title: Candida Arthritis: Analysis of 112 Pediatric and Adult Cases.
abstract: Background.  Candida arthritis is a debilitating form of deeply invasive candidiasis. However, its epidemiology, clinical manifestations, management, and outcome are not well understood. Methods.  Cases of Candida arthritis were reviewed from 1967 through 2014. Variables included Candida spp in joint and/or adjacent bone, underlying conditions, clinical manifestations, inflammatory biomarkers, diagnostic imaging, management, and outcome. Results.  Among 112 evaluable cases, 62% were males and 36% were pediatric. Median age was 40 years (range, <1-84 years). Most patients (65%) were not pharmacologically immunosuppressed. Polyarticular infection (≥3 joints) occurred in 31% of cases. Clinical manifestations included pain (82%), edema (71%), limited function (39%), and erythema (22%) with knees (75%) and hips (15%) most commonly infected. Median erythrocyte sedimentation rate was 62 mm/hr (10-141) and C reactive protein 26 mg/dL (0.5-95). Synovial fluid median white blood cell count was 27 500/µL (range, 100-220 000/µL) with 90% polymorphonuclear neutrophils (range, 24-98). Adjacent osteomyelitis was present in 30% of cases. Candida albicans constituted 63%, Candida tropicalis 14%, and Candida parapsilosis 11%. Most cases (66%) arose de novo, whereas 34% emerged during antifungal therapy. Osteolysis occurred in 42%, joint-effusion in 31%, and soft tissue extension in 21%. Amphotericin and fluconazole were the most commonly used agents. Surgical interventions included debridement in 25%, irrigation 10%, and drainage 12%. Complete or partial response was achieved in 96% and relapse in 16%. Conclusion.  Candida arthritis mainly emerges as a de novo infection in usually non-immunosuppressed patients with hips and knees being most commonly infected. Localizing symptoms are frequent, and the most common etiologic agents are C albicans, C tropicalis, and C parapsilosis. Management of Candida arthritis remains challenging with a clear risk of relapse, despite antifungal therapy.
authors: Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; National and Kapodistrian and University of Athens, Greece; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York.
authors: Maria N
authors: MN
authors: Gamaletsou
authors: Université Paris-Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine; Unité de Mycologie Moléculaire, Institut Pasteur, Paris, France.
authors: Blandine
authors: B
authors: Rammaert
authors: Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology , New York, New York.
authors: Marimelle A
authors: MA
authors: Bueno
authors: National and Kapodistrian and University of Athens, Greece; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York.
authors: Nikolaos V
authors: NV
authors: Sipsas
authors: Department of Pharmacy , National Institutes of Health Clinical Center , Bethesda, Maryland.
authors: Brad
authors: B
authors: Moriyama
authors: MD Anderson Cancer Center , Houston, Texas.
authors: Dimitrios P
authors: DP
authors: Kontoyiannis
authors: Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; 3rd Department of Pediatrics, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece.
authors: Emmanuel
authors: E
authors: Roilides
authors: Osteoarticular Reference Center , Groupe Hospitalier Diaconesses-Croix Saint-Simon , Paris , France.
authors: Valerie
authors: V
authors: Zeller
authors: Mycology Laboratory , University of Doha , Qatar.
authors: Saad J
authors: SJ
authors: Taj-Aldeen
authors: Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, New York, New York.
authors: Andy O
authors: AO
authors: Miller
authors: Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology , New York, New York.
authors: Ruta
authors: R
authors: Petraitiene
authors: Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Université Paris-Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine.
authors: Olivier
authors: O
authors: Lortholary
authors: Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, New York, New York.
authors: Thomas J
authors: TJ
authors: Walsh
keywords: Candida spp; antifungal therapy; arthritis; diagnosis; invasive candidiasis