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      Fungal prosthetic joint infection after total knee arthroplasty

      case-report

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          Abstract

          Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Total duration of fluconazole therapy was 30 weeks. At 2 year followup, she has pain less range of motion of 10 °-90 ° and there is no evidence of recurrence of infection.

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          Most cited references11

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          Comparison of biofilms formed by Candida albicans and Candida parapsilosis on bioprosthetic surfaces.

          Little is known about fungal biofilms, which may cause infection and antibiotic resistance. In this study, biofilm formation by different Candida species, particularly Candida albicans and C. parapsilosis, was evaluated by using a clinically relevant model of Candida biofilm on medical devices. Candida biofilms were allowed to form on silicone elastomer and were quantified by tetrazolium (XTT) and dry weight (DW) assays. Formed biofilm was visualized by using fluorescence microscopy and confocal scanning laser microscopy with Calcofluor White (Sigma Chemical Co., St. Louis, Mo.), concanavalin A-Alexafluor 488 (Molecular Probes, Eugene, Oreg.), and FUN-1 (Molecular Probes) dyes. Although minimal variations in biofilm production among invasive C. albicans isolates were seen, significant differences between invasive and noninvasive isolates (P 128 microg/ml). Importantly, XTT and FUN-1 activity showed biofilm cells to be metabolically active. In conclusion, our data show that C. albicans produces quantitatively larger and qualitatively more complex biofilms than other species, in particular, C. parapsilosis.
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            Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience.

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              Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature.

              Fungal prosthetic joint infection (PJI) is rare, with Candida species being the most frequently reported pathogen in the medical literature. The risk of relapse following delayed reimplantation arthroplasty for candidal PJI is unknown. We describe 4 new cases and summarize 6 previously reported cases of candidal PJI treated with delayed reimplantation arthroplasty. Ninety percent of the patients received antifungal therapy. Eight patients received amphotericin B either alone or in combination with other antifungals. One patient received fluconazole alone. The median duration of time from resection arthroplasty to reimplantation for total hip and total knee arthroplasties was 8.6 and 2.3 months, respectively. Eight patients did not have relapse of candidal PJI following delayed reimplantation arthroplasty after a median duration of follow-up of 50.7 months (range, 2--73 months). Candidal PJI can be successfully treated with delayed reimplantation arthroplasty after receipt appropriate antifungal therapy.
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                Author and article information

                Journal
                Indian J Orthop
                Indian J Orthop
                IJOrtho
                Indian Journal of Orthopaedics
                Medknow Publications & Media Pvt Ltd (India )
                0019-5413
                1998-3727
                Sep-Oct 2013
                : 47
                : 5
                : 526-529
                Affiliations
                [1]Department of Orthopedics and Trauma, Apollo Hospital, Jubilee Hills, Hyderabad, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Kankanala J Reddy, Room No. 960, International Block, Apollo Hospital, Jubilee Hills, Hyderabad - 500 033, Andhra Pradesh, India. E-mail: kjreddy@ 123456hotmail.co.uk
                Article
                IJOrtho-47-526
                10.4103/0019-5413.118213
                3796930
                24133317
                cc41f1d5-fa76-4a14-b5d4-54b9be282580
                Copyright: © Indian Journal of Orthopaedics

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Orthopedics
                candida tropicalis,fluconazole therapy,infected total knee arthroplasty,revision total knee arthroplasty

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