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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
[Aorto-bifermoral grafs infection due to Candida parapsilosis. An unusual pathogen]
Kerbi Alejandro Guevara-Noriega1, Alina Velescu1, Diana Teresa Zaffalon-Espinal2
1Servicio de Angiología y Cirugía Vascular, Parc de Salut Mar Barcelona, Barcelona, España.
Background:
Aorto-enteric fistula is a rare and potentially lethal entity. Its presentation may be as an enteric-paraprosthetic fistula, due to injury in the gut caused by direct contact with the vascular prosthesis.
Objective:
We report a case of enteric-paraprosthetic fistulae with the unusual finding of Candida parapsilosis as the only isolated pathogen.
Clinical Case:
A 65-year-old male, smoker, with aortobifemoral revascularisation with dacron due to aortoiliac occlusive disease, and re-intervention for thrombosis of left arm at 6 months. Hospitalisation at 22 months was required due to a toxic syndrome, which was diagnosed as enteric-paraprosthetic fistulae after complementary studies. The graft was removed and an extra-anatomic revascularisation was performed. Microbiology specimens taken from the duodenal segment in contact with the prosthesis showed the prosthetic segment and peri-prosthetic fluid were positive to C. parapsilosis.
Discussion:
The finding of C. parapsilosis in all cultures taken during surgery, along with negative blood cultures and no other known sources of infection, is of interest. It is an unusual pathogen with low virulence and limited as regards other Candida species. Our patient had no clinical data common to cases of infection with C. parapsilosis, and the mechanism of graft infection is unknown.
Conclusion:
Graft infection by C. parapsilosis may be anecdotal. However, its consequences can also be severe. Microbiological tests can be useful to adjust antimicrobial therapy in the post-operative period, but their usefulness for determining the aetiology is doubtful, as it may be just an incidental finding.
Insights
A rare aorto-enteric fistula case revealed Candida parapsilosis as the sole pathogen. This unusual finding in graft infection highlights the need for careful microbiological evaluation in complex cases.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Aorto-enteric fistula is a rare, life-threatening condition.
- Enteric-paraprosthetic fistulae arise from vascular prosthesis-gut contact.
- Prompt diagnosis and management are critical.
Observation:
- A 65-year-old male presented with toxic syndrome 22 months post-aortobifemoral bypass.
- Diagnosis of enteric-paraprosthetic fistula was confirmed.
- Surgical intervention involved graft removal and extra-anatomic revascularization.
Findings:
- Candida parapsilosis was the only pathogen isolated from prosthetic and peri-prosthetic samples.
- Blood cultures were negative, with no other identified infection source.
- The patient lacked typical clinical features of C. parapsilosis infection.
Implications:
- This case highlights an unusual pathogen in prosthetic graft infection.
- The role of C. parapsilosis in graft infection etiology requires further investigation.
- Microbiological findings, while guiding therapy, may not always indicate causation.
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