Recurrent Arthritis by Candida glabrata, a Diagnostic and Therapeutic Challenge

Erami, M. and Afzali, H. and Momen-Heravi, M. and Rezaei-Matehkolaei, A. and Najafzadeh, M.J. and Moazeni, M. and Dolatabadi, S. and Hosseinpour, L. (2014) Recurrent Arthritis by Candida glabrata, a Diagnostic and Therapeutic Challenge. Mycopathologia, 177 (5-6). pp. 291-298.

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Abstract

Infectious arthritis due to Candida glabrata is very rare. A 40-year-old Iranian man had developed a painful swelling on the left knee since a year ago. A surgery (meniscectomy) was performed on his knee. However, in follow-up visit after 2 months, the patient's condition was deteriorated. Direct examination of synovial fluid with Gram and hematoxylin-eosin stains were negative for any bacterial or fungal infection or crystal elements; however, inoculation into BACTEC� Mycosis IC/F and Plus Aerobic/F culture bottles led to the isolation of a yeast strain. The macroscopic examination on CHROMagar� Candida medium combined with microscopical examination on CMT80 agar made a presumptive identification of the isolate to be considered as C. glabrata, and it was later on confirmed by ITS sequencing. Initial empirical treatment was started with intravenous amphotericin B for 4 weeks followed by oral itraconazole which was unsuccessful. Prescription of an oral 150-mg tablet of fluconazole was considered for a 2-month course. All symptoms completely declined, and no recurrence of infection was detected. Antifungal susceptibility testing (AFST) was performed for this isolate, and the result showed sensitivity to both amphotericin B and itraconazole and less susceptibility to fluconazole while clinical recovery was achieved by fluconazole. In any suspected clinical case caused by infectious agents, application of an effective fungal diagnostic test should be considered to avoid complications due to misdiagnosis. The correlation of AFST result with real in vivo therapeutic responses can be strain or patient dependent, and this should be considered for a successive treatment. © 2014 Springer Science+Business Media Dordrecht.

Item Type: Article
Additional Information: cited By 0
Uncontrolled Keywords: antifungal agent; fluconazole, adult; arthritis; Candida glabrata; candidiasis; case report; drug effects; genetics; human; isolation and purification; male; microbiology; pathology; physiology; recurrent disease, Adult; Antifungal Agents; Arthritis; Candida glabrata; Candidiasis; Fluconazole; Humans; Male; Recurrence
Subjects: Medicine
Divisions: Faculty of Medicine > Clinical Sciences > Department of Infectious Diseases
Depositing User: editor . 2
Date Deposited: 04 Mar 2017 07:32
Last Modified: 11 Mar 2017 16:28
URI: http://eprints.kaums.ac.ir/id/eprint/531

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