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Spondylodiscitis caused by Candida krusei: case report and susceptibility patterns
Javier Pemán1, Isidro Jarque, María Bosch
1Microbiology Department, La Fe University Hospital, Av. Campanar 21, 46009 Valencia, Spain. peman_jav@gva.es
Journal of Clinical Microbiology
|May 5, 2006
Summary
A patient with a rare Candida krusei bone infection, resistant to amphotericin B, was successfully treated with caspofungin and voriconazole. This case highlights a novel treatment approach for difficult-to-treat fungal infections.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Candida krusei is an opportunistic fungal pathogen known for its intrinsic resistance to azole antifungals.
- Spondylodiscitis, an infection of the spine, can be caused by various pathogens, including fungi, and poses significant treatment challenges.
- Amphotericin B is a common antifungal agent, but resistance can occur, necessitating alternative therapeutic strategies.
Observation:
- A 62-year-old male presented with spondylodiscitis caused by Candida krusei, a strain exhibiting resistance to amphotericin B.
- The patient had a preceding episode of candidemia with the same fungal isolate.
Findings:
- Successful treatment was achieved using a combination therapy of caspofungin and voriconazole.
- Amphotericin B's fungicidal concentrations, rather than its minimum inhibitory concentrations (MICs), were found to be more predictive of the clinical outcome.
- This represents the first reported case of Candida krusei spondylodiscitis in the medical literature.
Implications:
- The findings suggest that combination antifungal therapy with caspofungin and voriconazole can be effective for treating refractory Candida krusei infections, including invasive forms like spondylodiscitis.
- Monitoring fungicidal concentrations of antifungals may offer a more accurate assessment of treatment efficacy compared to standard MIC testing in certain challenging cases.
- This case expands the understanding of treatment options for rare and resistant fungal infections of the spine.