Experiences and brief literature review of a rare infection: Candida lusitaniae osteomyelitis

Experiences and brief literature review of a rare infection: Candida lusitaniae osteomyelitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Experiences and brief literature review of a rare infection: Candida lusitaniae osteomyelitis Serkan Atıcı This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5983254/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Osteoarticular infections caused by Candida , especially the lusitaniae subspecies, are extremely rare in an immunocompetent host. The optimal management of Candida osteomyelitis treatment is not clearly defined but most guidelines advise prolonged antifungal therapy in addition to surgery. Case presentation: In this report, we aimed to present our experience with Candida lusitaniae osteomyelitis in an immunocompetent patient in light of a brief literature review. To the best of our knowledge, it is the third report of C. lusitaniae osteomyelitis in the English literature. Conclusions We want to highlight rare osteomyelitis agents like C. lusitaniae and the importance of careful microbiological identification. We also observed that antifungal treatment with fluconazole and surgical debridement were effective in accordance with the treatment recommendations in the literature and as in the other cases. Candida lusitaniae osteomyelitis literature review Figures Figure 1 Background Candida osteomyelitis is a rare disorder; especially in immunocompetent hosts. The diagnosis may be delayed when it is not suspected because the symptoms are also nonspecific. Thus, its management would not be performed on time, which leads to increased mortality and morbidity. The optimal management of Candida osteomyelitis treatment is not clearly defined but most guidelines advise prolonged antifungal therapy in addition to surgery [ 1 , 2 ]. Herein, we aimed to present our experience with Candida lusitaniae ( C. lusitaniae ) osteomyelitis in an immunocompetent patient in the light of literature. We searched databases such as PubMed, PMC (PubMed Central), MEDLINE, SciELO, and Cochrane Library for osteomyelitis caused by C. lusitaniae . To the best of our knowledge, it is the third report of C. lusitaniae osteomyelitis in the English literature. We observed that antifungal treatment with fluconazole and surgical debridement were effective by the treatment recommendations in the literature and as in the other cases [ 1 – 4 ]. Case presantation An 11-year-old boy presented with swelling and pain in the left side mandibular area. He had a three-day history of left jaw pain and decreased oral intake. He was afebrile. He had no significant past medical history. Examination findings included mild trismus and marked left submandibular swelling. Oral hygiene was very poor and 6th tooth was tender and decayed. His laboratory findings showed leukocytosis and high levels of acute phase reactants. Neck ultrasound and contrast-enhanced magnetic resonance imaging (MRI) were compatible with submandibular abscess and mandibular osteomyelitis (Fig. 1 a). Ceftriaxone was started empirically and the abscess was drained surgically. Bacterial and fungal cultures were incubated from abscess samples and regular-shaped colonies with white color were seen on incubation in the blood agar and sabouraud dextrose agar. Using the matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS; VITEK®; bioMérieux Diagnostics, France), C. lusitaniae was identified. Simultaneous blood culture resulted negative. The antibiotherapy was switched with intravenous fluconazole. He was consulted by the pediatric immunology department with suspected immunodeficiency. Lymphocyte subset analysis, dihydrorhodamine 123 flow cytometry, and serum immunoglobulin levels were normal. No pathology was detected on abdominal ultrasonography, echocardiography, eye examination, and cranial MRI performed to exclude metastatic complications of candidemia. Contrast-enhanced mandibular MRI was normal at 6 months (Fig. 1 b). Antifungal therapy was discontinued after completing 6 months as recommended in the guideline 1 . Relapse was not determined during the one-year follow-up. Discussion Osteomyelitis is an inflammatory disease, related to bone infection and characterized by progressive inflammation and bone destruction 5 . The skeletal system is highly resistant to infections and candida species are low virulence pathogens in the immunocompetent host. These reasons explain why Candida osteomyelitis rarely occurs. When the studies and case reports in the literature were analyzed, it was observed that the risk factors associated with Candida infection include neutropenia, post-trauma, central venous catheters, hematological malignancies, broad-spectrum antibiotic usage and the use of immunosuppressive agents [ 2 – 4 ]. Candida osteomyelitis is rare, with Candida albicans being the most commonly responsible fungus, followed by non albicans Candida, including C. glabrata , C. parapsilosis , C. freyschusii , and C. lusitaniae . C. lusitaniae is an uncommon pathogen in osteomyelitis especially in immunocompetent host [ 3 – 5 ]. Although the number of cases related to joint infection such as arthritis is higher, there were only two cases related to C. lusitaniae osteomyelitis to the best of our knowledge. The first case of osteomyelitis of the distal humerus caused by C. lusitaniae was a premature infant. The second case of osteomyelitis caused by C. lusitaniae was observed in a 49-year-old female with a splinter injury [ 3 , 4 ]. In this study, the case was an 11-year-old boy diagnosed with mandibular osteomyelitis caused by C. lusitaniae as a result of radiological and microbiological tests. There was no risk factor other than dental disease and no immunodeficiency was detected. Treatment of C. lusitaniae is challenging due to the frequent resistance of this organism to antifungal agents and the lack of standardized susceptibility testing for fungi [ 1 – 6 ]. Fluconazole has been used successfully as initial therapy for patients who have susceptible isolates. Fluconazole was also used in other two cases of C. lusitaniae osteomyelitis and the results were reported as successful. Surgical debridement is strongly recommended in selected cases like those who have neurological deficits, spinal instability, large abscesses, or persistent or worsening symptoms during therapy [ 1 ]. The recommended duration of therapy for Candida osteomyelitis is 6–12 months. Cure rates are significantly high if there are no obvious metastatic complications and an antifungal agent has been administered for at least 6 months [ 1 ]. In this case, C. lusitane osteomyelitis was successfully cured with 6 months of antifungal treatment followed by surgical drainage. In conclusion, we want to highlight rare osteomyelitis agents like C. lusitaniae and the importance of careful microbiological identification. We believe that early surgical debridement and initiation of antifungal therapy in Candida osteomyelitis will increase the success of treatment and the patient will regain health without loss of organ function. Abbreviations MRI: magnetic resonance imaging Declarations Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Okan University committee of and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: Informed consent was obtained from the parents/legal guardians of the participant included in the study. Competing interests: The authors declare no competing interests Acknowledgements: None Funding: The authors have not received any specific funds for the publication of this work Author contributions: Conceptualization, S.A; Writing—original draft preparation, S.A; investigation, S.A; Picture drawingting, S.A; writing—review and editing, S.A. All authors have read, reviewed and agreed to the manuscript. References Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:1–50. Horn DL, Neofytos D, Anaissie EJ, Fishman JA, Steinbach WJ, Olyaei AJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695–703. Acar E, Bezirgan U. A rare cause of osteomyelitis of distal phalanx: Candida lusitaniae. Jt Dis Relat Surg. 2021;32(2):556–9. Oleinik EM, Della-Latta P, Rinaldi MG, Saiman L. Candida lusitaniae osteomyelitis in a premature infant. Am J Perinatol. 1993;10(4):313–5. Brembilla C, Lanterna LA, Risso A, Bonaldi G, Gritti P, Resmini B, et al. Cervical Bone Graft Candida albicans Osteomyelitis: Management Strategies for an Uncommon Infection. Case Rep Orthop. 2014;2014:986393. Vitale RG. Role of Antifungal Combinations in Difficult to Treat Candida Infections. J Fungi (Basel). 2021;7(9):731. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Feb, 2025 Editor assigned by journal 14 Feb, 2025 Submission checks completed at journal 14 Feb, 2025 First submitted to journal 07 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5983254","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":415822207,"identity":"0bfcbabf-c376-46be-81ff-4389ee4a1a78","order_by":0,"name":"Serkan Atıcı","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIie3PPQrCMBTA8YaCLmLX9haK4OhFXAyuxsWl4NeTgi4ewEHaK7RL50ogXYKugovFwbVudTMt4iC01k0w/+FlyY+XKIpM9osFr4FA6ZniVFUoSSop4SlBpUm6aPlcV1T9FEYXk3eGmmMt4siedrWVIInp5xJjP2g1+bE/0hmydOyHZEMRoDU/5ZIGr1UMiFUMTLwK+4yAICpaFpHq9Q7xHDsZ2TLifCZKG8GRYjcjMCHuJ2LwWssAHmKPYUvvsYB4guyK/lLn1egGbIxtGka3ZDIj9oHuzomZT96j2QxK3xfNvrksk8lkf9IDyTplkQqDVVkAAAAASUVORK5CYII=","orcid":"","institution":"Okan University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Serkan","middleName":"","lastName":"Atıcı","suffix":""}],"badges":[],"createdAt":"2025-02-07 18:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5983254/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5983254/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76685810,"identity":"8c05eebc-1881-4a6d-8d37-aae7db0765b8","added_by":"auto","created_at":"2025-02-19 16:07:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":326592,"visible":true,"origin":"","legend":"\u003cp\u003eMagnetic resonance imaging findings before (a) and after (b) treatment\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5983254/v1/1e523cc8f5b2fda6ed866566.jpeg"},{"id":76686660,"identity":"fd99f6ca-8fd7-47f0-ba0e-41c872f4bc98","added_by":"auto","created_at":"2025-02-19 16:15:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":632479,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5983254/v1/0b91fe2c-f1f6-4f15-9874-5ea7f577c88f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences and brief literature review of a rare infection: Candida lusitaniae osteomyelitis","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cem\u003eCandida\u003c/em\u003e osteomyelitis is a rare disorder; especially in immunocompetent hosts. The diagnosis may be delayed when it is not suspected because the symptoms are also nonspecific. Thus, its management would not be performed on time, which leads to increased mortality and morbidity. The optimal management of \u003cem\u003eCandida\u003c/em\u003e osteomyelitis treatment is not clearly defined but most guidelines advise prolonged antifungal therapy in addition to surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHerein, we aimed to present our experience with \u003cem\u003eCandida lusitaniae\u003c/em\u003e (\u003cem\u003eC. lusitaniae\u003c/em\u003e) osteomyelitis in an immunocompetent patient in the light of literature. We searched databases such as PubMed, PMC (PubMed Central), MEDLINE, SciELO, and Cochrane Library for osteomyelitis caused by \u003cem\u003eC. lusitaniae\u003c/em\u003e. To the best of our knowledge, it is the third report of \u003cem\u003eC. lusitaniae\u003c/em\u003e osteomyelitis in the English literature. We observed that antifungal treatment with fluconazole and surgical debridement were effective by the treatment recommendations in the literature and as in the other cases [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case presantation","content":"\u003cp\u003eAn 11-year-old boy presented with swelling and pain in the left side mandibular area. He had a three-day history of left jaw pain and decreased oral intake. He was afebrile. He had no significant past medical history. Examination findings included mild trismus and marked left submandibular swelling. Oral hygiene was very poor and 6th tooth was tender and decayed. His laboratory findings showed leukocytosis and high levels of acute phase reactants. Neck ultrasound and contrast-enhanced magnetic resonance imaging (MRI) were compatible with submandibular abscess and mandibular osteomyelitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). Ceftriaxone was started empirically and the abscess was drained surgically.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBacterial and fungal cultures were incubated from abscess samples and regular-shaped colonies with white color were seen on incubation in the blood agar and sabouraud dextrose agar. Using the matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS; VITEK\u0026reg;; bioM\u0026eacute;rieux Diagnostics, France), \u003cem\u003eC. lusitaniae\u003c/em\u003e was identified. Simultaneous blood culture resulted negative. The antibiotherapy was switched with intravenous fluconazole. He was consulted by the pediatric immunology department with suspected immunodeficiency. Lymphocyte subset analysis, dihydrorhodamine 123 flow cytometry, and serum immunoglobulin levels were normal. No pathology was detected on abdominal ultrasonography, echocardiography, eye examination, and cranial MRI performed to exclude metastatic complications of candidemia. Contrast-enhanced mandibular MRI was normal at 6 months (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). Antifungal therapy was discontinued after completing 6 months as recommended in the guideline\u003csup\u003e1\u003c/sup\u003e. Relapse was not determined during the one-year follow-up.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOsteomyelitis is an inflammatory disease, related to bone infection and characterized by progressive inflammation and bone destruction\u003csup\u003e5\u003c/sup\u003e. The skeletal system is highly resistant to infections and candida species are low virulence pathogens in the immunocompetent host. These reasons explain why Candida osteomyelitis rarely occurs. When the studies and case reports in the literature were analyzed, it was observed that the risk factors associated with Candida infection include neutropenia, post-trauma, central venous catheters, hematological malignancies, broad-spectrum antibiotic usage and the use of immunosuppressive agents [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Candida osteomyelitis is rare, with \u003cem\u003eCandida albicans\u003c/em\u003e being the most commonly responsible fungus, followed by non albicans Candida, including \u003cem\u003eC. glabrata\u003c/em\u003e, \u003cem\u003eC. parapsilosis\u003c/em\u003e, \u003cem\u003eC. freyschusii\u003c/em\u003e, and \u003cem\u003eC. lusitaniae\u003c/em\u003e. \u003cem\u003eC. lusitaniae\u003c/em\u003e is an uncommon pathogen in osteomyelitis especially in immunocompetent host [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although the number of cases related to joint infection such as arthritis is higher, there were only two cases related to \u003cem\u003eC. lusitaniae\u003c/em\u003e osteomyelitis to the best of our knowledge. The first case of osteomyelitis of the distal humerus caused by \u003cem\u003eC. lusitaniae\u003c/em\u003e was a premature infant. The second case of osteomyelitis caused by \u003cem\u003eC. lusitaniae\u003c/em\u003e was observed in a 49-year-old female with a splinter injury [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this study, the case was an 11-year-old boy diagnosed with mandibular osteomyelitis caused by \u003cem\u003eC. lusitaniae\u003c/em\u003e as a result of radiological and microbiological tests. There was no risk factor other than dental disease and no immunodeficiency was detected.\u003c/p\u003e \u003cp\u003eTreatment of \u003cem\u003eC. lusitaniae\u003c/em\u003e is challenging due to the frequent resistance of this organism to antifungal agents and the lack of standardized susceptibility testing for fungi [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Fluconazole has been used successfully as initial therapy for patients who have susceptible isolates. Fluconazole was also used in other two cases of \u003cem\u003eC. lusitaniae\u003c/em\u003e osteomyelitis and the results were reported as successful. Surgical debridement is strongly recommended in selected cases like those who have neurological deficits, spinal instability, large abscesses, or persistent or worsening symptoms during therapy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The recommended duration of therapy for \u003cem\u003eCandida\u003c/em\u003e osteomyelitis is 6\u0026ndash;12 months. Cure rates are significantly high if there are no obvious metastatic complications and an antifungal agent has been administered for at least 6 months [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this case, \u003cem\u003eC. lusitane\u003c/em\u003e osteomyelitis was successfully cured with 6 months of antifungal treatment followed by surgical drainage.\u003c/p\u003e \u003cp\u003eIn conclusion, we want to highlight rare osteomyelitis agents like \u003cem\u003eC. lusitaniae\u003c/em\u003e and the importance of careful microbiological identification. We believe that early surgical debridement and initiation of antifungal therapy in \u003cem\u003eCandida\u003c/em\u003e osteomyelitis will increase the success of treatment and the patient will regain health without loss of organ function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMRI: magnetic resonance imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the Okan University committee of and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from the parents/legal guardians of the participant included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors have not received any specific funds for the publication of this work\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eConceptualization, S.A; Writing\u0026mdash;original draft preparation, S.A; investigation, S.A; Picture drawingting, S.A; writing\u0026mdash;review and editing, S.A. All authors have read, reviewed and agreed to the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:1\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorn DL, Neofytos D, Anaissie EJ, Fishman JA, Steinbach WJ, Olyaei AJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695\u0026ndash;703.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcar E, Bezirgan U. A rare cause of osteomyelitis of distal phalanx: Candida lusitaniae. Jt Dis Relat Surg. 2021;32(2):556\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOleinik EM, Della-Latta P, Rinaldi MG, Saiman L. Candida lusitaniae osteomyelitis in a premature infant. Am J Perinatol. 1993;10(4):313\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrembilla C, Lanterna LA, Risso A, Bonaldi G, Gritti P, Resmini B, et al. Cervical Bone Graft Candida albicans Osteomyelitis: Management Strategies for an Uncommon Infection. Case Rep Orthop. 2014;2014:986393.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVitale RG. Role of Antifungal Combinations in Difficult to Treat Candida Infections. J Fungi (Basel). 2021;7(9):731.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Candida lusitaniae, osteomyelitis, literature review","lastPublishedDoi":"10.21203/rs.3.rs-5983254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5983254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOsteoarticular infections caused by \u003cem\u003eCandida\u003c/em\u003e, especially the \u003cem\u003elusitaniae\u003c/em\u003e subspecies, are extremely rare in an immunocompetent host. The optimal management of \u003cem\u003eCandida\u003c/em\u003e osteomyelitis treatment is not clearly defined but most guidelines advise prolonged antifungal therapy in addition to surgery.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eIn this report, we aimed to present our experience with \u003cem\u003eCandida lusitaniae\u003c/em\u003e osteomyelitis in an immunocompetent patient in light of a brief literature review. To the best of our knowledge, it is the third report of \u003cem\u003eC. lusitaniae\u003c/em\u003e osteomyelitis in the English literature.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe want to highlight rare osteomyelitis agents like \u003cem\u003eC. lusitaniae\u003c/em\u003e and the importance of careful microbiological identification. We also observed that antifungal treatment with fluconazole and surgical debridement were effective in accordance with the treatment recommendations in the literature and as in the other cases.\u003c/p\u003e","manuscriptTitle":"Experiences and brief literature review of a rare infection: Candida lusitaniae osteomyelitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-19 16:07:29","doi":"10.21203/rs.3.rs-5983254/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-18T10:13:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-14T12:02:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-14T12:01:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-02-07T17:54:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b2d97c01-76bb-4794-b7f7-8046ac9c8ab4","owner":[],"postedDate":"February 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T22:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-19 16:07:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5983254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5983254","identity":"rs-5983254","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}