Candidaemia in an Orthopaedic Patient Detected Coincidentally by Peripheral Blood Smear

An elderly male, with recent COVID-19 and cardiovascular comorbidities, had a prolonged hospitalisation due to periprosthetic joint infection and bacteraemia, post hip hemiarthroplasty. Despite the initial clinical improvement while under targeted antimicrobial therapy, low-grade fever and signs of myelosuppression later occurred. In the May-Grünwald-Giemsa stain of peripheral blood smear (PBS), pseudohyphae among RBCs and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidaemia and not contamination of the stain. Echinocandin treatment was immediately initiated, and Candida albicans was identified, using multiplex PCR, from the obtained blood cultures. Despite the early initiation of antifungal therapy and the removal of the CVL (central venus line), the patient passed away within the next twenty-four hours. Candidaemia is a leading cause of nosocomial bloodstream infections with very high morbidity and mortality and is associated with multiple risk factors (surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, immunosuppression). The isolation from blood cultures is the gold standard for candidaemia diagnosis. Detection of candidaemia 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 can lead to prompt antifungal treatment.