Kobayashi finds, treats extremely rare fungal infection

Fungal periprosthetic joint infections (PJI) are essentially unheard of, contributing to only 1% of PJIs. Because they are so rare, fungal PJIs can be hard to identify and treat, leaving physicians without answers for their patients. However, fungal PJI is associated with significant cost and morbidity, especially among immunocompromised patients.

Takaaki Kobayashi, MD, third-year fellow in Infectious Diseases, examined causes, obstacles, and solutions to treating PJI. In collaboration with members from the Departments of Orthopedics and Pathology, Kobayashi published the case study in a recent issue of Open Forum Infectious Diseases titled “Prosthetic finger joint infection due to Aspergillus terreus.”

This case study centers around a 74-year-old woman who had a silicone left ring finger prosthetic joint implant. A month after her operation, she experienced redness, swelling, and pain at the surgical site. Microbiology lab notified Kobayashi and his mentor Poorani Sekar, MD, clinical assistant professor in Infectious Diseases, that culture of the joint tissue grew an unusual pathogen, Aspergillus terreus. The implant was removed by the orthopedic surgeon and the patient completed a course of antifungal medication. She is now infection-free and resumed day-to-day activities with no restrictions.

In the publication, Kobayashi clarifies that although fungal PJIs are rare, this particular fungus, Aspergillus terreus, is common in soil, compost, dust, and decaying plant matter. 

“In the case of the 74-year-old woman, a fairy garden that she made with soil and peat moss while her surgical wound was healing was how she likely acquired this rare fungal infection,” Kobayashi said. “An interesting tidbit is that lovastatin, a compound that lowers cholesterol, was first isolated from this fungus!”

Fortunately, in this case, the fungus was identified early and the patient was successfully treated with a joint effort between Infectious Diseases, Orthopedics, and Pathology departments. Kobayashi, et al. explain that although amphotericin B is one of the most commonly used antifungal drugs for severe infections, Aspergillus terreus is resistant to amphotericin B, so voriconazole is used as first-line therapy. 

Kobayashi and Sekar worked with Ericka Lawler, MD, clinical associate professor of Orthopedics; Hasan Samra, MD, Medical Microbiology fellow; and Bradley Ford, MD, PhD, clinical associate professor of Pathology and Microbiology. 

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