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Clinical feature, image findings and outcome of hepatosplenic candidiasis in patients with acute myeloid leukemia. Biomed J 2020; 44:S252-S257. [PMID: 35292266 PMCID: PMC9068564 DOI: 10.1016/j.bj.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background Patients with acute myeloid leukemia (AML) are at risk of hepatosplenic candidiasis (HSC). HSC is often associated with prolonged fever and difficulty in definitive clinical diagnosis. We aimed to explore the incidence, clinical features, image findings and outcomes of HSC among patients with AML in a tertiary hospital, Taiwan. Methods We did a chart review of patient data in our institute from 2009 to 2012. The diagnosis of HSC was based on risk factors, febrile symptoms and image findings. Results Two hundred and ninety-two patients with AML were analyzed. In total, 1051 chemotherapy sessions were administered. Eleven patients (4 males and 7 females) experienced HSC (incidence 3.8%, 95% conference interval 2.11–6.72%). Among those with HSC, the median age was 62. Eight patients developed HSC following induction or re-induction chemotherapies. Three developed HSC following consolidation chemotherapies. The median duration of severe neutropenia was 25 days (range 10–142). In all patients with HSC, multiple hypodense lesions were found in the involved organs by computed tomography scans. Lesions consistent with HSC could be identified by ultrasound in 5 out of 6 patients. Other than liver and spleen, lung was frequently (7 cases) and kidney occasionally (3 cases) involved. Four patients died within 90 days. Prolonged neutropenia was associated with mortality. Conclusion HSC occurred more often during induction or re-induction periods. Lungs are commonly involved and pleural effusion was frequently seen in CT scans. Pleural effusion may suggest more serious infections but its clinical relevance should be investigated in large-scale studies. Prolonged neutropenia is the only prognostic factor. Prophylaxis should be considered. In the absence of prophylaxis, we advise early image studies and prompt antifungal treatment in patients at risk for HSC.
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Madney Y, Shalaby L, Elanany M, Adel N, Nasr E, Alsheshtawi K, Younes A, Hafez H. Clinical features and outcome of hepatosplenic fungal infections in children with haematological malignancies. Mycoses 2019; 63:30-37. [PMID: 31514231 DOI: 10.1111/myc.13002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/03/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
Hepatosplenic fungal infection (HSFI) is a severe invasive fungal infection observed during neutrophil recovery in patients with acute leukaemia treated with intensive chemotherapy. Retrospective analysis including all paediatric haematological malignancies patients with HSC treated in Children Cancer Hospital Egypt (2013-2018). Twenty-five patients with acute leukaemia developed HSFI (19 patients diagnosed as hepatosplenic candidiasis). Most of the cases (92%) occurred during the induction phase. Organs affected were as follows: liver in 18 patients, renal in 13 patients, spleen in 12 patients, skin in four patients and retina in one patient. Five (20%) patients had proven HSC, 14 (56%) probable and six (24%) possible HSFI. Ten patients had a PET-CT for response assessment. Candida tropicalis was the most common isolated spp. from blood/tissue culture. Six (24%) patients developed HSFI on top of antifungal prophylaxis. Steroids were given in 12 (52%) patients with HSFI as immune reconstitution syndrome (IRS). Caspofungin was the first line of treatment in 14 (56%) patients, liposomal amphotericin B in six (24%) patients and azoles in five (20%) patients. HSFI was associated with delayed of intensification phase of chemotherapy (median 42 days). The success rate was reported in 24 patients with complete response (68%) and partial response in (28%) patients, while failure (death) seen in 1(4%) patient. HSC is still a major challenge in paediatric leukaemias patients with impact on treatment delay and survival outcome. PET scan, non-culture diagnostics and steroid role evidence in IRS are growing. Antifungal stewardship for screening, early detection for high-risk patients and better response assessment is challenging.
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Affiliation(s)
- Youssef Madney
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Lobna Shalaby
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Mervat Elanany
- Department of Clinical Microbiology, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Naglaa Adel
- Department of Clinical Pharmacology, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Eman Nasr
- Department of Radiodiagnosis, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Khaled Alsheshtawi
- Department of Clinical Research, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Alaa Younes
- Department of Surgical Oncology, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Children Cancer Hospital Egypt (CCHE), Cairo, Egypt
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Chen CY, Cheng A, Tien FM, Lee PC, Tien HF, Sheng WH, Chen YC. Chronic disseminated candidiasis manifesting as hepatosplenic abscesses among patients with hematological malignancies. BMC Infect Dis 2019; 19:635. [PMID: 31315582 PMCID: PMC6637637 DOI: 10.1186/s12879-019-4260-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes of deep-seated abscesses attributed to chronic disseminated candidiasis (CDC) in patients with hematological malignancies have rarely been reported in recent years. METHODS We retrospectively reviewed and analyzed the data of patients with hematological malignancies who received a diagnosis of CDC at a medical center in Taiwan between 2008 and 2013. RESULTS Sixty-one patients (32 men and 29 women) were diagnosed with CDC. The median age was 51 years (range: 18-83). The overall incidence of CDC was 1.53 per 100 patient-years in patients with hematological malignancies between 2008 and 2013. The highest incidence of CDC was 4.3 per 100 patient-years for acute lymphoblastic leukemia, followed by 3.6 for acute myeloid leukemia. We detected 3 (4.9%) proven, 13 (21.3%) probable, and 45 (73.8%) possible cases of CDC. A total of 13 patients had positive blood cultures for Candida species: C. tropicalis (8), C. albicans (2), C. glabrata (2), and C. famata (1). The median duration of antifungal treatment was 96 days (range: 7-796 days). Serial imaging studies revealed that the resolution rate of CDC was 30.0% at 3 months and 54.3% at 6 months. Five patients (8.2%) had residual lesions that persisted beyond one year. A multivariate analysis of the 90-day outcome revealed that shock was the only independent prognostic factor of 90-day survival in patients with CDC. CONCLUSION The incidence of CDC did not decrease between 2008 and 2013. Patients with acute leukemia had a higher risk of CDC than those with other hematological malignancies. Imaging studies conducted at 6 months after diagnosis revealed that only half of the patients showed complete resolution. CDC requires prolonged treatment, and serial imaging at 6 months interval is suggested. Shock is the only independent prognostic factor of 90-day survival in patients with CDC.
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Affiliation(s)
- Chien-Yuan Chen
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
| | - Aristine Cheng
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Ming Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.,Tai-Cheng Stem Cell Center, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chu Lee
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.,Department of Medicine, National Taiwan University, College of Medicine, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Wang-Huei Sheng
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Medicine, National Taiwan University, College of Medicine, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
| | - Yee-Chun Chen
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, National Taiwan University, College of Medicine, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan
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Hepatosplenic Fungal Infections in Children With Leukemia-Risk Factors and Outcome: A Multicentric Study. J Pediatr Hematol Oncol 2019; 41:256-260. [PMID: 30730381 DOI: 10.1097/mph.0000000000001431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment. PROCEDURE In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers. RESULTS All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals. CONCLUSIONS Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.
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Response of Symptomatic Persistent Chronic Disseminated Candidiasis to Corticosteroid Therapy in Immunosuppressed Pediatric Patients: Case Study and Review of the Literature. Pediatr Infect Dis J 2018; 37:686-690. [PMID: 29140934 DOI: 10.1097/inf.0000000000001844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic disseminated candidiasis (CDC) is a severe invasive fungal infection principally observed during neutrophil recovery in patients with acute leukemia treated with intensive chemotherapy. Its pathophysiology remains unclear. We describe the management of 6 children with symptomatic CDC who did not respond to antifungal therapy. METHODS The databases of the hematology-oncology departments of 2 tertiary pediatric medical centers were searched for all patients diagnosed with CDC from 2003 to 2015, who responded to corticosteroids after failing antifungal therapy. Clinical, laboratory and radiologic data were collected. RESULTS Six patients (3 women, 3 men; 9-18 years of age) met the study criteria. Underlying diseases were acute lymphoblastic leukemia (n = 3) and large B-cell lymphoma, acute myeloid leukemia and severe aplastic anemia (n = 1 each). Presenting symptoms/signs of CDC were fever in all cases, with abdominal or chest pain, and/or mucositis. Candida infection was identified in blood cultures in 4 patients and in bronchoalveolar lavage fluid in one. In the absence of response to antifungal agents (4-50 days from CDC diagnosis), prednisone 2 mg/kg/day or equivalent was administered. CDC-attributable clinical symptoms resolved in 4 patients within 6-19 days; one patient required an additional nonsteroidal anti-inflammatory agent. Abnormalities on imaging decreased or disappeared within 5 months to 2 years in 4 patients. CONCLUSIONS In children with persistent symptomatic CDC, despite adequate antifungal therapy, administration of corticosteroids may yield rapid resolution of symptoms and decreased inflammatory markers. In patients who do not respond to steroids, the addition of a nonsteroidal anti-inflammatory drug should be considered.
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Della Pepa R, Cerchione C, Pugliese N, Colicchio R, Salvatore P, Sirignano C, Soscia E, Pagano L, Sanguinetti M, Pane F, Picardi M. Diagnostic-driven antifungal approach in neutropenic patients at high risk for chronic disseminated candidiasis: preliminary observations on the role of 1,3-β-D-glucan antigenemia and multiphasic contrast-enhanced computed tomography. Support Care Cancer 2018. [PMID: 29523967 DOI: 10.1007/s00520-018-4138-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Claudio Cerchione
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Roberta Colicchio
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
- CEINGE, Biotecnologie Avanzate s.c.ar.l., Naples, Italy
| | - Cesare Sirignano
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Ernesto Soscia
- Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Livio Pagano
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Marco Picardi
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
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Della Pepa R, Picardi M, Sorà F, Stamouli M, Busca A, Candoni A, Delia M, Fanci R, Perriello V, Zancanella M, Nosari A, Salutari P, Marchesi F, Pane F, Pagano L. Successful management of chronic disseminated candidiasis in hematologic patients treated with high-dose liposomal amphotericin B: a retrospective study of the SEIFEM registry. Support Care Cancer 2016; 24:3839-45. [PMID: 27075673 PMCID: PMC4967093 DOI: 10.1007/s00520-016-3208-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/03/2016] [Indexed: 12/29/2022]
Abstract
Purpose Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC. Methods In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemotherapy plan, due to the infection, were evaluated. Results Six patients were treated with high-dose (HD; 5 mg/kg/daily) liposomal amphotericin B (L-AmB), whereas three received standard-dose (SD) L-AmB (3 mg/kg/daily). Azoles were given to six patients; the remaining five were treated with echinocandins. All patients treated with HD L-AmB (6/6—100 %) achieved complete resolution of CDC; one of them had to interrupt the chemotherapy program for the infection. In the SD L-AmB group, treatment failed in the 100 % of cases and one patient had to delay chemotherapy for the infection. Of the six patients who received azoles, two achieved complete resolution of the infection, four experienced treatment failure, and only three performed chemotherapy as planned. Echinocandins treatment resulted in complete resolution of the infection in 2/5 cases, partial response in 2/5 cases, and failure in one case. In this group, 3/5 patients completed chemotherapy as planned. Conclusions This study shows that HD L-AmB was particularly effective against CDC in hematologic patients, allowing most patients to continue cytotoxic agent program.
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Affiliation(s)
- Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
| | - M Picardi
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - F Sorà
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - M Stamouli
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - A Busca
- Hematology Le Molinette Hospital, Torino, Italy
| | - A Candoni
- Hematology University of Udine, Udine, Italy
| | - M Delia
- Hematology University of Bari, Bari, Italy
| | - R Fanci
- Hematology University of Firenze, Florence, Italy
| | - V Perriello
- Hematology University of Perugia, Perugia, Italy
| | | | - A Nosari
- Hematology Niguarda Hospital, Milan, Italy
| | - P Salutari
- Hematology Pescara Hospital, Pescara, Italy
| | - F Marchesi
- Haematology, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - L Pagano
- Hematology Catholic University Sacro Cuore, Rome, Italy
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Chaussade H, Bastides F, Lissandre S, Blouin P, Bailly E, Chandenier J, Gyan E, Bernard L. Usefulness of corticosteroid therapy during chronic disseminated candidiasis: case reports and literature review. J Antimicrob Chemother 2012; 67:1493-5. [DOI: 10.1093/jac/dks044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rammaert B, Desjardins A, Lortholary O. New insights into hepatosplenic candidosis, a manifestation of chronic disseminated candidosis. Mycoses 2012; 55:e74-84. [DOI: 10.1111/j.1439-0507.2012.02182.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
The liver plays an important role in host defense against invasive microorganisms. The effect of microbial pathogens on the liver can vary greatly, presenting with a wide variety of manifestations from asymptomatic increases in aminotransaminases, acute liver failure, hepatic fibrosis, and cirrhosis. In evaluating the liver manifestations of a potential infectious pathogen, diagnosis of some of the less common infectious pathogens is dependent on a high level of suspicion and recognition of some of the key diagnostic clues. Successful diagnosis can only be accomplished through a careful history, including travel and exposures, physical examination, and appropriate microbiologic studies. This article reviews the involvement of the liver during systemic infections with organisms that are not considered to be primarily hepatotropic.
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Affiliation(s)
- Rohit Talwani
- Assistant Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Bruce L. Gilliam
- Associate Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Charles Howell
- Profesor of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
- Director of Hepatology Research University of Maryland School of Medicine, Baltimore, MD
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Yen TY, Huang LM, Lee PI, Lu CY, Shao PL, Chang LY. Clinical characteristics of hepatosplenic fungal infection in pediatric patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:296-302. [PMID: 21524963 DOI: 10.1016/j.jmii.2010.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/25/2010] [Accepted: 08/12/2010] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hepatosplenic fungal infection (HSF) is a distinct form of invasive fungal infection with main involvement of the liver, spleen, and occasionally the kidney. In this study, we investigated the clinical characteristics and outcomes of patients with HSF in childhood. METHODS We retrospectively reviewed pediatric patients with the diagnosis of HSF in a tertiary medical center in Taiwan between July 1999 and June 2009. The definition of HSF included imaging studies demonstrating multiple focal lesions in the liver and/or spleen with or without a microbiologic evidence for fungal infection. The clinical characteristics and outcomes were analyzed. RESULTS We identified 15 pediatric patients with HSF. Eleven patients had diagnosis of hemato-oncologic malignancy, and two patients had severe aplastic anemia. All patients had fever, and most patients had abdominal pain, nausea, vomiting, and hepatosplenomegaly. The detection rate of computed tomography scan (15/15, 100%) was superior to abdominal sonography (10/15, 67%, p = 0.01). Ten (91%) of the 11 patients with microbiologic evidence were infected by Candida species. Neither recurrence nor breakthrough fungal infection was noted when the patients underwent further chemotherapy and stem cell transplantation. Six patients (40%) died before the end of the study, but no mortality was directly related to HSF. CONCLUSION Candida species was the major pathogen for HSF, and computed tomography scan was a good diagnostic tool to detect the multiple focal lesions. Under adequate antifungal treatment, HSF could be cured without recurrence in spite of further chemotherapy and stem cell transplantation.
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Affiliation(s)
- Ting-Yu Yen
- Department of Pediatric, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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12
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Poon LM, Chia HY, Tan LK, Liu TC, Koh LP. Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature. Transpl Infect Dis 2009; 11:160-6. [DOI: 10.1111/j.1399-3062.2009.00363.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS, Lortholary O. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis 2008; 46:696-702. [PMID: 18230039 DOI: 10.1086/527390] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic disseminated candidiasis (CDC) is typically observed during neutrophil recovery in patients with acute leukemia and requires protracted antifungal therapy. OBJECTIVE Our objective was to document the efficacy and tolerance of corticosteroid therapy (CST) in patients with symptomatic CDC, including those who experienced fever and abdominal pain despite ongoing antifungal therapy. METHODS We performed a retrospective, multicenter study involving 10 pediatric and adult patients who experienced ongoing symptomatic CDC despite receipt of appropriate antifungal therapy for whom adjuvant oral CST was initiated. RESULTS All cases of CDC were proven or probable, as determined on the basis of the European Organization for Research and Treatment of Cancer-Mycosis Study Group definition criteria, and occurred in patients with leukemia. CDC-attributable clinical symptoms resolved with CST, which was started a mean of 33.8 days after antifungal therapy had been initiated. Fever and abdominal pain disappeared a median of 4-5 days, and serum fibrinogen and C-reactive protein levels returned to normal values within 14-30 days. The median duration of hospitalization after CST initiation was 8.8 days. Hepatosplenic microabscesses decreased or disappeared within a mean period of 107 days (range, 30-210 days). No relapses of CDC were observed during a median duration of follow-up of 6.5 years (range, 4-9 years). CONCLUSIONS In children and adults who experience persistently symptomatic CDC despite ongoing receipt of antifungal therapy, CST involving a prednisone equivalent at a dosage of > or =0.5 mg/kg per day for at least 3 weeks is associated with a prompt resolution of symptoms and of inflammatory response. These findings support the pathophysiological hypothesis that CDC belongs to the spectrum of fungus-related immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Faézeh Legrand
- Université Paris-7, Service d'Hématologie-Pédiatrique, Hôpital Robert Debré, Paris, France
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Goyal R, Vaiphei K, Vankalakunti M, Marwaha RK. Pathology teach and tell disseminated candidiasis in an infant with acute myeloid leukemia without prior chemotherapy. Fetal Pediatr Pathol 2006; 25:333-8. [PMID: 17696044 DOI: 10.1080/15513810701209579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Opportunistic fungal infections are significant problems for neutropenic patients who are undergoing cytotoxic therapy for acute leukemia. Systemic and hepatosplenic candidiasis have been reported in acute leukemic patients who are on chemotherapy. Gastrointestinal tract involvement is a rare phenomenon in disseminated candidiasis, especially in acute leukemia. We report one such rare case of acute myeloid leukemia in an infant who died of disseminated candidiasis with gastrointestinal tract involvement prior to the institution of chemotherapy.
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Affiliation(s)
- Richa Goyal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Pellegrino B, Le Guyader N, Thien V, Fasola S, Auvrignon A, Leverger G. Infections candidosiques sévères chez le patient neutropénique en onco-hématologie pédiatrique. Arch Pediatr 2003; 10 Suppl 5:575s-581s. [PMID: 15022784 DOI: 10.1016/s0929-693x(03)90040-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Incidence of severe candidal infections is rapidly increasing since 15 years and is becoming a major concern in onco-hematology practice, especially due to its poor prognosis in neutropenic patients. Diagnosis of candidemia is suspected in case of persistent fever resistant to a large antibiotherapy and requires to search for secondary locations as cutaneous and hepatosplenic candidal infection. Improvement of yeasts detection in blood culture bottles with specific medium is now helpful but use of specific immunoserodiagnosis or PCR methods is at this point unuseful. Fluconazole and Amphotericine B remain the recommended treatments for candidemia. Indications for "new antifongal drugs" are still limited regarding their high cost and the limited clinical studies.
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Affiliation(s)
- B Pellegrino
- Service d'hématologie et oncologie pédiatrique, hôpital d'Enfants Armand-Trousseau, AP-HP, Paris, France.
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Gangadharan VP, Sasidharan K, Preetha S, Chithrathara K. Chronic systemic (hepatosplenic) candidiasis in a patient with granulocytic sarcoma. Am J Clin Oncol 2000; 23:562-3. [PMID: 11202796 DOI: 10.1097/00000421-200012000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic systemic (hepatosplenic) candidiasis (CSC) is a syndrome of invasive candidiasis characterized by fever without localizing signs or symptoms. It occurs predominantly in patients with acute leukemia, after prolonged severe neutropenia. We report a young woman who underwent extensive chemotherapy for granulocytic sarcoma of the ovary; CSC then developed in this patient. She was successfully treated with fluconazole and liposomal amphotericin B. Clinical presentation, diagnostic problems, and the current successful treatment with fluconazole and liposomal amphotericin B are discussed.
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Affiliation(s)
- V P Gangadharan
- Division of Medical Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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García-Ruiz JC, Pontón J. [Invasive fungal infections in patients with hematological malignancies: a clinical approach]. Med Clin (Barc) 2000; 115:305-12. [PMID: 11093887 DOI: 10.1016/s0025-7753(00)71542-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J C García-Ruiz
- Servicio de Hematología. Hospital de Cruces. Baracaldo. Vizcaya.
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18
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Kontoyiannis DP, Luna MA, Samuels BI, Bodey GP. Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis. Infect Dis Clin North Am 2000; 14:721-39. [PMID: 10987117 DOI: 10.1016/s0891-5520(05)70128-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Much progress has been made over the last decade in diagnosing and treating CDC, a chronic and debilitating infection that interferes with the delivery of intensive cytotoxic chemotherapy in patients with leukemia. The use of fluconazole prophylaxis in these patients has decreased the incidence of CDC dramatically. The greatest future challenges are gaining a better understanding of its pathophysiology, and the continued development of effective diagnostic and therapeutic strategies to treat this unusual manifestation of systemic candidiasis.
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Affiliation(s)
- D P Kontoyiannis
- Department of Internal Medicine Specialties, University of Texas MD Anderson Cancer Center, Houston, USA
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19
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Hepatic Lesions of Chronic Disseminated Systemic Candidiasis in Leukemia Patients May Become Visible During Neutropenia: Value of Serial Ultrasound Examinations. Blood 1998. [DOI: 10.1182/blood.v91.8.3087.3087_3087_3089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Woolley I, Curtis D, Szer J, Fairley C, Vujovic O, Ugoni A, Spelman D. High dose cytosine arabinoside is a major risk factor for the development of hepatosplenic candidiasis in patients with leukemia. Leuk Lymphoma 1997; 27:469-74. [PMID: 9477128 DOI: 10.3109/10428199709058313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A retrospective study of hepatosplenic candidiasis in patients with acute leukemia from a single centre was performed. The significance of age, sex, type of leukemia, dose of cytosine arabinoside (Ara-C), duration of neutropenia, steroid use and period of therapeutic antibiotics in the development of hepatosplenic candidiasis was analyzed, using logistic regression analysis. Nine of 51 patients had hepatosplenic candidiasis. Ara-C use was highly associated with the development of hepatosplenic candidiasis (p = 0.001); with a high association with a higher dose (p < 0.0001). On the basis of these results consideration should be given to further trial of antifungal prophylaxis for patients receiving high dose Ara-C.
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Affiliation(s)
- I Woolley
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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21
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Anttila VJ, Färkkilä M, Jansson SE, Taavitsainen M, Kaukoranta-Tolvanen SS, Nordling S, Koukila-Kähkölä P, Ruutu T, Ruutu P. Diagnostic laparoscopy in patients with acute leukemia and suspected hepatic candidiasis. Eur J Clin Microbiol Infect Dis 1997; 16:637-43. [PMID: 9352255 DOI: 10.1007/bf01708552] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To assess the value of laparoscopy in the diagnosis of suspected hepatosplenic candidiasis in patients with acute leukemia, a retrospective analysis of 28 laparoscopies was conducted. In all but two cases, imaging of the liver showed focal lesions before laparoscopy. Diagnosis of hepatic candidiasis was established significantly more often when the biopsy was targeted at white nodules (in 12 of 22 laparoscopies) than when targeted randomly or at scars (0 of 6 laparoscopies) (p = 0.017, chi-square test). Yeast was detected more often if the laparoscopy was performed during the three-week period after recovery from neutropenia (in 8 of 12 laparoscopies) than when performed later (in 4 of 16 laparoscopies) (p = 0.028, chi-square test). In addition to the 12 laparoscopically diagnosed patients, eight (29%) patients were diagnosed with disseminated Candida infection by other methods. In another eight (29%) patients the causative agent was not identified. No bleeding or other problems occurred after the laparoscopy. Laparoscopy-guided liver biopsy is most useful if biopsies are targeted to macroscopic lesions and if laparoscopy is performed soon after recovery from neutropenia.
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Affiliation(s)
- V J Anttila
- Division of Haematology, Helsinki University Central Hospital, Finland
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22
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Edwards JE, Bodey GP, Bowden RA, Büchner T, de Pauw BE, Filler SG, Ghannoum MA, Glauser M, Herbrecht R, Kauffman CA, Kohno S, Martino P, Meunier F, Mori T, Pfaller MA, Rex JH, Rogers TR, Rubin RH, Solomkin J, Viscoli C, Walsh TJ, White M. International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections. Clin Infect Dis 1997; 25:43-59. [PMID: 9243032 DOI: 10.1086/514504] [Citation(s) in RCA: 333] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Because of the rapidly increasing incidence of serious candidal infections, a consensus conference of 22 investigators from the United States, Europe, and Japan was held to discuss strategies for the prevention and treatment of deep-organ infections caused by Candida species. Commonly asked questions concerning the management of candidal infections were selected for discussion by the participating investigators. Possible answers to the questions were developed by the investigators, who then voted anonymously for their preferences. In certain instances, unanimity or a strong consensus was the result. In all cases, the full spectrum of responses was recorded and is presented in this report. The forms of candidal infection addressed included candidemia, candiduria, hepatosplenic candidiasis (chronic systemic candidiasis), candidal endophthalmitis, and candidal peritonitis. Prevention and treatment strategies were considered for patients who have undergone surgery, for neutropenic and nonneutropenic patients, and for patients who have undergone bone marrow and solid organ transplantation. The therapeutic roles of amphotericin B (standard and lipid formulations) and the azoles were considered.
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Affiliation(s)
- J E Edwards
- Harbor/UCLA Medical Center, Division of Infectious Diseases, St. John's Cardiovascular Research Center, Torrance, California 90502-2064, USA
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23
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Spindel S, Darouiche R, Saeed Z. Hepatosplenic candidiasis in non-neutropenic patients: a case report and literature survey. Int J Antimicrob Agents 1996; 7:149-52. [DOI: 10.1016/0924-8579(96)00306-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/1996] [Indexed: 12/16/2022]
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24
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Anttila VJ, Lamminen AE, Bondestam S, Korhola O, Färkkilä M, Sivonen A, Ruutu T, Ruutu P. Magnetic resonance imaging is superior to computed tomography and ultrasonography in imaging infectious liver foci in acute leukaemia. Eur J Haematol Suppl 1996; 56:82-7. [PMID: 8600000 DOI: 10.1111/j.1600-0609.1996.tb00300.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We conducted a prospective study in order to compare ultrasonography, computed tomography and magnetic resonance imaging in the detection of liver foci in patients with acute leukaemia and clinical suspicion of hepatic candidiasis. 28 adult patients fulfilling set entry criteria after recovery from neutropenia were studied. Lesions in the liver were detected by at least one imaging modality in 21 patients: by ultrasonography in 7 (33% of detected cases), computed tomography in 12 (57%) and by magnetic resonance imaging in 20 patients (95%). Magnetic resonance imaging was significantly more sensitive than ultrasonography (p<0.001) and computed tomography (p<0.02). The difference between computed tomography and ultrasonography was not statistically significant (p=0.1). Invasive procedures performed in 10 patients provided definite proof of candidiasis in 5 patients, and nodes on the liver surface, compatible with yeast infection, were seen during laparoscopy in 3 other patients without proof of fungal infection. We confirm that magnetic resonance imaging is superior to ultrasonography and computed tomography in imaging liver foci in leukaemic patients recovering from neutropenia with persistent non-specific signs of infection or hepatic involvement.
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Affiliation(s)
- V J Anttila
- Department of Medicine, University of Helsinki, Finland
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