Case: Aspergillus is an opportunistic pathogen that causes severe clinical diseases in immunosuppressive patients. It is widely distributed in nature and rarely causes disease in immunocompetent patients. A 69 year-old immunocompetent female patient was admitted to our hospital one and a half month after implantation of bilateral knee prothesis. She had no other underlying disease. Her complaints were fever, cough, hemoptysis, pleuritic chest pain and dyspnea on the 5th week after operation. She was hospitalized with the suspicion of pulmoner thromboembolism and anticoagulant therapy was started. The purulan drainage from both knees was noticed during the follow up. Polymorphonuclear leukocytes and Grampositive cocci were seen in the microscopic examination of the joint fluid. Teicoplanin treatment was begun. She improved, fever resolved but necrotic areas appeared during teicoplanin treatment. The pathological examination of the necrotic material demonstrated fungal hyphae and the culture grew Aspergillus niger. Amphotericin B was started along with debridman and the patient improved dramatically. After 42 days of amphotericin B therapy, both knees and the patient were well without prothesis replacement. She was still in good health three months after discharge. Conclusion: Prosthetic joint infections are troublesome complications of orthopedic surgery. Usually Gram-positive microorganisms cause such infections but in descending order Gram-negative bacilli or Candida spp. may be the causative agents. Aspergillus arthritis is a rare clinical entity especially in immunocompetent patients. Other interesting side of this case is the rescument of the prothesis with medical therapy and debridman only.
Full conference title:
- ECCMID 15th (2005)