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Ergin M, Budin M, Canbaz SB, Ciloglu O, Salber J, Gehrke T, Citak M. Microbial Diversity of Periprosthetic Joint Infections in Diabetic and Non-Diabetic Patients Following Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00874-X. [PMID: 39187168 DOI: 10.1016/j.arth.2024.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a major complication following hip arthroplasty, leading to prolonged hospital stays, increased healthcare costs, and major morbidity. Diabetes mellitus is a prevalent comorbidity among hip arthroplasty patients, contributing to an increased risk of surgical complications, including infections. However, limited evidence exists regarding the microbial profiles of PJIs in diabetic patients compared to non-diabetic counterparts. METHODS We conducted a retrospective cohort study to investigate the microbial diversity of PJIs in diabetic and non-diabetic patients following hip arthroplasty. Medical records of patients who underwent hip arthroplasty procedures between 1996 and 2021 were reviewed. Patients diagnosed with PJI, based on the international consensus meeting (ICM), were included in the study. Microbiological data, including culture results, and risk factors were collected and analyzed. A total of 4,261 culture-positive patients diagnosed with PJI following hip arthroplasty were included in the analysis. RESULTS Microbiological analysis revealed a diverse spectrum of microbial pathogens, with Staphylococcus species being the most commonly isolated pathogen. Comparison between diabetic and non-diabetic patients revealed differences in the microbial profiles of PJIs, with diabetic patients more likely to be infected with specific pathogens, including Candida albicans (P = 0.01 OR [odds ratio] 2.8, CI [confidence interval] 1.2 to 6.2), Klebsiella pneumoniae (P = 0.03 OR 2.4, CI 1.0 to 5.6), Staphylococcus aureus (P = 0.04 OR 1.3, CI 1.0 to 1.8), Staphylococcus epidermidis (P < 0.001 (R 1.7, CI 1.4 to 2.2), Polymicrobial infections (P < 0.001 OR 1.5, CI 1.2 to 1.8), and Clostridium perfringens (P = 0.04 OR 5.9, CI 1.0 to 33.1). CONCLUSION Our study provides valuable insights into the microbial diversity of PJIs in diabetic and non-diabetic patients following hip arthroplasty. The identification of a tendency to different microbial profiles in diabetic patients underscores the need for tailored approaches to infection prevention and management in this high-risk population. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve patient outcomes.
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Affiliation(s)
- Musa Ergin
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany; Cihanbeyli State Hospital, Department of Orthopedics and Traumatology, Konya, Turkey
| | - Maximilian Budin
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany
| | - Sebati Başer Canbaz
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany
| | - Osman Ciloglu
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Gehrke
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery Holstenstr. 2, 22767, Hamburg, Germany.
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Starnes V, Duggan J, Hollingshead C. Fungal Prosthetic Joint Infection: A Case Series and Review of the Literature. Infect Dis Ther 2024; 13:1051-1065. [PMID: 38613628 PMCID: PMC11098995 DOI: 10.1007/s40121-024-00964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes. METHODS A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed. RESULTS Candida was the most common isolate, and a two-stage revision was the most commonly employed surgical modality. The type of surgical intervention had a statistically significant relationship with outcome (P = 0.022). CONCLUSIONS Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.
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Affiliation(s)
- Victoria Starnes
- The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Joan Duggan
- Division of Infectious Diseases, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Caitlyn Hollingshead
- Division of Infectious Diseases, The University of Toledo College of Medicine and Life Sciences, Toledo, USA.
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Asif M, Yousaf HM, Saleem M, Saadullah M, Chohan TA, Shamas MU, Yaseen HS, Mahrukh, Yousaf MU, Yaseen M. Trigonella foenum-graecum Seeds Oil Attenuated Inflammation and Angiogenesis in vivo through Down-Regulation of TNF-α. Anticancer Agents Med Chem 2021; 21:1460-1471. [PMID: 33019940 DOI: 10.2174/1871520620666201005100132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Inflammation is a vital reaction of the natural immune system that protects against encroaching agents. However, uncontrolled inflammation can lead to complications. Trigonella foenumgraecum is traditionally used as an anti-inflammatory herb. OBJECTIVES The current study was conducted to explore the antioxidant, anti-inflammatory, and antiangiogenic potentials of Trigonella foenum-graecum seeds oil. METHODS Oil was extracted from seeds of Trigonella foenum-graecum by cold press method and labelled as TgSO. Phytochemical (GC-MS, Folin-Ciocalteu method) and metal analyses were conducted to evaluate the metalo-chemical profile of TgSO. In vitro antioxidant assays (2,2-diphenyl-1-picrylhydrazyl, 2,2'-azino-bis-3- ethylbenzothiazoline-6-sulfonic acid and ferric reducing antioxidant power) were performed to assess its antioxidant potential. In vitro antimicrobial activity was evaluated using agar disc diffusion method and the safety profile of TgSO was assessed in acute toxicological studies following OECD 425 guidelines. In vivo antiinflammatory activities of TgSO were assessed in carrageenan, serotonin, histamine, formalin, and cotton pelletinduced oedema models. Serum TNF-α, Superoxide Dismutase (SOD) and, Catalases (CAT) levels were assessed by ELISA kits. In vivo antiangiogenic activity of TgSO was screened in chick Chorioallantoic Membrane (CAM) assay. Histopathological studies using excised paws were conducted to observe the effects of TgSO treatment at the tissue level. In silico docking studies were conducted to screen the binding potentials of identified compounds with TNF-α. RESULTS Extraction by cold press method yielded 16% of TgSO. Phytochemical analysis of TgSO through GCMS showed the presence of eugenol, dihydrocoumairn, heptadecanoic acid, tri- and tetradecanoic acid, and hexadecanoic acid, respectively. Total phenolic contents of TgSO were found to be 0.30±0.01mg/g gallic acid equivalent in Folin-Ciocalteu method. Metal analysis indicated the presence of different metals in TgSO. Findings of antioxidant models showed the moderate antioxidant potential of TgSO. Findings of antimicrobial assays showed that TgSO was active against bacterial (S. aureus, S. epidermidis) and fungal (C. albicans, and A. niger) strains. In vivo toxicity study data showed that TgSO was safe up to the dose of 5000 mg/kg. Data of oedema models showed a significant (p<0.05) reduction in oedema development in TgSO treated animals in both acute and chronic models. Histopathological evaluations of paws showed minimum tissue infiltration with inflammatory cells in TgSO-treated animals. Treatment with TgSO also significantly (p<0.05) down-regulated TNF-α in serum while levels of SOD and CAT were up-regulated. Findings of the CAM assay revealed the antiangiogenic activity of TgSO. Findings of in silico docking studies showed that identified phytoconstituents can bind with culprit cytokine (TNF-α). CONCLUSION Data obtained from the current study conclude that TgSO has antioxidant, anti-inflammatory, and antiangiogenic effects that validate its traditional uses. Synergistic actions of different phytoconstituents are proposed to be responsible for the observed effects.
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Affiliation(s)
- Muhammad Asif
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan
| | - Hafiz M Yousaf
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Punjab, Pakistan
| | - Mohammad Saleem
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Malik Saadullah
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Punjab, Pakistan
| | - Tahir A Chohan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | - Hafiza S Yaseen
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Punjab, Pakistan
| | - Mahrukh
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Punjab, Pakistan
| | - Muhammad U Yousaf
- Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Punjab, Pakistan
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Alraiyes T, Petis S, Drosdowech D, LeBel ME. Chronic, persistent fungal shoulder arthropathy secondary to genetic mutation: a case report. J Shoulder Elbow Surg 2021; 30:e69-e75. [PMID: 33010436 DOI: 10.1016/j.jse.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Thamer Alraiyes
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Stephen Petis
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Darren Drosdowech
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada
| | - Marie-Eve LeBel
- Department of Orthopaedic Surgery, Roth
- McFarlane Hand & Upper Limb Centre, Western University, London, ON, Canada.
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Maldonado A, Pirracchio L, Imber JC, Bürgin W, Möller B, Sculean A, Eick S. Citrullination in periodontium is associated with Porphyromonas gingivalis. Arch Oral Biol 2020; 114:104695. [PMID: 32315811 DOI: 10.1016/j.archoralbio.2020.104695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyse the citrulline level in the periodontium in association with the presence of or antibody levels against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. DESIGN Gingival crevicular fluid (GCF), subgingival biofilm and blood serum were sampled from 98 subjects (26 with RA, 72 without RA (NoRA)). GCF was analyzed for the level of citrulline, for interleukin (IL)-1β, IL-17, IL-10 and monocyte-chemoattractant protein (MCP)-1. Microorganisms were identified in subgingival biofilms. Antibodies againstP. gingivalis, and Aggregatibacter actinomycetemcomitans were quantified in serum. RESULTS GCF citrulline level was the lowest (by trend) in NoRA group without periodontitis. In NoRA, but not in RA an association between GCF citrulline level and P. gingivalis antibody levels was found and the GCF citrulline levels were higher in P. gingivalis positive samples. Any association of A. actinomycetemcomitans with GCF citrulline level did not exist. A model of univariate variance analysis (p = 0.001) showed a dependence of GCF citrulline level from the number of sites with PD (probing depth) ≥5 mm (p = 0.003) and the GCF MCP-1/CCL2 level (p = 0.019). Compared with NoRA in RA the number of teeth was lower, the number of sites with PD ≥ 5 mm was less, GCF levels of interleukin-17 and MCP-1/CCL2 were higher and those of IL-10 lower. Yeasts were only cultured in 15 RA patients (p < 0.001). CONCLUSION Citrullination in periodontium might be associated with P. gingivalis supporting the potential role as a trigger in the development of RA. Pathogenesis of periodontal disease in RA patients seems to differ from that in NoRA and should be investigated further.
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Affiliation(s)
- Alejandra Maldonado
- Department of Periodontology, University of Bern, School of Dental Medicine, Switzerland.
| | - Luca Pirracchio
- Department of Periodontology, University of Bern, School of Dental Medicine, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, University of Bern, School of Dental Medicine, Switzerland
| | - Walter Bürgin
- Ressort Research, University of Bern, School of Dental Medicine, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Burkhard Möller
- Clinic of Rheumatology, Immunology and Allergology, University Hospital Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, School of Dental Medicine, Switzerland
| | - Sigrun Eick
- Department of Periodontology, University of Bern, School of Dental Medicine, Switzerland
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Saconi ES, de Carvalho VC, de Oliveira PRD, Lima ALLM. Prosthetic joint infection due to Candida species: Case series and review of literature. Medicine (Baltimore) 2020; 99:e19735. [PMID: 32282732 PMCID: PMC7220503 DOI: 10.1097/md.0000000000019735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES After the initial management, 73% of the patients achieved clinical remission. CONCLUSION The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS Prosthetic joint infection, Candida, treatment, and diagnosis.
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Lee YR, Kim HJ, Lee EJ, Sohn JW, Kim MJ, Yoon YK. Prosthetic Joint Infections Caused by Candida Species: A Systematic Review and a Case Series. Mycopathologia 2018; 184:23-33. [PMID: 30051279 DOI: 10.1007/s11046-018-0286-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to evaluate the efficacy of echinocandins in the treatment of Candida prosthetic joint infection (PJI) based on published literature and on patients we examined. A structured literature review of multiple databases was conducted to identify patients who received echinocandins for Candida PJIs. Additionally, we describe here the first cases of PJIs due to C. parapsilosis, successfully treated with prolonged anidulafungin therapy. Out of 17 patients, 12 were female and the mean age at diagnosis was 66.0 years. No risk factors associated with Candida PJIs were found in four patients (23.5%). Infection sites included the knee (n = 10, 62.5%), the hip (n = 6, 35.3%) and the shoulder (n = 1, 5.9%). The most frequently isolated Candida species were C. albicans (n = 7, 41.2%) and C. glabrata (n = 7, 41.2%), followed by C. parapsilosis (n = 2, 11.8%) and C. freyschussii (n = 1, 5.9%). All patients were cured with the combination of systemic antifungal therapy and surgical interventions. Two-stage exchange arthroplasty and resection arthroplasty were performed in five and nine patients, respectively. The most frequently used echinocandins were caspofungin (n = 11, 64.7%), followed by anidulafungin (n = 4, 23.5%) and micafungin (n = 2, 11.8%). The median duration (days) of echinocandin therapy was as follows: caspofungin (25.5, range 8-56), micafungin (14.0, range 4-56) and anidulafungin (58, range 14-90). This study supports the effective role of echinocandins, as well as the potential advantage of surgical intervention in the treatment of Candida PJIs. Furthermore, it provides fundamental data on the safety of long-term echinocandin therapy.
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Affiliation(s)
- Yoo Ra Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Seoul, Republic of Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Lee
- Medical Library, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Çevik R, Tekin R, Gem M. Candida arthritis in a patient diagnosed with spondyloarthritis. Rev Soc Bras Med Trop 2016; 49:793-795. [PMID: 28001233 DOI: 10.1590/0037-8682-0089-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/22/2016] [Indexed: 11/21/2022] Open
Abstract
Candida arthritis is an unusual manifestation that usually affects the knees. A 35-year-old man presented with a 2-month history of pain and swelling in the right knee. Swelling persisted after anti-inflammatory treatment. Peripheric spondyloarthritis was considered, but methotrexate, sulfasalazine, and methylprednisolone did not reduce the swelling. Direct examination of synovial fluid and a culture were positive for Candida albicans. Intravenous and intra-articular amphotericin-B were administered. The arthritis regressed and a culture and direct staining showed negative results. Candida arthritis should be considered in patients with arthritis that is resistant to treatment and prolonged, even if risk factors are absent.
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Affiliation(s)
- Remzi Çevik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University Diyarbakir, Turkey
| | - Mehmet Gem
- Department of Orthopaedics, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Aikawa NE, Rosa DT, Del Negro GM, Moraes JC, Ribeiro AC, Saad CG, Silva CA, Bonfá E. Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy. ACTA ACUST UNITED AC 2016; 56:478-482. [DOI: 10.1016/j.rbre.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 03/01/2015] [Indexed: 01/29/2023]
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Aikawa NE, Rosa DTA, Del Negro GMB, Moraes JCB, Ribeiro ACM, Saad CG, Silva CA, Bonfá E. [Systemic and localized infection by Candida species in patients with rheumatic diseases receiving anti-TNF therapy]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 56:S0482-5004(15)00096-0. [PMID: 26292781 DOI: 10.1016/j.rbr.2015.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 01/19/2015] [Accepted: 03/01/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of systemic and localized infection by Candida species and its possible association with demographic, clinical and laboratory manifestations and therapy in patients with rheumatic diseases taking TNF blockers. METHODS Consecutive patients with rheumatic diseases receiving anti-TNF agents were included. The following risk factors up to four weeks prior to the study were analyzed: use of antibiotics, immunosuppressant drugs, hospitalization and invasive procedures. All subjects were evaluated for clinical complaints, specific blood cultures were obtained for fungi and blood samples were collected for Candida spp. detection by polymerase chain reaction. RESULTS 194 patients [67 with rheumatoid arthritis (RA), 47 with ankylosing spondylitis (AS), 36 with juvenile idiopathic arthritis (JIA), 28 with psoriatic arthritis and 16 with other conditions] were included. The average age of patients was 42±16 years, with 68 (35%) male and mean disease duration of 15±10 years. Sixty-four (33%) patients were receiving adalimumab, 59 (30%) etanercept and 71 (36%) infliximab. Eighty-one percent of patients were concomitantly taking immunosuppressants drugs. At the time of the study, only one (0.5%) patient had localized fungal infection (vaginal candidiasis). None of the patients included had systemic candidiasis with positive blood cultures for fungi or PCR positive for Candida spp. in peripheral blood sample. CONCLUSIONS This was the first study to assess the prevalence of invasive and localized fungal disease by candida in a significant number of patients with rheumatic diseases on anti-TNF therapy, and demonstrated low risk of candidiasis, despite the high prevalence of immunosuppressive drug use.
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Affiliation(s)
- Nadia E Aikawa
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil.
| | - Daniela T A Rosa
- Laboratório de Micologia Médica (LIM 53), Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Gilda M B Del Negro
- Laboratório de Micologia Médica (LIM 53), Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Julio C B Moraes
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
| | - Ana C M Ribeiro
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
| | - Carla Gonçalves Saad
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil; Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
| | - Eloisa Bonfá
- Disciplina de Reumatologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
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Zuo Q, Dong L, Mu W, Zhou L, Hu T, Zhang H. Trichosporon asahii infection after total knee arthroplasty: A case report and review of the literature. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2015; 26:47-51. [PMID: 25798156 PMCID: PMC4353271 DOI: 10.1155/2015/458670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reports of fungal infection after total knee arthroplasty are extremely rare. In most reports, the infecting organism is a Candida species. The present report describes a case involving a 73-year-old immunocompetent woman who underwent total knee arthroplasty and presented one month later with signs of prosthetic infection. She underwent joint debridement and the fluid was sent for culture and sensitivity testing. The culture showed growth of Trichosporon asahii. The patient was administered intravenous and intra-articular injections of amphotericin B, followed by antifungal treatment with voriconazole for one year. At 26 months of follow-up, there was no evidence of infection and the patient was ambulating with a walker. To the authors' knowledge, the present case is the first report of T asahii infection following knee replacement. Early detection, prompt institution of the appropriate antibiotics and regular follow-up are recommended.
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Affiliation(s)
- Qiang Zuo
- Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province
- Department of Orthopedics, the First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia
| | - Lele Dong
- Department of Orthopedics, the First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia
| | - Weidong Mu
- Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province
- Correspondence: Dr Weidong Mu, Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong Province, People’s Republic of China. Telephone 86-151-6886-3989, fax 86-180-4721-1365, e-mail
| | - Lingyun Zhou
- International Education College, Jiang Xi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province
| | - Tongping Hu
- Clinical Laboratory, the First Affiliated Hospital of Baotou Medical College
| | - Hua Zhang
- Department of Oncology, the Third Affiliated Hospital of Inner Mongolia Medical College, Baotou, Inner Mongolia, People’s Republic of China
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TANEJA ATULK, TORRIANI MARTIN, SIMEONE FJOSEPH. Septic Arthritis and Osteomyelitis of the Hip by Candida albicans. J Rheumatol 2014; 41:2270. [DOI: 10.3899/jrheum.140354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Management of fungal osteomyelitis and fungal septic arthritis is challenging, especially in the setting of immunodeficiency and conditions that require immunosuppression. Because fungal osteomyelitis and fungal septic arthritis are rare conditions, study of their pathophysiology and treatment has been limited. In the literature, evidence-based treatment is lacking and, historically, outcomes have been poor. The most common offending organisms are Candida and Aspergillus, which are widely distributed in humans and soil. However, some fungal pathogens, such as Histoplasma, Blastomyces, Coccidioides, Cryptococcus, and Sporothrix, have more focal areas of endemicity. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. These infections may be difficult to diagnose and eradicate, especially in the setting of total joint arthroplasty. Although there is no clear consensus on treatment, guidelines are available for management of many of these pathogens.
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Smeekens SP, van de Veerdonk FL, Kullberg BJ, Netea MG. Genetic susceptibility to Candida infections. EMBO Mol Med 2013; 5:805-13. [PMID: 23629947 PMCID: PMC3779444 DOI: 10.1002/emmm.201201678] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/28/2013] [Accepted: 03/14/2013] [Indexed: 12/21/2022] Open
Abstract
Candida spp. are medically important fungi causing severe mucosal and life-threatening invasive infections, especially in immunocompromised hosts. However, not all individuals at risk develop Candida infections, and it is believed that genetic variation plays an important role in host susceptibility. On the one hand, severe fungal infections are associated with monogenic primary immunodeficiencies such as defects in STAT1, STAT3 or CARD9, recently discovered as novel clinical entities. On the other hand, more common polymorphisms in genes of the immune system have also been associated with fungal infections such as recurrent vulvovaginal candidiasis and candidemia. The discovery of the genetic susceptibility to Candida infections can lead to a better understanding of the pathogenesis of the disease, as well as to the design of novel immunotherapeutic strategies. This review is part of the review series on host-pathogen interactions. See more reviews from this series.
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Affiliation(s)
- Sanne P Smeekens
- Department of Medicine, Radboud University Nijmegen Medical Centre and Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Nijmegen, The Netherlands
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Current world literature. Curr Opin Infect Dis 2012; 25:718-28. [PMID: 23147811 DOI: 10.1097/qco.0b013e32835af239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Candida albicans Infection of a Reverse-Polarity Shoulder Replacement in a Patient With Rheumatoid Arthritis Treated With Etanercept. J Clin Rheumatol 2012; 18:323. [DOI: 10.1097/rhu.0b013e3182685b83] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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