fungal arthritis
Introduction
Introduction to fungal arthritis Fungal arthritis, also known as mycotic arthritis, is rare in musculoskeletal diseases caused by fungal infections, but the occurrence of pathogenic and opportunistic fungal infections and the emergence of new fungal infections are increasing, especially in immunosuppressed patients, chronic evolution. And delays in diagnosis are commonplace. Fungi are common virulence factors for chronic granulomatous arthritis. Various fungi can cause bone and joint lesions. The most common fungi that invade the bone and bone system are Coccidioideimmitis, Histoplasma capsulatum, Blastomycetes dermatitis, and Sporothrixschenckii. And Candida, Aspergillus, Cryptococcus and Histoplasma of immune dysfunction. basic knowledge The proportion of patients: HIV, low immunity, the incidence rate is about 0.0005%-0.0009% Susceptible people: no specific population Mode of infection: non-infectious Complications: osteomyelitis
Cause
Cause of fungal arthritis
(1) Causes of the disease
Fungi are common virulence factors of chronic granulomatous arthritis. All kinds of fungi can cause bone and joint diseases. The most common fungi that invade the bone and bone system are Coccidioide immitis, Histoplasma capsulatum. ), Blastomycetes dermatitis, Sporotrichum schenckii and Candida, Aspergillus, Cryptococcus and Histoplasma of immune dysfunction.
(two) pathogenesis
The way in which fungi infect joints is rarely transmitted by bloodstream, mostly due to skeletal fungal lesions of adjacent joints, which directly spread to the joints. Sporozoites can also directly invade the joints through the skin and subcutaneously. Coccidioides inhaled from the respiratory tract. It can also enter the skin with minor skin damage, causing primary lung or skin infections.
Prevention
Fungal arthritis prevention
1. Eliminate and reduce or avoid the disease factors, improve the living environment, develop good living habits, prevent infection, pay attention to food hygiene, and rational diet.
2. Pay attention to exercise, increase the body's ability to resist disease, do not fatigue, excessive consumption, quit smoking and alcohol.
3. Early detection and early diagnosis and early treatment, establish confidence in the fight against disease, adhere to treatment.
4. Susceptible people, do a good job in labor protection.
Complication
Fungal arthritis complications Complications osteomyelitis
The systemic type of spores can be complicated by infection of the lungs and meninges. The buds can be complicated by osteomyelitis. Coccidioides can be combined with nodules of 2 to 3 cm in diameter in the middle and lower lobe, and half of them have osteomyelitis of adjacent joints.
Symptom
Fungal arthritis symptoms Common symptoms Nodular joint pain Soft tissue swelling Chest pain Skin involvement Wound infection Ineffective pustules
Most cases show chronic painless arthritis. Because the original lesions of the body attract the attention of patients and their families, the discomfort and swelling of the joints, the range of motion is reduced, and the symptoms such as a small amount of fluid are often ignored, sometimes until the joints It was noticed when the bone and cartilage were irreversibly damaged.
1. Candida is a normal parasite in the human body. When the body's resistance is significantly reduced, Candida will be transformed from parasitic bacteria into pathogens that invade the body. In recent years, patients with candidiasis have an increasing trend, almost every case. There are obvious factors that weaken the normal defense function of the human body. However, due to the advancement of medical level, the lesions of most patients can be controlled after active treatment. Candida arthritis mainly occurs in patients with disseminated candidiasis. In the knee joint, a considerable number of patients have multiple joint involvement.
2. Sporozoites are soil, wood, and plant saprophytic bacteria, which are widely found in nature. Sporotrichosis is a chronic granulomatous disease caused by S. sphaeroides. It is common in farmers, garden workers, because of skin. Stabs and other stab wounds, spores infected the body through skin wounds, the main pathological change is suppurative granulomatous reaction, this reaction can be seen in the skin nodules, in the affected lymph nodes, there are special three layers in typical nodular lesions Arranged, the center is a purulent layer containing neutrophils, the second layer is surrounded by a "tuberculosis-like" layer, and the third layer is a "ceramic cell" layer composed of lymphocytes and plasma cells.
Clinically, sporotrichosis is divided into two types: skin type and system type. The skin type is nodules, follicular pustules, plaques, warts, tumor-like lesions and ulcers; or tapes along the lymphatic vessels. Propagation, a typical band-like distribution, skin lesions are broad bean-sized granuloma, nodules, abscesses and ulcers, systemic manifestations of lung and meningeal infections, and the most common are violations of bones and joints.
The affected joints of sporozoite arthritis have more joints and upper extremities, which can be single or a few joints involved, or multiple joints. At the same time, there may be visceral and skin involvement. Arthritis is a subacute or chronic process. There is damage to the surrounding skin or sinus formation.
3. Dermatitis buds are widely distributed in nature, such as soil, wood, the pathogenesis of this disease often manifests as acute onset, systemic poisoning symptoms, fever, local suppuration and formation of sinus, arthritis and skin and lungs The damage often occurs at the same time. The affected joints are more common in the knee joint and the ankle joint. The pathogenesis is mostly caused by vaginal myeloinitis caused by blood-borne infection, and then the osteomyelitis extends to the joint and causes arthritis.
4. Coccidioidomycosis is an endemic disease, the pathogen is Coccidioides, and the conidia is highly contagious. It is reported that 80% of residents living in the southern United States and Mexico are infected for 5 years. This strain, only 75% of the carriers have no clinical symptoms, called asymptomatic, among those with symptoms, the light is similar to a cold, and the severe one may have fever, chest pain, cough, weakness, chest X-ray film, in the middle The lower lung lobe can be seen with 2 to 3 cm diameter nodules. After healing, the nodules are calcified. There are 0.1% to 0.2% carriers. Coccidioides spread in the body, invading the brain, meninges, digestive tract, muscles. Following the hair style, 20% of them invade bones and joints.
Most of the affected joints are single joints, which occur in the ankle joint, knee joint, wrist and elbow joint. Histopathology shows that suppuration and granuloma alternate with each other. The clinical manifestations are similar to other granulomatous arthritis, mainly characterized by joint pain. Swelling, X-ray film showed no significant changes except soft tissue swelling; a few had joint space stenosis; half of the adjacent joint bone osteomyelitis, joint damage process is slow, if not treated, can eventually cause permanent damage to the joint.
Examine
Examination of fungal arthritis
Fungal arthritis can find pathogenic fungi in synovial membrane and joint fluid. Synovial tissue culture has a higher positive rate than joint fluid culture. For example, candida disease and sporotrichosis are mostly positive for synovial pathogen culture.
X-ray film, manifested as osteolysis or osteolysis and bone sclerosis at the same time, but X-ray performance is difficult to distinguish from other granulomatous arthritis, such as candidiasis X-ray examination can be seen 2 / 3 patient proximity There is osteomyelitis at the joint, and the positive culture of the synovial fluid pathogen can establish a diagnosis.
Diagnosis
Diagnosis and diagnosis of fungal arthritis
The diagnosis of fungal arthritis relies on the discovery of pathogenic fungi in the synovial membrane and joint fluid. Synovial tissue culture has a higher positive rate than joint fluid culture, and smear and culture should avoid contamination to avoid interference judgment.
1. X-ray examination of candidiasis can be seen in 2/3 patients with osteomyelitis adjacent to the joint, and positive culture of synovial fluid pathogen can establish a diagnosis.
2. The fungus can be confirmed by the culture of fungi in the synovial or synovial tissue of sporotrichosis. The granuloma synovitis can be seen by histological examination, but the cigar-shaped bacteria are rarely seen directly.
3. The germination of arthritis is difficult to distinguish from tuberculous arthritis in clinical practice, and it is necessary to rely on the isolation of pathogenic bacteria to determine the diagnosis.
It is necessary to pay attention to the difference between tuberculous arthritis and relying on the isolation of pathogens and histological examination to determine the diagnosis.
