Management of Fungal or Atypical Periprosthetic Joint Infections

doi:10.1002/jor.22559

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…The procedure-related risk factors include; prolonged operation time, previous joint surgery and the presence of remote infection or bacteremia. [ 4 , 5 ]. In spite of that, almost half of the cases occur in patients without identifiable risk factor [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Fungal Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report

Mafrachi¹,

Debei²,

Muhtaseb³

et al. 2021

JOCR

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Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan. Keywords: Fungal prosthetic joint infection, fungal infection, total knee replacement, total knee replacement complication.

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Section: Discussionmentioning

confidence: 99%

Fungal Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report

Mafrachi¹,

Debei²,

Muhtaseb³

et al. 2021

JOCR

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“…have been documented mostly in cancer patients and in critically ill patients following multiple invasive medical procedures. In addition, there is an increased risk of fungal infection after use of antibiotics for a prolonged period, indwelling catheters, and in patients in the intensive care unit [4] , [5] , [6] , [10] .…”

Section: Discussionmentioning

confidence: 99%

“…The findings in the present report suggest that in cases with a confounding clinical and laboratory picture in which the diagnosis is in doubt, fungal infection must be considered. Such cases warrant a high degree of suspicion for the presence of rare microorganisms, specific culture conditions, and an extended culture time, with an aggressive 2-stage treatment protocol with removal of all foreign materials [1] , [10] .…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic fungal infection of a hip caused by Trichosporon inkin

et al. 2018

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An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms.

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