fungal infections elsewhere in the body may help prevent fungal arthritis.

• References

  Espinoza LR. Infections of bursae, joints, and bones. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 293.

  Ohl CA. Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 102.

Review Date: 12/1/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.