Abstract
Periprosthetic joint infections are one of the most dreaded and complex complications of total joint arthroplasty, with fungal infection accountting for less than 1% of the cases. Treatment is challenging due to the lack of scientific evidence.
We report a case of a Candida albicans total hip arthroplasty (THA) infection and performed a review of the literature.
We report a case of a 79 year old women with an early THA infection (less of one month) from the primary surgery.
She presented with pain and serous drainage from the operative wound and for that was submited to surgical debridement and revision of polyethilene. Cultures where taken (steril) and empirical vancomicin and rifampicin treatment was initiated.
Because of persistent complains and drainage, the patient was submitted to another surgery. Cultures were taken at the time of surgery. A cement spacer impregnated with gentamicin was placed after implant removal.
Cultures isolated Candida albicans. In light of this new evidence fluconazole was added to the previous scheme.
After introduction of fluconazole, the clinical evolution was good. Drainage stoped 1 week after, and the wound closed. The inflammatory markers became normal shortly after. Leg pain became better.
The patient was given oral suppressive treatment with fluconazole and was discharged, weight bearing as tolerated.
A total of 4 mouths of treatment is programmed with close follow-up, untill the second staged revision is programmed.
Prosthetic fungal infections are rare with most of the published articles being case reports.
A substantial delay in diagnosis may occur because culture results are sometimes interpreted as contamination and there is a need for obtaining multiple samples, prolonged culture, and special staining.
The best results are being reported with a long period of oral antifungal treatment and a two staged joint revision but there is an absence of standardized clinical and evidence-based treatment guidelines.
