Differences in epidemiological and clinical findings between localized and systemic osteoarticular infection caused by Sporothrix: A systematic review of individual participant data

Knowledge of the clinical recognition and management of osteoarticular sporotrichosis is derived from case reports and limited series. Our aim was to perform a systematic review to evaluate the differences in epidemiologic and clinical findings between localized and systemic forms of osteoarticular sporotrichosis. We searched MEDLINE/PubMed, SCOPUS, Web of Science (WoS), Ovid, SCiELO, Cochrane, China National Knowledge Infrastructure (CNKI), Wanfang Data, CQVIP, and xueshu.baidu.com on December 31, 2023. The retrieved case data was divided into two groups: (1) localized osteoarticular infection and (2) systemic osteoarticular infection. We estimated differences between the two groups using generalized linear models with Poisson distribution for robust variances to estimate prevalence ratios (PRs) with 95% confidence intervals (95% CIs). A total of 111 cases of localized infection and 100 cases of systemic infection were included. Individuals with systemic infection were more likely to be from hyperendemic areas (adjusted prevalence ratio (aPR) = 1.64; 95% CI, 1.24-2.18; P =. 001), have HIV infection (aPR = 2.33; 95% CI, 1.42-3.82; P =. 001), and have cancer (aPR = 1.90; 95% CI, 1.09-3.31; P =. 023). Arthritis (50.4%) and osteomyelitis (46.0%) were predominant in localized and systemic infections, respectively. Osteomyelitis in two or more bones was more common in individuals with a systemic infection (aPR = 10.3; 95% CI, 3.38-31.7; P <. 0001). Most cases of localized infection were treated with combination antifungals and surgery (32.2%), combination antifungals (25.3%) and amphotericin B monotherapy (19.1%), and systemic infection with combination antifungals (49.4%). As for the outcome, there were better outcomes in localized than in systemic infection. Therefore, Sporothrix infection should be considered in the differential diagnosis of osteomyelitis or arthritis, especially in immunocompromised patients from hyperendemic areas.