Related Experiment Videos
[Candida albicans arthritis during induction treatment of acute lymphoblastic leukemia]
R L Touraine1, Y Bertrand, C Nakache
1Service d'hématologie pédiatrique et de transplantation de moelle osseuse, hôpital Debrousse, Lyon, France.
Abstract:
Candida arthritis is a rare event which is a result of direct intraarticular inoculation, or--in compromised host--of hematogenous spread. We report on the case of an 18-month-old boy who experienced such an infection during induction treatment for acute lymphoblastic leukemia with aplastic onset. He was healed by daily systemic amphotericin B administered over a period of 3 wks associated with intravenous flucytosine during the first 2 wks; the treatment was continued with oral administration of ketoconazole for 5 wks. Treatment control was performed by drug monitoring in plasma and synovial fluid, as well as by determination of Candida antigenemia and antibody levels. We consider that the required doses of amphotericin B should be based upon plasma concentrations greater than 0.5 or 1 mg/l to be maintained during 2-3 wks. Providing that there is no resistance, the association with flucytosine may be useful.
Insights
This case study details a rare Candida arthritis infection in an 18-month-old boy undergoing leukemia treatment. Successful treatment involved amphotericin B, flucytosine, and ketoconazole, with drug monitoring for efficacy.
Area of Science:
- Mycology
- Infectious Diseases
- Pediatric Hematology-Oncology
Background:
- Candida arthritis is a rare fungal joint infection, often occurring via direct inoculation or hematogenous spread in immunocompromised individuals.
- Acute lymphoblastic leukemia (ALL) treatment, particularly during induction with aplastic onset, can severely compromise a patient's immune system, increasing susceptibility to opportunistic infections.
Observation:
- An 18-month-old boy with ALL and aplastic onset developed Candida arthritis.
- The infection was treated with a multi-drug regimen including systemic amphotericin B, intravenous flucytosine, and oral ketoconazole.
Findings:
- The treatment regimen successfully resolved the Candida arthritis.
- Therapeutic drug monitoring of plasma and synovial fluid concentrations, alongside monitoring of Candida antigenemia and antibody levels, was crucial for treatment control.
- Optimal amphotericin B dosing requires maintaining plasma concentrations above 0.5-1 mg/l for 2-3 weeks.
Implications:
- This case highlights the importance of considering rare fungal infections like Candida arthritis in immunocompromised pediatric patients.
- Combination therapy with amphotericin B and flucytosine can be effective for Candida arthritis, provided there is no fungal resistance.
- Establishing therapeutic drug monitoring protocols is essential for optimizing antifungal treatment and patient outcomes in complex cases.