Diseases, Disorders information

CANDIDA OSTEOMYELITIS
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Hematogenous dissemination of candida can result in Candida osteomyelitis. Gathe et al reviewed infections in 32 adults reported in the literature and reported on five patients with Candida osteomyelitis. They concluded that Candida osteomyelitis frequently occurred with hematogenously disseminated candidiasis or as a late sequela. Infrequently Candida osteomyelitis also has presented secondary to postoperative wound infections. Therapy with amphotericin B usually controls local infection but rarely eradicates concurrent osseous focus. The diagnosis of Candida osteomyelitis usually is delayed for several months or years because infection is insidious, with local pain being the most prominent feature. Complicating and further delaying the diagnoses are the nonspecific natures of laboratory and radiographic findings. Definitive diagnosis is usually made by culturing the organism from samples obtained using closed-needle or open-needle aspiration. Combination therapy including surgical debridement and antifungal therapy, usually with amphotericin B, is often successful at eradicating infection.
CANDIDA AND ANTIBIOTIC ASSOCIATED DIARRHEA
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Nosocomial diarrhea is a well-recognized problem in several hospitals across the United States, with Clostridium difficile being one of the most common etiologic agents. Candida species also are being associated with diarrhea. Danna et al evaluated the role of candida in antibiotic-associated diarrhea in elderly patients. The 24 patients with antibiotic-associated diarrhea were matched by age and sex with two selected controls who were either on antibiotics and had no diarrhea or were not on antibiotics and had no diarrhea. They concluded that 7 of 24 patients with stools negative for Clostridium difficile and other intestinal pathogens had intestinal overgrowth caused by Candida species (104 cfu/mL). None of the 24 matched, antibiotic-treated control patients without diarrhea had candida overgrowth. The five patients with diarrhea and candida overgrowth had resolution of their diarrhea and lowering of fecal counts to less than 104 cfu/mL within 7 days of antifungal therapy with nystatin despite continuation of the antibiotics. Two other patients who had overgrowth of candida were not treated with antifungal therapy, and the diarrhea resolved with lowering of fecal candida counts to less than 104 cfu/mL at the time antibacterial agents were withdrawn. In patients without candida overgrowth, diarrhea persisted until antibiotics were withdrawn, at a mean of 16 days after study entry. Several questions remain unanswered after reviewing this study. Why did patients recover despite overgrowth of candida in the stool in the absence of antifungal therapy? Were stool samples from patients without diarrhea accurately reflecting the true bioburden of candida (none of these stools had candida counts 105 cfu/mL)? Finally, can these samples be compared with watery stools obtained from patients with diarrhea?
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