Fungal Arthritis

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

Symptoms of Rheumatoid Arthritis

Fungal arthritis facts

  • Fungal arthritis is inflammation of a joint by a fungus microorganism that has invaded the body and is growing in the normally sterile joint.
  • Fungal arthritis can be caused by the spread of fungus through the bloodstream or by directly inserting fungus into a joint.
  • Fungal arthritis in people with normal immune systems is rare.
  • Symptoms of fungal arthritis include pain, heat, swelling, warmth, redness, and loss of range of motion of the affected joint.
  • Fungal arthritis is diagnosed by analyzing affected joint fluid.
  • Fungal arthritis is treated with antibiotics that are directed against the precise fungal microbe that is causing the joint infection.
  • The outlook for fungal arthritis is directly related to how much damage occurs to the cartilage and bone of the joint. Earlier treatment leads to optimal outcomes.

What is fungal arthritis?

Fungal arthritis is inflammation of a joint by a fungus microorganism that has invaded the body and is growing in the normally sterile joint. Fungal infection of a joint is a serious condition that can lead to permanent damage to the joint with loss of function. Fungal arthritis is also referred to as mycotic arthritis.

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Fungal Arthritis Symptoms & Signs

Swollen Joint

Swollen joints refers to the enlargement of the joints, usually as a result of an inflammatory process or injury to the joint or to surrounding structures. Joint swelling may be accompanied by other symptoms, including stiffness, pain, redness, warmth, and apparent loss of range of motion of the joint. Depending upon the exact cause, swollen joints may occur singly, or multiple joints in the body may be involved at one time. The many arthritis conditions are a common cause of swollen joints.

What causes fungal arthritis?

Fungal arthritis is usually caused by the fungus traveling through the bloodstream to reside in the joint. This manner of infection through the blood is referred to as hematogenous spread.

Alternatively, if medication that is contaminated by fungus is directly injected into the joint, fungal arthritis can result. This manner of infection by directly injecting the fungus into the joint is referred to as exogenous inoculation. Rarely, fungal infection can result from a contaminated prosthesis used in joint replacement surgery.

Fungal organisms that can cause fungal arthritis include Candida, Aspergillus, and Exserohilum species.

What are risks for developing fungal arthritis?

Fungal arthritis in people with normal immune systems is rare. One risk for developing fungal arthritis in such people is the accidental injection of medications that are contaminated with fungus microbes in the vials used. This, in fact, was the situation when contaminated vials of medications produced by a compounding pharmacy (New England Compounding Center) caused a multistate outbreak of rare fungal meningitis and fungal arthritis in September 2012.

People with abnormally suppressed immune systems are at risk for fungal infections, including fungal arthritis. This includes people with severely low white blood counts (neutropenia), HIV infection, injection drug abusers, and those taking chronic cortisone medication.

What are fungal arthritis symptoms and signs?

Symptoms of fungal arthritis include pain, heat, swelling, warmth, redness, and loss of range of motion of the affected joint. The most common joint to develop fungal arthritis is the knee joint. Fever may or may not be present.

Symptoms of fungal arthritis typically become manifest weeks to months after the initial infection of the joint. Ultimately, fungal arthritis can potentially permanently damage the involved joint.

What specialists treat fungal arthritis?

Fungal arthritis is a medical emergency. It is treated by infectious-disease specialists together with orthopedic surgeons.

How do health-care professionals diagnose fungal arthritis?

Fungal arthritis is considered when a patient whose immune system is compromised develops inflammation of a joint. Blood tests can include testing the blood for the white blood count, inflammation markers (sedimentation rate, or ESR, and C-reactive protein, or CRP), and cultures of the blood. Plain X-ray images, CAT scanning, and/or MRI scanning can be used to determine the character and extent of joint damage. Ultimately, joint fluid is aspirated from the joint with a needle and syringe and this fluid is analyzed in the laboratory to culture the precise fungal organism and establish the diagnosis.

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What is the treatment for fungal arthritis?

Fungal arthritis is treated with antibiotics that are directed against the precise fungal microbe that is causing the joint infection. Examples of antibiotics for fungal arthritis include amphotericin B, fluconazole (Diflucan), and caspofungin (Cancidas). Adequate drainage of the infected joint is an additional essential part of the treatment. This generally requires orthopedic surgical procedures.

Are there home remedies for fungal arthritis?

No. There are no home remedies for fungal arthritis.

What is the prognosis of fungal arthritis?

The outlook for fungal arthritis is directly related to how much damage occurs to the cartilage and bone of the joint. Earlier treatment leads to optimal outcomes.

Is it possible to prevent fungal arthritis?

Fungal arthritis can be prevented by minimizing the risks of immune suppression and avoiding intravenous drug abuse. Fungal arthritis can also be prevented by active sterilization measures by companies producing injectable medications.

REFERENCE:

Kauffman, Carol. "Candida Osteoarticular Infections." UpToDate.com. Feb. 2013.

Last Editorial Review: 9/2/2016

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Reviewed on 9/2/2016
References
REFERENCE:

Kauffman, Carol. "Candida Osteoarticular Infections." UpToDate.com. Feb. 2013.

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