Abstract
Fungal osteomyelitis is rare in immunocompetent patients and is often difficult to cure, even with optimal medical and surgical management. The authors present two cases of fungal osteomyelitis in which the common swimming pool cleaner, polyhexamethylene biguanide, was used successfully as an adjunct to standard surgical and medical treatment. Also presented is a literature review on the use of polyhexamethylene biguanide for this indication. The authors recommend that this safe and well-tolerated compound be considered as part of the treatment for fungal osteomyelitis.
Highlights
G Walls, L Noonan, E Wilson, D Holland, S Briggs
We report two cases of fungal osteomyelitis in which local application of the common swimming pool cleaner polyhexamethylene biguanide (PHMB) was used in conjunction with antifungal treatment and surgical debridement to achieve cure or prolonged remission
We review the literature on the use of PHMB for the treatment of fungal osteomyelitis
Summary
Case 1 An immunocompetent 35-year-old Samoan woman presented in 1996 with a two- to three-year history of right heel pain. Successful treatment of fungal osteomyelitis in immunocompetent patients usually requires a combination of systemic antifungal treatment and extensive surgical debridement including, at times, amputation. A case report and review of 29 apparently immunocompetent patients with Scedosporium species osteomyelitis or septic arthritis [2] included 19 patients with osteomyelitis Six of these 19 (32%) were cured (four received systemic antifungals in combination with surgery and two with knee osteomyelitis received intra-articular amphotericin B alone), nine (47%) achieved ‘improvement’ (without cure), three (16%) required amputation and one (5%) died of an unrelated cause. In a small series involving four immunocompetent patients with Fusarium species osteomyelitis [4], two were cured with systemic or topical amphotericin B and extensive surgical debridement, and two required amputation. PHMB ( known as polyhexanide and polyaminopropyl biguanide) is structurally related to hexamidine and was developed in the Fungal osteomyelitis and polyhexamethylene biguanide
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