Periprosthetic joint infection of a total hip arthroplasty with Candida parapsilosis
| Autor: | Renata De Kesel, Laurence Vergison, Jan Victor, Koen Liekens, Hans Van Der Bracht, Alexander Schepens |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Candida parapsilosis MSIS Muskuloskeletal Infection Society PJI periprosthetic joint infection Periprosthetic Arthritis Article 03 medical and health sciences THA total hip arthroplasty 0302 clinical medicine CRP c-reactive protein DTT difficult-to-treat Fungal periprosthetic infection Case report Medicine and Health Sciences Medicine Subcutaneous abscess Fluconazole ESR erythrocyte sedimentation rate Surgical treatment EBJIS European Bone and Joint Infection Society biology business.industry IDSA Infectious Diseases Society of America HPF high power field DAIR Debridement antibiotics irrigation and retention medicine.disease biology.organism_classification Surgery Joint aspiration 030220 oncology & carcinogenesis TKA total knee arthroplasty 030211 gastroenterology & hepatology Complication business Total hip arthroplasty medicine.drug |
| Zdroj: | International Journal of Surgery Case Reports INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Symptoms, diagnosis and treatment options of fungal periprosthetic joint infection (PJI) are described. • We emphasize the importance of a low threshold for joint aspiration when a PJI is suspected. • Debridement, antibiotics, irrigation and retention (DAIR) is not recommended as a treatment option for fungal PJI. • PJI treated with a two-stage revision arthroplasty without spacer in combination with fluconazole is a usefull treatment option. • Difficult-to-treat (DTT) organisms produce complex biofilms which provide resistance to biofilm-active antimicrobials. 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|