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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Periprosthetic joint infection of a total hip arthroplasty with Candida parapsilosis
Laurence Vergison1, Alexander Schepens2, Koen Liekens2
1Department of Orthopaedic Surgery and Traumatology, General Hospital St-Lucas, Ghent, Belgium; Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
Introduction:
Fungal periprosthetic joint infection (PJI) is a disruptive and complex complication of joint arthroplasty. We present a case of a fungal PJI with Candida parapsilosis after a total hip arthroplasty (THA).
Presentation Of Case:
A 73-year-old woman with a history of ovarian cancer with peritoneal metastases, was treated with a THA, due to symptomatic arthritis of the right hip. One month after surgery, she had difficulties walking. Inflammatory parameters were mildly increased. Aspiration of a subcutaneous abscess diagnosed Candida parapsilosis. A two-stage revision arthroplasty without spacer was performed. During a six-week prosthesis-free interval, intravenous fluconazole 400 mg was given. After reimplantation, fluconazole was continued for two weeks intravenously and life-long perorally. Follow-up of the patient after six months showed no recurrence of infection.
Discussion:
This case revealed that when PJI is suspected, a low treshold for joint aspiration is important. Two-stage revision with systematic antifungal therapy is the preferred treatment of fungal PJI. Our case demonstrated a good result with a prosthesis-free interval. Fluconazole is the preferred antifungal treatment and it should be applied for at least six months or longer.
Conclusion:
To our knowledge, this is the first case of a fungal PJI with Candida parapsilosis after a THA treated with a two-stage revision arthroplasty without spacer and a life-long fluconazole treatment.
Insights
Fungal periprosthetic joint infection (PJI) after total hip arthroplasty (THA) requires prompt diagnosis and treatment. This case highlights successful two-stage revision surgery and long-term fluconazole therapy for Candida parapsilosis PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infection (PJI) is a rare but serious complication following joint arthroplasty.
- Candida parapsilosis is an opportunistic fungal pathogen that can cause PJI.
Observation:
- A 73-year-old woman developed PJI with Candida parapsilosis one month after total hip arthroplasty (THA).
- Initial presentation included difficulty walking and mildly elevated inflammatory markers.
Findings:
- Diagnosis was confirmed by aspirating a subcutaneous abscess, identifying Candida parapsilosis.
- A two-stage revision arthroplasty without a spacer was performed, combined with a six-week prosthesis-free interval.
- Intravenous and subsequent lifelong oral fluconazole therapy was administered.
Implications:
- Early joint aspiration is crucial for diagnosing suspected PJI.
- Two-stage revision arthroplasty with systemic antifungal therapy is an effective treatment for fungal PJI.
- Long-term fluconazole treatment, at least six months, is recommended for successful outcomes.
