Cryptococcus neoformans prosthetic joint infection: case report and review of the literature.
Cryptococcus neoformans prosthetic joint infection: case report and review of the literature.
复制标题
新型隐球菌假体关节感染：病例报告及文献复习。
DOI：
10.1007/s11046-014-9847-0
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发表时间：
2015
期刊：
影响因子：
5.5
通讯作者：
Nayak,Seema
中科院分区：
文献类型：
--
作者：
Shah,NeelB;Shoham,Shmuel;Nayak,Seema
一名患有糖尿病、重症肌无力并接受双侧全髋关节置换术的 77 岁女性接受了两阶段手术，随后用万古霉素治疗凝固酶阴性葡萄球菌假体髋部感染。由于自发性左髋脱位并清除血肿，情况变得更加复杂。所有术中培养物均生长出新型隐球菌。开始静脉注射脂质体两性霉素 B 治疗。她的假肢装置被保留，并接受了 12 周的治疗，之后转用氟康唑进行长期治疗。入院一年后，髋部保持稳定，并且在助行器的帮助下保持活动能力。真菌是假体关节感染的一种罕见但具有潜在破坏性的原因，大多数是由念珠菌属引起的[1]。新生隐球菌是一种普遍存在的酵母菌，分布于世界各地，通常会导致患有主要 T 细胞免疫缺陷（例如 HIV、移植和接受皮质类固醇）的患者感染。天然骨关节结构的隐球菌感染并不常见，但在文献中已有详细描述 [2, 3]。然而，有关隐球菌假体关节感染的数据很少[4]。
A 77-year-old woman with diabetes mellitus, myasthenia gravis and bilateral total hip arthroplasties underwent a two-stage procedure followed by treatment with vancomycin for a coagulase-negative staphylococcal prosthetic hip infection. This was complicated by a spontaneous left hip dislocation with a hematoma that was evacuated; all intraoperative cultures grew outCryptococcus neoformans.Treatment with intravenous liposomal amphotericin B was started. Her prosthetic device was retained, and she was treated for 12 weeks, after which she was transitioned to fluconazole for long-term therapy. The hip remained stable 1 year out from her admission, and she retained mobility with the assistance of a walker. Fungi are an uncommon but potentially devastating cause of prosthetic joint infections, and most are due toCandida species[1].Cryptococcus neoformansis an ubiquitous yeast with worldwide distribution that generally causes infections in patients with major T cell immune deficiencies (e.g., HIV, transplantation and receipt of corticosteroids). Cryptococcal infections of native osteoarticular structures are uncommon, but have been well described in the literature [2, 3]. Data regarding cryptococcal prosthetic joint infections, however, are sparse [4].