Prosthetic joint infections with osteomyelitis due to Candida albicans

Mycoses. 2003 Dec;46(11-12):462-6. doi: 10.1046/j.0933-7407.2003.00928.x.

Abstract

We report the case of a 78-year-old woman who suffered from a severe soft tissue and bone infection of her left knee 3 years after a total knee-joint replacement without loosening of her endoprosthesis. Cultures from joint aspiration and tissue specimen identified Staphylococcus aureus and Candida albicans. Direct microscopic examination of vital spongy bone and fibrous tissue revealed microabscesses and seeds of yeasts inside the fatty marrow and interface. After removal of the prosthesis several soft tissue and bone specimens were taken during planned re-operations. The histological examination showed no morphological changing, no reduction or extinction of the yeast cells under fluconazole therapy with a dosage of 6 mg kg(-1) body weight (400 mg daily). Curing of the fungal infection with eradication of the yeasts in the bony specimens was achieved with higher doses of 12 mg kg(-1) body weight (800 mg day(-1)) over a 2 month regimen in combination with repeated surgical debridements.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use
  • Arthritis, Infectious / complications
  • Arthritis, Infectious / microbiology*
  • Arthritis, Infectious / surgery
  • Arthroplasty, Replacement, Knee
  • Bone and Bones / pathology
  • Candida albicans / isolation & purification*
  • Candidiasis / drug therapy
  • Candidiasis / microbiology*
  • Candidiasis / pathology
  • Candidiasis / surgery
  • Debridement
  • Female
  • Fluconazole / administration & dosage
  • Fluconazole / therapeutic use
  • Humans
  • Knee Prosthesis / microbiology*
  • Osteomyelitis / drug therapy
  • Osteomyelitis / microbiology*
  • Osteomyelitis / pathology
  • Osteomyelitis / surgery
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology*
  • Prosthesis-Related Infections / surgery
  • Staphylococcus aureus / isolation & purification

Substances

  • Antifungal Agents
  • Fluconazole