INTRODUCTION

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".)

MECHANISMS AND SITES OF INFECTION

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".)
• After surgical procedures, such as median sternotomy for heart surgery [14]. (See "Candida infections of the abdomen and thorax", section on 'Mediastinitis'.)
• In injection drug users, especially those who use brown heroin [15]. These patients may develop a unique syndrome consisting of septic arthritis (usually costochondral or sternoclavicular), endophthalmitis, and folliculitis involving the face, scalp, and chest.