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Table 1 Timeline

From: First case report of Cryptococcus laurentii knee infection in a previously healthy patient

Timeline Clinical manifestations / Examination results Treatment
March 2016 Stabbed by plants on the posterolateral side of his left knee.Pain, warmth and swelling in the left knee joint. Antibiotics, intra-articular puncture with knee fluid aspiration and steroidal injection.
November 4th, 2016 Admission of patient. The left knee was moderately swollen without effusion and the local skin temperature was slightly increase.  
November 7th, 2016   Surgical of the left knee with a synovectomy and meniscus repair under arthroscopy. Postoperatively, the left knee was irrigated with Gentamicin sulfate and other routine treatments were carried out for 5 days.
November 15th, 2016 The patient’s symptoms were relieved and discharged.
November 23th, 2016 Culture result of the patient’s operative sample revealed a Cryptococcus laurentii infection. Inform the patient to return to the hospital for treatment.
December 12th, 2016 Admission of patient.Left knee was moderately swollen and warm, and more than 5 ml of yellow purulent fluid was withdrawn 200 mg of intravenous (IV) voriconazole every 12 h (q12 h; 400 mg q12 h on the first day), debridement and irrigation of the left knee with amphotericin B until the infection was controlled and 400 mg of fluconazole per os (PO) q24 h maintained for 6 months.
December 15th, 2016   Incision, debridement and irrigation of the left knee. Suction, resection and repeated irrigation with iodophors, hydrogen peroxide and normal saline in the knee joint were performed thoroughly, and 2 flushing tubes and 2 suction drainage tubes were placed in the knee joint. Postoperatively, an antifungal regimen was carried out.
December 27th, 2016 The tube became obstructed. Secondary incision, debridement and irrigation of the left knee was performed.The antifungal regimen and knee joint irrigation with amphotericin B were continued.
January 6th, 2017, The skin around the drainage tube on the medial side of the left knee was a mild red color and swollen. ESR:44 mm/h, hsCRP:150.9 mg/dL. IV clindamycin hydrochloride (0.45 g, q8 h) was administered for a week, and then IV clindamycin hydrochloride was discontinued and replaced with clindamycin palmitate hydrochloride dispersible tablets (150 mg PO qid).
January 11th, 2017, ESR:29 mm/h, hsCRP:19.5 mg/dL. The left knee joint irrigation was discontinued, intravenous voriconazole was also discontinued, fluconazole 400 mg IV q24 h was initiated, and the lateral flushing tube and drainage tube were maintained to continue draining the joint liquid.
January 25th, 2017, The operative wound of the lateral drainage tube slightly effused a light-yellow liquid, so the liquid sample was sent for culture, and the result revealed Pseudomonas aeruginosa and Enterobacter cloacae infections. Clindamycin palmitate hydrochloride dispersible tablets were discontinued and replaced with ciprofloxacin lactate (0.2 g IV q12 h).
January 30th, 2017 No swelling, and the operative wounds were healing without effusion, and the joint was able to be moved well. Discharged from hospital.Antifungal and antibacterial therapy of fluconazole (400 mg PO qd) and ciprofloxacin lactate were continued for 6 months and 3 weeks.
April, 2017 Outpatient follow-up.There was no swelling, pain or warmth of the left knee; the medial, middle and lateral operative wounds were healed well with no infection recurrence; and the range of motion of the left knee was 0–120°
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