Septic arthritis due to candida species in patients with cancer: Report of five cases and review of the literature

In disseminated candidiasis, various organs frequently become involved, usually as a consequence of hematogenous spread of the organism. However, involvement of the joints is rare even with dissemination. Nineteen cases of joint involvement have previously been reported in adults and 21 cases in children. The most commonly involved joint has been the knee; in such cases, amphotericin B has been effective in controlling the infection. Five patients with cancer developed septic arthritis due to Candida species at the M. C. Anderson Hospital and Tumor Institute in the past five years. Four of these patients were seen in 1980. Candida albicans was isolated from three patients and Candida tropicalis from two. All five patients had predisposing conditions - e.g., intravenous and/or urinary catheterization, neutropenia, and previous treatment with steroids and antibiotics. The knee was the affected joint in all five. Different modalities of treatment were used, including intravenous miconazole, oral ketoconazole, and systemic and local amphotericin B; adequate levels of these drugs were found in the joint fluid when measured. Infection was cured in two patients. The condition of the third patient improved. The fourth patient died of disseminated disease despite therapy, and the fifth died of malignancy without the benefit of antifungal therapy. For treatment of such infections, the use of an antifungal agent is recommended in addition to frequent evacuation of the joint fluid. Some new compounds may prove useful alternatives to amphotericin B. Arthritis can be resolved even in the presence of unresolved disseminated disease.