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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Candida parapsilosis in Late Prosthetic Joint Infections Among Immunocompetent Patients: A Case Series
James C George1, B Samuel Chittaranjan1, Subin Babu1
1Department of Orthopaedic Surgery, Believers Church Medical College Hospital, Pathanamthitta, Kerala, India.
Introduction:
Fungal prosthetic joint infections (PJIs) are very rare in immunocompetent patients. PJI can present either early, delayed, or as late chronic infections. Diagnosis of fungal PJI presenting late is challenging due to the difficulty in isolation as well as the clinical presentation very similar to an aseptic loosening. There are no clear guidelines regarding the management of these patients.
Case Report:
We present five cases of Candida parapsilosis PJI presenting as late chronic infections. All five patients were culture-negative preoperatively, immunocompetent, and with good soft-tissue condition. There were three infected knee prostheses and two infected hip hemiarthroplasty. All of them were treated with extensive debridement, meticulous sampling, and extended culture. We treated all of them with long-term antifungals without any disease reactivation or recurrence till the last follow-up.
Conclusion:
Fungal infection should be suspected in immunocompetent patients presenting early with features of aseptic loosening but without typical signs of periprosthetic infection. Revision with long-term suppressive therapy can give good results in these patients.
Insights
Fungal prosthetic joint infections (PJIs) are rare in immunocompetent individuals. Late-presenting fungal PJIs can be successfully managed with debridement, extended cultures, and long-term antifungal therapy, preventing recurrence.
Area of Science:
- Orthopedics
- Infectious Diseases
- Mycology
Background:
- Fungal prosthetic joint infections (PJIs) are uncommon, particularly in immunocompetent patients.
- Late-presenting fungal PJIs often mimic aseptic loosening, complicating diagnosis due to challenges in pathogen isolation.
- Current management guidelines for these specific cases are lacking.
Purpose of the Study:
- To report on the clinical presentation and management of five cases of late-chronic prosthetic joint infections caused by Candida parapsilosis.
- To highlight the diagnostic challenges and treatment outcomes for fungal PJIs in immunocompetent individuals.
Main Methods:
- Retrospective case series of five immunocompetent patients with culture-negative, late-presenting fungal PJIs.
- Involved extensive surgical debridement, meticulous intraoperative sampling for extended fungal cultures.
- Treatment consisted of long-term antifungal therapy post-debridement.
Main Results:
- All five patients presented with late chronic PJI, were immunocompetent, and culture-negative preoperatively.
- Three knee and two hip hemiarthroplasty PJIs were identified.
- All patients achieved successful outcomes with no disease reactivation or recurrence during follow-up after treatment with antifungals.
Conclusions:
- Fungal PJI should be considered in immunocompetent patients presenting with aseptic loosening symptoms without typical signs of infection.
- Surgical revision combined with extended antifungal suppressive therapy can yield favorable results in managing late fungal PJIs.
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