Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear
An elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the p...
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MDPI AG
2024-11-01
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| author | Eirini Spatha Loredana-Mariana Gheorghe Ioulia Chaliori Nikolaos J. Tsagarakis Nikolaos Patsiogiannis Sofia K. Chaniotaki |
| author_facet | Eirini Spatha Loredana-Mariana Gheorghe Ioulia Chaliori Nikolaos J. Tsagarakis Nikolaos Patsiogiannis Sofia K. Chaniotaki |
| author_sort | Eirini Spatha |
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| description | An elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the patient later developed a low-grade fever and signs of myelosuppression. In the May–Grünwald–Giemsa stain of peripheral blood smear (PBS), pseudohyphae among red blood cells (RBCs) and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidemia rather than contamination of the stain. Echinocandin treatment was immediately initiated, and <i>Candida albicans</i> was identified from the blood culture, using multiplex polymerase chain reaction (PCR). Despite the early initiation of antifungal therapy and the removal of the central venous line (CVL), the patient passed away within 24 h. Candidemia is a leading cause of nosocomial bloodstream infections with high morbidity and mortality and is associated with multiple risk factors including surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, and immunosuppression. Isolation from blood cultures remains the gold standard for diagnosing candidemia. Detection of candidemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification are crucial for prompt antifungal treatment. |
| format | Article |
| id | doaj-art-bbb1eb1bf61a4f7f8b3b53b92a070853 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-bbb1eb1bf61a4f7f8b3b53b92a0708532024-11-26T18:00:04ZengMDPI AGDiagnostics2075-44182024-11-011422259710.3390/diagnostics14222597Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood SmearEirini Spatha0Loredana-Mariana Gheorghe1Ioulia Chaliori2Nikolaos J. Tsagarakis3Nikolaos Patsiogiannis4Sofia K. Chaniotaki5Haematology Laboratory, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceHaematology Laboratory, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceHaematology Laboratory, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceHaematology Laboratory, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceFirst Orthopaedic Department, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceHaematology Laboratory, Peripheral General Hospital of Athens Georgios Gennimatas, 11527 Athens, GreeceAn elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the patient later developed a low-grade fever and signs of myelosuppression. In the May–Grünwald–Giemsa stain of peripheral blood smear (PBS), pseudohyphae among red blood cells (RBCs) and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidemia rather than contamination of the stain. Echinocandin treatment was immediately initiated, and <i>Candida albicans</i> was identified from the blood culture, using multiplex polymerase chain reaction (PCR). Despite the early initiation of antifungal therapy and the removal of the central venous line (CVL), the patient passed away within 24 h. Candidemia is a leading cause of nosocomial bloodstream infections with high morbidity and mortality and is associated with multiple risk factors including surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, and immunosuppression. Isolation from blood cultures remains the gold standard for diagnosing candidemia. Detection of candidemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification are crucial for prompt antifungal treatment.https://www.mdpi.com/2075-4418/14/22/2597candidemiabloodstream infectionperiprosthetic joint infectionphagocytosed blastosporespseudohyphaemonocytes |
| spellingShingle | Eirini Spatha Loredana-Mariana Gheorghe Ioulia Chaliori Nikolaos J. Tsagarakis Nikolaos Patsiogiannis Sofia K. Chaniotaki Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear Diagnostics candidemia bloodstream infection periprosthetic joint infection phagocytosed blastospores pseudohyphae monocytes |
| title | Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear |
| title_full | Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear |
| title_fullStr | Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear |
| title_full_unstemmed | Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear |
| title_short | Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear |
| title_sort | candidemia in an orthopedic patient detected coincidentally by peripheral blood smear |
| topic | candidemia bloodstream infection periprosthetic joint infection phagocytosed blastospores pseudohyphae monocytes |
| url | https://www.mdpi.com/2075-4418/14/22/2597 |
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