Arthritis bei Pilzerkrankungen

Zusammenfassung

Pilzinfektionen gehören in der klinischen Praxis nicht selten zu differenzialdiagnostischen Problemfällen. Ein Grund dafür ist das häufige Fehlen charakteristischer Symptome im Frühstadium. Dazu kommen noch Schwierigkeiten des spezifischen Erregernachweises. Pilzinfektionen können osteoartikuläre Erkrankungen verursachen, deren zu späte Erkennung zu bleibender Schädigung der Gelenke und ihrer Funktion führt. Allerdings kommen Pilzarthritiden nicht oft vor.

Zu den häufigsten Fungusarthritiden zählen: Candidiasis, Kokzidioidomykose, Blastomykose und Sporotrichose. Seltenere Verursacher von Arthritiden sind Histoplasmose, Kryptokokkose und Aspergillose. Noch seltenere Pilzarthritiden gewinnen mit Zunahme von Immunschwächen an Bedeutung.

Verschiedene auslösende Faktoren, auch als Risikofaktoren bezeichnet, spielen bei der Entstehung von Pilzinfektionen und/oder Fungusarthritiden eine bedeutende Rolle. Es handelt sich dabei meistens um Krankheiten oder Formen der Behandlung, die eine Immunschwäche verursachen. Hierzu gehören Alkoholkrankheit, Leberzirrhose, Diabetes mellitus, Tuberkulose, Neoplasien, Organtransplantationen, AIDS (Acquired Immune Deficiency Syndrome) und Medikamente wie Kortikosteroide, Immunsuppressiva und neuerdings TNF-alpha-Blocker. Alle diese Risikofaktoren können zur Schwächung des Immunsystems beitragen und die Aussaat einer Pilzinfektion verursachen.

Summary

Fungal infections are among those not readily recognized differential diagnostic problems. The causative organism of most fungal infections is not easy to be demonstrated. Fungal infections can trigger chronic bone and joint disease whose late diagnosis may result in permanent damage to the joint and its function. Certainly, fungal arthritis is not so frequent.

The most common fungal arthritides are considered to be Candidiasis, Coccidioidomycosis, Blastomycosis, and Sporotrichosis. Less frequent causes are Histoplasmosis, Cryptococcosis and Aspergillosis followed by some very rare fungal joint manifestations with the increasingly failing immune response.

Various predisposing factors (risk factors) have been implicated in a majority of patients developing fungal infections and/or fungal arthritis. Alcoholism, cirrhosis of the liver, diabetes mellitus, tuberculosis, cancer, organ transplants, AIDS (Acquired Immune Deficiency Syndrome), and drugs like corticosteroids, immunosuppressive substances, and tumor necrosis factor alpha inhibitors are known to suppress the immune response. They play an important role in the dessimination of fungal infections.

Schlüsselwörter

Pilzinfektionen (Fungusinfektionen) - Pilzarthritis (Fungus-arthritis)

Keywords

Fungal infections - fungal arthritis

• Literatur

• 1 Abril A., Campbell MD., Cotten VR.. et al Polyarticular Blastomycotic arthritis. J Rheumatol 1998; 25: 1019-21.
• 2 Almekinders LC., Greene WB.. Vertebral Candida infections: A case report and review of the literature. Clin Orthop 1991; 267: 174-8.
• 3 Al-Tawfiq JA., Wools KK.. Disseminated Sporotrichosis and Sporothrix schenckii fungemia as the initial presentation of immunodeficiency infection. Clin Infect Dis 1998; 26: 1403-6.
• 4 Andriole VT.. Aspergillus infections: Problems in diagnosis and treatment. Infect Agents Dis 1996; 5: 47-54.
• 5 Barson WJ., Marcon MJ.. Successful therapy of Candida albicans arthritis with a sequential intravenous amphotericin B and oral fluconazole regimen. Pediatr Infect Dis J 1996; 15: 1119-22.
• 6 Bayer AS., Guze LB.. Fungal arthritis. I. Candida arthritis: Diagnostic and prognostic implications and therapeutic considerations. Semin Arthritis Rheum 1978; 8: 142-50.
• 7 Bayer AS., Guze LB.. Fungal arthritis. II. Coccidioidal synovitis: Clinical, diagnostic, therapeutic, prognostic considerations. Semin. Arthritis Rheum 1979; 8: 200-11.
• 8 Bayer AS., Choi C., Tillman D.. et al Fungal arthritis. V. Cryptococcal and Histoplasmal arthritis. Semin Arthr Rheum 1980; 9: 218-27.
• 9 Bayer AS., Scott VJ., Guze LB.. Fungal arthritis. III. Sporotrichal arthritis. Semin Arthritis Rheum 1979; a 9: 66-74.
• 10 Bayer AS., Scott VJ., Guze IV LB.. Fungal arthritis. Blastomycosis arthritis. Semin Arthritis Rheum 1979; b 9: 145-51.
• 11 Bayer AS., Yoshikawa TT., Galpin JE.. et al Unusual syndromes of Cocccidioidomycosis. Medicine (Baltimore) 1976; 55: 131-52.
• 12 Behar SM., Chertow GM.. Olecranon bursitis caused by infection with Candida lusitaniae. J Rheumatol 1998; 25: 598-600.
• 13 Behrman RE., Masci JR., Nicholas P.. Cryptococcal skeletal infections: Case report and review. Rev Infect Dis 1990; 12: 181-90.
• 14 Bisbe J., Miro JM., Latorre X.. et al. Disseminated Candidiasis in addicts who use brown heroin: Report of 83 cases and review. Clin Infect Dis 1992; 15: 910-23.
• 15 Blankenship JR., Singh N., Alexander BD.. et al Cryptococcus neoformans isolates from transplant recipients are not selected for resistance to calcineurin inhibitors by current immunosuppressive regimens. J Clin Microbiol 2005; 43: 464-7.
• 16 Bocanegra TS.. Mycobacterial, Brucella, Fungal and Parasitic arthritis. In Klippel JH., Dieppe PA.. Hrsg. Rheumatology. London: Mosby; 1997: 6.4.1-6.4.12.
• 17 Bolao F., Podzameczer D., Ventin M.. et al Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with Sporotrichosis. Eur J Clin Microbiol Infect Dis 1994; 13: 609-12.
• 18 Botterel F., Romand S., Saliba F.. et al A case of disseminated Histoplasmosis likely due to infection from a liver allograft. Eur J Clin Microbiol Infect Dis 1999; 18: 662-4.
• 19 Bradsher RW.. Therapy of Blastomycosis. Semin Respir Infect 1997; 12: 263-7.
• 20 Bradsher RW., Chapman SW., Pappas PG.. Blastomycosis. Infect Dis Clin North Am 2003; 17: 21-40.
• 21 Bried JM., Galgiani JN.. Coccidioidosis immitis infections in bones and joints. Clin Orthop 1986; 211: 235-43.
• 22 Bruno KM., Farhoomand L., Libman BS.. et al Cryptococcal arthritis, tendinitis, tenosynovitis, and carpal tunnel syndrome: Report of a case and review of the literature. Arthritis Rheum 2002; 47: 104-8.
• 23 Cairns L., Blythe D., Kao A.. et al Outbreak of Coccidioidomycosis in Washington state residents returning from Mexico. Clin Infect Dis 2000; 30: 61-4.
• 24 Campisi E., Mancianti F., Pini G.. et al Investigation in Central Italy of the possible association between Cryptococcus neoformans var. gattii and eucalyptus camaldulensis. Eur J Epidemiol 2003; 18: 357-62.
• 25 Castagnola E., Bucci B., Montinaro E.. et al Fungel infections in patients undergoing bone marrow transplantation: An aproach to a rational menagement protocol. Bone Marrow Transplant 1996; 18 (Suppl. 02) Suppl 97-106.
• 26 Chapman SW., Bradsher RW., Campbell GD.. et al Practice guidelines for the management of patients with Blastomycosis. Clin Infect Dis 2000; 30: 697-83.
• 27 Chapman SW., Lin AC., Hendricks A.. et al. Endemic Blastomycosis in Mississippi: Epidemiological and clinical studies. Semin Respir Infect 1997; 12: 21928.
• 28 Chaturvedi V., Ramani R., Gromadzki S.. et al Cocidioidomycosis in New York State. Emerg. Infect. Dis. 2000; 6: 25-9.
• 29 Centers for Disease Control and Prevention. Coccidioidomycosis in travelers returning for Mexico– Pennsylvania. JAMA 2000; 284: 2990-1.
• 30 Centers for Disease Control and Prevention. Coccidioidomycosis in workers at an archaeologic site – Dinosaur National Monument, Utha. Morb Mortal Wkly Rep 2001; 50: 1005-8.
• 31 Class RN., Cascio FS.. Histoplasmosis presenting as acute polyarthritis. N Engl J Med 1972; 287: 1133-4.
• 32 Cohen IM., Galgiani JN., Potter D.. et al Coccidioidomycosis in renal replacement therapy. Arch Intern Med 1982; 142: 489-94.
• 33 Cole GT., Sun SH.. Arthroconidium – Spherule – Endospore Transformation in Coccidioido-mycosis immitis. In Szanizlo PJ.. Hrsg. Fungal Dimorphism. New York: Plenum Publishing Corporation; 1985: 281.
• 34 Collignon PJ., Sorrell TC.. Disseminated Candidiasis: Evidence of a distinctive syndrome in heroin abusers. Brit Med J 1983; 287: 861-2.
• 35 Crout JE., Brewer NS., Tompkin RB.. Sporotrichosis arthritis: Clinical features in seven patients. Ann Intern Med 1977; 86: 294-7.
• 36 Cuellar ML., Silveira LH., Espinoza LR.. Fungal arthritis. Ann Rheum Dis 1992; 51: 690-7.
• 37 Davies SF., Khan M., Sarosi GA.. Disseminated Histoplasmosis in immunologically suppressed patients. Am J Med 1978; 64: 64-94.
• 38 Darouiche RO., Cadle RM., Zenon GJ.. et al Articular Histoplasmosis. J Rheumatol 1992; 19: 1991-3.
• 39 Deepe GS., Bullock WE.. Histoplasmosis: A Granulomatous Inflammatory Response. In Gallin JL., Goldstein IM., Snyderman R.. Hrsg. Inflammation: Basic Principles and Clinical Correlates. New York: aven Press; 1988: 733.
• 40 Desai SA., Minai OA., Gordon SM.. et al Coccidioidomycosis in non-endemic areas: A case series. Respir Med 2005; 95: 305-9.
• 41 Dupont B., Drouhet E.. Cutaneous, ocular and osteoarticular Candidiasis in heroin addicts: New clinical and therapeutic aspects in 38 patients. J Infect Dis 1985; 152: 577-91.
• 42 Ehrlich GE.. Fungal arthritis. JAMA 1978; 240: 563.
• 43 Ellis D., Pfeiffer T.. The ecology of Cryptococcus neoformans. Eur J Epidemiol 1992; 8: 321-5.
• 44 Ellis M.. Fungal endocarditis. J Infect 1997; 35: 99-103.
• 45 Espinoza LR., Bergen-Losee LL.. Basic Pathogenic Considerations. In Espinoza L., Goldenberg D., Arnett F., Alarcon G.. Hrsg. Infections in the Rheumatic Diseases. Orlando-New York: Grune & Stratton; 1988: 125-9.
• 46 Feld R., Fornasier NL., Bombardier C.. et al Septic arthritis due to Saccharomyces species in a patient with chronic rheumatoid arthritis. J Rheumatol 1982; 9: 637-40.
• 47 Ferra C., Doebbeling BN., Hollis RJ.. et al Candida tropicalis vertebral osteomyelitis: A late sequelae of fungemia. Clin Infect Dis 1994; 19: 697-703.
• 48 Fiese MJ.. Coccidioidomycosis. Charles C. Thomas, Springfield, Illinois 1958
• 49 Fish DG., Ampel NM., Galgiani JN.. et al Cocci-dioidomycosis during human immunode-ficiency virus infection. A review of 77 patients. Medicine (Baltimore) 1990; 69: 384-391.
• 50 Formadley JA., Parker GS., Rickman LS.. Candida myositis manifesting as a discrete neck mass. Otolaryngol Head Neck Surg 1990; 102: 74-6.
• 51 Friedman SJ., Black JL., Duffy J.. Histoplasmosis presenting as erythema multiforme and polyarthritis. Cutis 1984; 34: 396-8.
• 52 Galgiani JN., Cantanzaro A., Cloud GA.. et al Comparison of oral fluconazole and itraconazole for progressive, non-meningeal Coccidioidomycosis: A randomized, double-blind trial. Ann Intern Med 2000; 133: 676-86.
• 53 Gardella S., Nomeden B., Bombi JA.. et al Fatal fungemia with arthritis involvement caused by Trichosporon beigelii in a bone marrow transplant receipient (letter). J Infect Dis 1985; 151: 566.
• 54 Gathe JC., Harris RL., Garland B.. et al Candida osteomyelitis: Report of five cases and review of the literature. Am J Med 1987; 82: 927-37.
• 55 Goodwin RA., Shapiro JL., Thurman GH.. et al Disseminated Histoplasmosis: Clinical and pathologic correlations. Medicine (Baltimore) 1980; 59: 1-33.
• 56 Graybill JR., Stevens DA., Galgiani JN.. et al Itraconazole treatment of Coccidioidomycosis. Am J Med 1990; 89: 282-90.
• 57 Guerrero A., Torres P., Duran MT.. et al Airborne outbreak of nosocomial Scedosporium prolificans infection. Lancet 2001; 357: 1267-8.
• 58 Hall KA., Sethi GK., Rosado LJ.. et al Coccidioidomycosis and heart transplantation. J Heart Lung Transplant. 1993; 12: 525-6.
• 59 Halverson B., Lahiri S., Wojno WC.. et al Sporotrichal arthritis presenting as granulomatous myositis. Arthritis Rheumatism 1985; 28: 1425-9.
• 60 Harrell E., Honeycutt WM.. Cocidioidomycosis – A traveling fungus disease. Arch. Derm 1963; 87: 98-106.
• 61 Harrington JT.. Mycobacterial and Fungel Infections. In Harris ED., Budd GS., Genovese MC.. et al. Hrsg. Kelley’s Textbook of Rheumatology. 7th Edition. Philadelphia: Elsevier Saunders; 2005: 1646-60.
• 62 Hendrickx L., Van Wijngaerden E., Samson I.. et al Candida vertebral osteomyelitis: Report of 6 patients, and a review. Clin Infect Dis 2001; 32: 527-33.
• 63 Hennequin C., Bonree P., Hiesse C.. et al Spondylodiscitis due to Candida albicans : Report of two patients who were successfully treated with fluconazole and review of the literature. Clin Infect Dis 1996; 23: 176-8.
• 64 Holt CD., Winston DJ Kubak. et al Coccidioidomycosis in liver transplant patients. Clin Infect Dis 1997; 24: 216-21.
• 65 Jakle C., Leek JC., Olson DA.. et al Septic arthritis due to Fusarium solani. J Rheumatol 1983; 10: 151-3.
• 66 Johnson WM.. Cocidioidomycosis mortalitiy in Arizona. In Ajello L.. Hrsg. Coccidioidomycosis – Current Clinical and Diagnostic Status. Miami: Symposia Specialists; 1977: 33.
• 67 Johnson JE., Perry JE., Fekety FR.. et al Laboratory-acquired Coccidioidomycosis: A report of 210 cases. Ann Intern Med 1964; 60: 941-56.
• 68 Jones PG., Rolston K., Hopfer RL.. Septic arthritis due to Histoplasma capsulatum in a leukaemic patient. Ann Rheum Dis 1985; 44: 128-9.
• 69 Joshi S., Wattal C., Duggal L.. et al Cutaneous Cryptococcosis. J Assoc Physicians India 2004; 52: 242-3.
• 70 Kaell AT., Weitzman I.. Acute monarticular arthritis due to Phialospora parasitica. Am J Med 1983; 74: 519-22.
• 71 Katzenstein D.. Isolated Candida arthritis: Report of a case and definition of a distinct clinical syndrome. Arthritis Rheum 1985; 28: 1421-4.
• 72 Kaufman CA.. Old and new therapies for Sporotrichosis. Clin Infect Dis 1995; 21: 981-5.
• 73 Kauffman CA.. Sporotrichosis. Clin Infect Dis 1999; 29: 231-7.
• 74 Kauffman CA., Hajjeh R., Chapman SW.. Practice guidelines for management of patients with Sporotrichosis. Clin Infect Dis 2000; 30: 684-7.
• 75 Kauffmann CA., Pappas PG., McKinsey DS.. et al. Treatment of lymphocutaneous and visceral Sporotrichosis with fluoconazole. Clin Infect Dis 1996; 22: 46-50.
• 76 Key JA., Large AM.. Histoplasmosis of the knee. J Bone Joint Surg 1942; 24: 281-90.
• 77 Khan MI., Goss G., Gottsman A.. et al Sprorotrichosis arthritis. S A Med J 1983; 64: 1099-1101.
• 78 Klein BS., Vergeront JM., Davis JP.. Epidemiologic aspects of Blastomycosis, the enigmatic systemic mycosis. Semin Respir Infect 1986; 1: 29-39.
• 79 Klein BS., Vergeront JM., DiSalvo AF.. et al. Two outbreaks of Blastomycosis along rivers in Wisconsin: Isolation of blasomyces dermatitidis from riverbank soil and evidence of its transmission along waterways. Am Rev Respir Dis 1987; 136: 1333-8.
• 80 Klein BS., Vergeront JM., Weeks RJ.. et al. Isolation of Blastomyces dermatitidis in soil associated with a large outbreak of blastomycosis in Wisconsin. N Engl J Med 1986; a 314: 520-34.
• 81 Köhler L., Jendro MC., Zeidler H.. Infektionsätiologie und -pathogenese. In: Zeidler-Zacher-Hiepe, Hrsg. Interdisziplinäre klinische Rheumatologie. Berlin-Heidelberg: Springer; 2001: 90-102.
• 82 Kontoyiannia DP., Bodey GP.. Invasive Aspergilossis in 2002. An update. Eur J Microbiol Dis 2002; 21: 161-72.
• 83 Kretschmar M., Hof H Pilze. In Hof H., Müller RL., Dörries R.. Hrsg. Mikrobiologie. Stuttgart: Thieme; 2000: 457-88.
• 84 Kwon-Chung KJ., Bennett JE.. Sporotrichosis. In: Medical Mycology. Philadelphia: Lea & Febiger; 1992: 707.
• 85 Kwon-Chung KJ., Sorrell TC., Dromet F.. et al. Cryptococcosis: Clinical and biological aspects. Med Mycol 2000; 38 (Suppl. 01) Suppl 205-13.
• 86 Lafont A., Olive A., Gelman M.. et al Candida albicans spondylodiscitis and vertebral osteomyelitis in patients with intravenous drug addiction: Report of 3 new cases. J Rheumatol 1994; 21: 953-6.
• 87 Lee J-H, Slifman NR., Gershon SK.. et al Life-threatening Histoplasmosis complicating immunotherapy with tumor necrosis factor alpha antagonists infliximab and etanercept. Arthritis Rheum 2002; 46: 2565-70.
• 88 Levitz SM.. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev Infect Dis 1991; 13: 1163-9.
• 89 Limaye AP., Connolly PA., Sagar M.. et al Transmission of Histoplasma capsulatum by organ transplantation. N Engl. J Med 2000; 343: 1163-6.
• 90 Lonky SA., Catanzaro A., Moser KM.. et al Acute Coccidioidal pleural effusion. Am. Rev. Resp. Dis. 1976; 114: 681-8.
• 91 Louthrenoo W., Thamprasert K., Sirisanthana T.. Osteoarticular Penicilliosis marneffei: A report of eight cases and review of the literature. Br J Rheumatol 1994; 33: 1145-50.
• 92 Lynch PJ., Voorhees JJ., Harrell ER.. Systemic Sporotrichosis. Ann Intern Med 1970; 73: 23-30.
• 93 Lyon GM., Zurita S., Casquero J.. et al Populationbased surveillance and a case-control study of risk factors for endemic lymphocutaneous Sporotrichosis in Peru. Clin Infect Dis 2003; 36: 34-9.
• 94 MacDonald PB., Black GB., MacKenzie R.. Orthopedic manifestations of Blastomycosis. J Bone Joint Surg Am 1990; 72: 860-4.
• 95 Malani PN., McNeil SA., Bradley SF.. et al Candida albicans sternal normal infections: A chronic and recurrent complication of median sternotomy. Clin Infect Dis 2002; 35: 1316-20.
• 96 Martin MV.. The use of fluconazole and itraconazole in the treatment of Candida albicans infections. J Antimicrob Chemother 1999; 44: 429-37.
• 97 Matsumoto T.. Triple fungal infection – chronic mucocutaneous Candidiasis, exophytic Dermato-phytosis and Cryptococcal meningitis: A new and unusual combination. J Dermatol 1976; 3: 139-46.
• 98 McCullers JA., Flynn PM.. Candida tropicalis osteomyelitis: Case report and review. Clin Infect Dis 1998; 26: 1000-1.
• 99 Miller DJ., Mejicano GC.. Vertebral osteomyelitis due to Candida species: Case report and literature review. Clin Infect Dis 2001; 33: 523-30.
• 100 Miller WT.. Aspergillosis: A disease with many faces. Semin Roentgenol 1996; 31: 52-66.
• 101 Mocherla S., Wheat JL.. Treatment of Histoplasmosis. Semin Respir Infect 2001; 16: 141-8.
• 102 Omer GE., Lockwood RS., Travis LO.. Histoplasmosis involving the carpal joint: A case report. J Bone Joint Surg 1963; 45A: 1699-1703.
• 103 Onwuasoigwe O., Gugnani HC.. African histoplasmosis: Osteomyelitis of the radius. Mycoses 1998; 41: 105-7.
• 104 Oscherwitz SL., Rinaldi MG.. Disseminated Sporotrichosis in a pateint infected with human immunodeficiency virus. Clin Infect Dis 1992; 15: 568-9.
• 105 Page JL., Friedlander G., Dockery GL.. Postoperative Fusarium osteomyelitis. J Foot Surg 1982; 21: 174-6.
• 106 Pappagianis D.. Coccidioidomycosis (San Joaquin or Valley Fever). In Di Salvo A.. Hrsg. Occupational Mycoses. Philadelphia: Lea & Febiger; 1983: 13.
• 107 Pappas PG., Bradsher RW., Kauffman CA.. et al Treatment of Blastomycosis with higher doses of fluconazole. Clin Infect Dis 1997; 25: 200-5.
• 108 Pappas PG., Rex JH., Sobel JD.. et al IDSA guidlines for treatment of Candidiasis. Clin Infect Dis 2004; 38: 161-89.
• 109 Pappas PG., Tellez I., Deep AE.. et al Sporotrichosis in Peru: Decription of an area of hyperendemicity. Clin Infect Dis 2000; 30: 65-70.
• 110 Pasic S., Abinum M., Pistignjat B.. et al Aspergillus osteomyelitis in chronic granulomatous disease: Treatment with recombinant gammainterferon and itraconazole. Pediatr Infect Dis 1996; 15: 833-4.
• 111 Perlman R., Jubelirer RA., Schwarz J.. Histoplasmosis of the common palmar tendon sheath. J Bone Joint Surg 1972; 54A: 676-8.
• 112 Pfaller MA., Kyriakos M., Week PM.. et al Disseminated Histoplasmosis presenting as an acute tenosynovitis. Diagn Microbiol Infect Dis 1985; 3: 251-5.
• 113 Phelan DM., Osmon DR., Keating MR.. et al Delayed reimplantation arthroplasty for Candidal prosthetic joint infection: A report of 4 cases and review of the literature. Clin Infect Dis 2002; 34: 930-9.
• 114 Pritchard DJ.. Granulomatous infection of the bones and joints. Orthop Clin North Am 1975; 6: 1029-47.
• 115 Ricciardi DD., Sepkowitz DV., Berkowitz LB.. et al Cryptococcal arthritis in a patient with acquired immune deficiency syndrome. J Rheum 1986; 13: 455-8.
• 116 Rosenberg EF., Dockerty EF., Meyerding HW.. Coccidioidal arthritis. Arch Intern Med 142 69: 238-50.
• 117 Rosenthal J., Brandt KD., Wheat LJ.. et al Rheumatologic manifestations of Histoplasmosis in the recent Indianapolis epidemic. Arthritis Rheum 1983; 26: 1065-70.
• 118 Rutale PJ., Smith JW.. Coccidioidomycosis in potentially compromised hosts: The effect of immunosuppressive therapy in dissemination. Am J Med Sci 1978; 275: 283-95.
• 119 Saag MS., Graybill RJ., Larsen RA.. et al Practice guidelines for the Management of Cryptococcal disease. Infectious Disease Society of America. Clin Infect Dis 2000; 30: 710-18.
• 120 Saccente M., Abernathy RS., Pappas PG.. et al Vertebral Blastomycosis with paravertebral abscess. Report of eight cases and review of the literature. Clin Infect Dis 1998; 26: 413-8.
• 121 Safdar A., Singhal S., Mehta J.. Clinical significance of noncandida fungal blood isolation in patients undergoing high-risk allogeneic hematopietic stem cell transplantation. Cancer 2004; 100: 2456-60.
• 122 Saiz P., Gitelis RW., Virkus W.. et al Blastomycosis of long bones. Clin Orthop 2004; 421: 255-9.
• 123 Sarosi GA., Davies SF.. Blastomycosis. Am Rev Respir Dis 1979; 120: 911-38.
• 124 Sathapatayavongs B., Batteiger BE., Wheat LJ.. et al Clinical and laboratory features of disseminated Histoplasmosis during two large urban outbreaks. Medicine (Baltimore) 1983; 62: 263-70.
• 125 Sharkey-Mathis PK., Kauffman CA., Graybill JR.. et al Treatment of Sporotrichosis with itraconazole. Am J Med 1993; 95: 279-85.
• 126 Sheflin JR., Campbell JA., Thompson GP.. Pulmonary Blastomycosis: Findings on chest radiographs in 63 patients. Am J Roentgenol 1990; 154: 1177-80.
• 127 Singh VR., Smith DK., Lawrence J.. et al Coccidioidomycosis in patients infected with human immunodeficiency virus: Review of 91 cases at a single institution. Clin. Infect. Dis 1996; 23: 563-8.
• 128 Smith CE.. Coccidioidomycosis. Pediatr. Clin. N. Am. 1955; 39: 109-25.
• 129 Smith DK., Neal JJ., Holmberg SD.. et al Unexplained opportunistic infections and CD4 +T-lymphocytopenia without HIV infection. N Engl J Med 1993; 328: 373-9.
• 130 Steinfeld S., Durez P., Hautzeur J-P. et al Articular Aspergillosis: Two case reports and review of the literatur. Br J Rheumatol 1997; 36: 1331-4.
• 131 Strayer DS., Gutwein MB., Herbold D.. et al. Histoplasmosis presenting as the carpal tunnel syndrome. Am J Surg 1981; 141: 286-8.
• 132 Sugar AM., Saunders C., Diamond RD.. Successful treatment of Candida osteomyelitis with fluconazole: A noncomparative study of two patients. Diagn Microbiol Infect Dis 1990; 13: 517-20.
• 133 Sun SH., Cole GT., Drutz DJ.. et al Electron-microscopic observations of the Coccidioides immitis parasitic cycle in vivo. J Med Vet Mycol 1986; 24: 183-92.
• 134 Tang C.. Successful treatment of Candida albicans osteomyelitis with fluconazole. J Infect 1993; 26: 89-92.
• 135 Thornberry DK., Wheat LJ., Brandt KD.. et al. Histoplasmosis presenting with joint pain and hilar@@@.