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Candida krusei infectious arthritis. A rare complication of neutropenia
1Department of Medicine, Louisiana State University School of Medicine, Shreveport.
Abstract:
Candida krusei infections are increasing in neutropenic patients. This is the first report of a case of C. krusei arthritis in a neutropenic leukemic patient. The organism colonized the patient's respiratory tract and most likely seeded the right knee by hematogenous spread. Knee swelling and tenderness were minimal. Joint fluid Gram stain and fungal smears did not show the organism despite positive results on cultures. With therapy, the joint fluid converted from neutrophilic predominance to lymphocytic predominance. Despite sterilization of knee fluid, clinical relapse occurred after therapy with 256 mg of systemic amphotericin B; the infection was cured after a total dose of 456 mg.
Insights
This study reports the first case of Candida krusei arthritis in a neutropenic leukemia patient. Aggressive amphotericin B therapy was required to cure the invasive fungal infection.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Rising incidence of Candida krusei infections in neutropenic patients.
- Neutropenia is a significant risk factor for invasive fungal infections.
- Candida krusei is an emerging pathogen with intrinsic antifungal resistance.
Observation:
- A neutropenic leukemic patient developed arthritis due to Candida krusei.
- The infection likely originated from respiratory tract colonization and spread hematogenously.
- Clinical presentation of knee involvement was subtle, with minimal swelling and tenderness.
Findings:
- Standard diagnostic methods like Gram stain and smears of joint fluid were negative for Candida krusei.
- Positive fungal cultures confirmed the diagnosis.
- Therapy led to a shift in joint fluid cytology from neutrophilic to lymphocytic predominance.
- A clinical relapse occurred despite initial treatment with amphotericin B.
- A higher cumulative dose of amphotericin B was necessary for successful treatment.
Implications:
- Highlights the challenge of diagnosing invasive Candida krusei infections in immunocompromised hosts.
- Underscores the importance of considering fungal arthritis in neutropenic patients with joint symptoms.
- Suggests that higher doses of amphotericin B may be required for treating Candida krusei arthritis.
- Emphasizes the need for vigilant monitoring and potential dose adjustments in managing invasive fungal infections.