wileyonlinelibrary.com/journal/myc Mycoses. 2018;61:266–269.
© 2017 Blackwell Verlag GmbH
Received: 8 October 2017
Accepted: 13 December 2017
SINGLE CASE REPORT
Candida glabrata prosthetic joint infection, successfully treated
with anidulafungin: A case report and review of the literature
| George Samonis
| Emmanouil Velivassakis
| Georgios Kontakis
| Diamantis P. Kofteridis
Department of Orthopaedics and
Traumatology, University Hospital of
Heraklion, Crete, Greece
Department of Internal Medicine, Infectious
Diseases Unit, University Hospital of
Heraklion, Crete, Greece
Christos Koutserimpas, Department of
Orthopaedics and Traumatology, University
Hospital of Heraklion, Crete, Greece.
Non- albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a
Candida glabrata knee PJI is a 68- year- old splenectomised female smoker, suffering
from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The
patient presented with a peri- prosthetic fracture, 15 years after total knee replace-
ment surgery. Cultures of the intraoperative peri- prosthetic tissue and materials
yielded C. glabrata, as well as a methicillin- resistant S. epidermitis. The patient was
treated with anidulafungin and vancomycin. The knee prosthetic joint was removed
and cement- spacer with vancomycin and gentamycin was placed. Additionally, an ex-
ternal fixation was performed. A second stage revision surgery was planned, after
completion of the antimicrobial and antifungal treatment. The patient is followed up
for 4 months without signs, symptoms or findings of infection. PJI Candida infections
require a high clinical suspicion index. It is of utmost importance to report these cases,
since there is no consensus yet of the proper antifungal treatment. Furthermore, a
literature review regarding treatment of those cases is provided. First- line treatment
with an echinocandin seems most proper, due to their fungicidal properties, their ef-
fectiveness against biofilm, as well as their minimal toxicity, making them ideal for
long- term use. Further experience is needed, for better understanding the disease’s
pathogenesis and optimal treatment.
anidulafungin, Candida glabrata, echinocandin, prosthetic joint infection
1 | INTRODUCTION
Candida prosthetic joint infection (PJI) is relatively rare, with most re-
ports limited to cases and small case series.
For non- albicans species,
only a few cases are reported.
PJI caused by Candida glabrata is an
extremely rare entity and its optimal treatment remains unclear.
therefore, important to report these cases for better understanding
the pathophysiology, treatment and outcome of these infections.
A case of Candida glabrata PJI in a 68- year- old female, who had
a total knee replacement 15 years ago, is presented. Furthermore, a
review regarding the treatment of C. glabrata PJIs is provided.
2 | CASE PRESENTATION
A 68- year- old female with body mass index of 27.3 presented to the
out- patient clinic due to knee pain, swelling and inability to bear full
weight, starting at least 2 months ago. The patient was afebrile, alert
and had stable vital parameters (blood pressure: 130/85 mmHg, heart
rate: 75 beats/min and respiratory rate: 16 breaths/min). Her medical
history was significant for a total knee replacement surgery due to oste-
oarthritis 15 years ago. Additionally, she had a history of smoking, alco-
holism and chronic obstructive pulmonary disease (COPD). She also had
undergone a splenectomy due to a road- traffic accident 12 years ago.