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Recurrent Arthritis by Candida glabrata, a Diagnostic and Therapeutic Challenge

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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.

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Authors and Affiliations

  1. Kashan Shahidbeheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran

    Mahzad Erami

  2. Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

    Hasan Afzali & Mansoureh Momen Heravi

  3. Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, 6135715794, Ahvaz, Iran

    Ali Rezaei-Matehkolaei

  4. Department of Parasitology and Mycology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

    Mohammad Javad Najafzadeh

  5. Invasive Fungi Research Center, Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Maryam Moazeni

  6. CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands

    Somayeh Dolatabadi

  7. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Leila Hosseinpour

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  1. Mahzad Erami
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  2. Hasan Afzali
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  4. Ali Rezaei-Matehkolaei
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  7. Somayeh Dolatabadi
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  8. Leila Hosseinpour
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Correspondence to Ali Rezaei-Matehkolaei.

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Erami, M., Afzali, H., Heravi, M.M. et al. Recurrent Arthritis by Candida glabrata, a Diagnostic and Therapeutic Challenge. Mycopathologia 177, 291–298 (2014). https://doi.org/10.1007/s11046-014-9744-6

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  • DOI: https://doi.org/10.1007/s11046-014-9744-6

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