Periprosthetic Knee Infection Caused by Candida glabrata: A case report and literature review

Main Article Content

Manoon Sakdinakiattikoon
Aree Tanavalee


Infection following total knee arthroplasty (TKA) is a serious complication that can cause devastating consequences. The treatment of this condition involves economic and social burden(1-2). A wide variety of pathogens are known to cause periprosthetic knee infection. The majority of infections are caused by gram-positive bacteria, of which, Staphylococcus aureus and Staphylococcus epidermidis infections occur most often(3-4). Fungal periprosthetic knee infection is uncommon. This condition represents a therapeutic challenge because clear treatment guidelines have not yet been established. We presented a case of Candida glabrata infection following TKA which successfully managed with two-stage exchange arthroplasty.

Article Details

Case Report


1. Hanssen AD. Managing the infected knee: As good as it get. J Arthroplasty 2002; 17: 98-101.
2. Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 2002; 404: 116-24.
3. Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003; 36: 1157-61.
4. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 1999; 48: 111-22.
5. Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B, et al. Microbiological, clinical, and surgical features of fungal periprosthetic joint infections: a multi-institutionl experience. J Bone Joint Surg Am 2009; 91: 142-9.
6. Hwang BH, Yoon JY, Nam CH, Jung KA, Lee SC, Han CD, et al. Fungal periproshetic joint infection after primary total knee replacement. J Bone Joint Surg Br 2012; 94: 656-9.
7. Cardinal E, Braunstein EM, Capello WN, Heck DA. Candida albicans infection of prosthetic joints. Orthopedics 1996; 19: 247-51.
8. Phelan DM, Osmon DR, Keating MR, Hanssen AD. Delayed reimplantation arthroplasty for candida prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis 2002: 34: 930-8.
9. Fidel PL Jr, Vazquez JA, Sobel JD. Candida glabrata: Review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev 1999; 12: 80-96.
10. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 1998; 80: 1306-13.
11. Silva M, Tharani R, Schmalzried TP. Results of direct exchange or debridement of the infected total knee arthroplasty. Clin Orthop Relat Res 2002; (404): 125-31.
12. Brooks DH, Pupparo F. Successful salvage of a primary total knee arthroplasty infectd with Candida parapsilosis. J Arthroplasty 1998; 13: 707-12.
13. Fukasawa N, Shirakura K. Candida arthritis after total knee arthroplasty-a case of successful treatment without prosthesis removal. Acta Orthop Scand 1997; 68: 306-7.
14. Selmon GP, Slater RN, Shepperd JA, Wright EP. Successful 1-stage exchange total knee arthroplasty for fungal infection. J Arthroplasty 1998; 13: 114-5.
15. Ji B, Zhang X, Xu B, Guo W, Mu W, Cao L. Single-stage revision for chronic fungal periprosthetic joint infection: an average of 5 years of follow-up. J Arthroplasty 2017.
16. Cushing RD, Fulgenzi WR. Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response. J Arthroplasty 1997; 12: 950.
17. Merrer J, Dupont B, Nieszkowska A, De Jonghe B, Outin H. Candida albicans prosthetic arthritis treated with fluconazole alone. J Infect 2001; 42: 208-9.
18. Yang SH, Pao JL, Hang YS. Staged reimplantation of total knee arthroplasty after Candida infection. J Arthroplasty 2001; 16: 529-32.
19. Anagnostakos K, Kelm J, Schmitt E, Jung J. Fungal periprosthetic hip and knee joint infections clinical experience with a 2-stage treatment protocol. J Arthroplasty 2012; 27: 293-8.
20. Tunkel AR, Thomas CY, Wispelwey B. Candida prosthetic arthritis: report of a case treated with fluconazole and review of the literature. Am J Med 1993; 94: 100-3.
21. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 503-35.
22. Goss B, Lutton C, Weinrauch P, Jabur M, Gillett G, Crawford R. Elution and mechanical properties of antifungal bone cement. J Arthroplasty 2007; 22: 902-8.
23. Marra F, Robbins GM, Masri BA, Duncan C, Wasan KM, Kwong EH, et al. Amphotericin B-loaded bone cement to treat osteomyelitis caused by Candida albicans. Can J Surg 2001; 44: 383-6.
24. Kuhn DM, Chandra J, Mukherjee PK Ghannoum MA. Comparison of biofilms formed by Candida albicans and Candida parapsilosis on bioprosthetic surfaces. Infect Immun 2002; 70: 878-8.
25. Silverberg D, Kodali P, Dipersio J, Acus R, Askew M. In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement. Clin Orthop Relat Res 2002; (403): 228-31.