Osteoarticular Candida Infection: Report of Three Cases and Literature Review of 44 Patients

Abstract

Fungal infections in the bones and joints are rare. Candida spp. osteomyelitis is also a very rare entity. The most common pathogen is Candida albicans, but an increase in the incidence of non-albicans Candida osteomyelitis has been reported in recent years. Herein, we present three patients with non-albicans Candida osteomyelitis. Osteoarticular involvement occurred in the lumbar vertebrae in one patient, in the hand in one patient, and the foot in the other patient. Diabetes mellitus and long-term antibiotic use were common risk factors in all three cases. In the patient with vertebral osteomyelitis, surgical intervention and foreign body were other risk factors. Magnetic resonance imaging was used in the diagnosis and the pathogens were isolated from deep tissue cultures. Surgical debridement was performed in all cases and antifungal treatment was given for 6-24 weeks. There was no reinfection or relapse during clinical and radiological follow-up. The patient with osteomyelitis of the foot died due to to acute cerebrovascular disease. In our study, the literature review for publications related to osteoarticular Candida infection was made between April 2010 and June 2019 and 44 cases are reviewed. Our aim in this study was to draw attention to Candida osteoarticular infections and to emphasize the importance of targeted treatment by defining the pathogen.

Keywords

• spondylodiscitis
• fluconazole
• caspofungin
• systematic review
• liposomal amphotericin b