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Candida osteoarticular infections

Carol A Kauffman, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD


Invasive Candida infections tend to occur in selected patients, including those who are immunocompromised (eg, neutropenia, glucocorticoid therapy), have indwelling central venous catheters, have received broad-spectrum antibiotics, or are injection drug users [1,2]. Candida albicans is the most common pathogen, but other species, such as C. glabrata, C. parapsilosis, and C. tropicalis, can be involved [2-8].

Clinical issues related to Candida osteomyelitis and arthritis will be reviewed here. An overview of Candida infections is presented separately. (See "Overview of Candida infections".)


Candida osteoarticular infections are most often due to hematogenous seeding of the joint or bone in patients who have been candidemic [1,2,8-11]. The areas most often seeded during an episode of candidemia in adults are intervertebral discs and knee joints [2,10,11].

Exogenous inoculation also can lead to infection in the following settings:

After trauma or at the time of intraarticular injection (most often the knee) or prosthesis implantation [9,12,13]. (See "Treatment and prevention of osteomyelitis following trauma in adults".)


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Literature review current through: Oct 2015. | This topic last updated: Nov 18, 2014.
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  1. Johnson MD, Perfect JR. Fungal Infections of the Bones and Joints. Curr Infect Dis Rep 2001; 3:450.
  2. Miller DJ, Mejicano GC. Vertebral osteomyelitis due to Candida species: case report and literature review. Clin Infect Dis 2001; 33:523.
  3. Ramamohan N, Zeineh N, Grigoris P, Butcher I. Candida glabrata infection after total hip arthroplasty. J Infect 2001; 42:74.
  4. Zmierczak H, Goemaere S, Mielants H, et al. Candida glabrata arthritis: case report and review of the literature of Candida arthritis. Clin Rheumatol 1999; 18:406.
  5. Gunthard HF, Meltzer H, Karpinski NC, Ziegler EJ. Spinal osteomyelitis caused by Candida glabrata: case report and review. Infect Dis Clin Pract 1998; 7:12.
  6. Ferra C, Doebbeling BN, Hollis RJ, et al. Candida tropicalis vertebral osteomyelitis: a late sequela of fungemia. Clin Infect Dis 1994; 19:697.
  7. Weers-Pothoff G, Havermans JF, Kamphuis J, et al. Candida tropicalis arthritis in a patient with acute myeloid leukemia successfully treated with fluconazole: case report and review of the literature. Infection 1997; 25:109.
  8. Gamaletsou MN, Kontoyiannis DP, Sipsas NV, et al. Candida osteomyelitis: analysis of 207 pediatric and adult cases (1970-2011). Clin Infect Dis 2012; 55:1338.
  9. Cuéllar ML, Silveira LH, Espinoza LR. Fungal arthritis. Ann Rheum Dis 1992; 51:690.
  10. Gathe JC Jr, Harris RL, Garland B, et al. Candida osteomyelitis. Report of five cases and review of the literature. Am J Med 1987; 82:927.
  11. Hendrickx L, Van Wijngaerden E, Samson I, Peetermans WE. Candidal vertebral osteomyelitis: report of 6 patients, and a review. Clin Infect Dis 2001; 32:527.
  12. Tunkel AR, Thomas CY, Wispelwey B. Candida prosthetic arthritis: report of a case treated with fluconazole and review of the literature. Am J Med 1993; 94:100.
  13. Brooks DH, Pupparo F. Successful salvage of a primary total knee arthroplasty infected with Candida parapsilosis. J Arthroplasty 1998; 13:707.
  14. Malani PN, McNeil SA, Bradley SF, Kauffman CA. Candida albicans sternal wound infections: a chronic and recurrent complication of median sternotomy. Clin Infect Dis 2002; 35:1316.
  15. Bisbe J, Miro JM, Latorre X, et al. Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review. Clin Infect Dis 1992; 15:910.
  16. Garbino J, Schnyder I, Lew D, et al. An unusual cause of vertebral osteomyelitis: Candida species. Scand J Infect Dis 2003; 35:288.
  17. Evdoridou J, Roilides E, Bibashi E, Kremenopoulos G. Multifocal osteoarthritis due to Candida albicans in a neonate: serum level monitoring of liposomal amphotericin B and literature review. Infection 1997; 25:112.
  18. Phelan DM, Osmon DR, Keating MR, Hanssen AD. Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis 2002; 34:930.
  19. O'Meeghan T, Varcoe R, Thomas M, Ellis-Pegler R. Fluconazole concentration in joint fluid during successful treatment of Candida albicans septic arthritis. J Antimicrob Chemother 1990; 26:601.
  20. Pérez-Gómez A, Prieto A, Torresano M, et al. Role of the new azoles in the treatment of fungal osteoarticular infections. Semin Arthritis Rheum 1998; 27:226.
  21. Fischman AJ, Alpert NM, Livni E, et al. Pharmacokinetics of 18F-labeled fluconazole in healthy human subjects by positron emission tomography. Antimicrob Agents Chemother 1993; 37:1270.
  22. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
  23. Merrer J, Dupont B, Nieszkowska A, et al. Candida albicans prosthetic arthritis treated with fluconazole alone. J Infect 2001; 42:208.
  24. Rössel P, Schønheyder HC, Nielsen H. Fluconazole therapy in Candida albicans spondylodiscitis. Scand J Infect Dis 1998; 30:527.
  25. Hennequin C, Bourée P, Hiesse C, et al. Spondylodiskitis due to Candida albicans: report of two patients who were successfully treated with fluconazole and review of the literature. Clin Infect Dis 1996; 23:176.
  26. Legout L, Assal M, Rohner P, et al. Successful treatment of Candida parapsilosis (fluconazole-resistant) osteomyelitis with caspofungin in a HIV patient. Scand J Infect Dis 2006; 38:728.
  27. Yang SC, Shao PL, Hsueh PR, et al. Successful treatment of Candida tropicalis arthritis, osteomyelitis and costochondritis with caspofungin and fluconazole in a recipient of bone marrow transplantation. Acta Paediatr 2006; 95:629.
  28. Pemán J, Jarque I, Bosch M, et al. Spondylodiscitis caused by Candida krusei: case report and susceptibility patterns. J Clin Microbiol 2006; 44:1912.
  29. Sili U, Yilmaz M, Ferhanoglu B, Mert A. Candida krusei arthritis in a patient with hematologic malignancy: successful treatment with voriconazole. Clin Infect Dis 2007; 45:897.