Acute disseminated candidiasis with skin lesions: a systematic review

Summary Background Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis. Objectives To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections. Patients/Methods This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016. Results Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans. Conclusion The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.

Section: Discussionmentioning

confidence: 99%

Candida spp bloodstream infections in a Latin American Pediatric Oncology Reference Center: Epidemiology and associated factors

Silva

Moraes-Pinto

Pignati

et al. 2020

“…It is characterised by haemodynamic instability, persistent positive blood cultures and deep organ and/or skin involvement. Patients present with sepsis, spiking fever, shaking chills and disseminated lesions of the skin and occasionally other organ infections such as endophthalmitis or osteomyelitis 149 . This entity was mostly reported before the use of azole prophylaxis in leukaemia patients and HSCT and appears rare today 150 .…”

Section: Resultsmentioning

confidence: 99%

Treatment of invasive fungal diseases in cancer patients—Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Ruhnke

Cornely

Schmidt‐Hieber

et al. 2020

Summary Background Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects. Objectives Since the last edition of recommendations for ‘Treatment of invasive fungal infections in cancer patients’ of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre‐emptive therapy of probable IFD. Methods The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English‐language publications from January 1975 up to September 2019 using the key terms such as ‘invasive fungal infection’ and/or ‘invasive fungal disease’ and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis. Results AFT of IFDs in cancer patients may include not only antifungal agents but also non‐pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials. Conclusions Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.

“…Skin lesions were most commonly seen with C tropicalis (68%) followed by C krusei (15%). 40 Diffuse maculopapular lesions were more common in C tropicalis cases in comparison with a nodular rash seen with C krusei. Therefore, skin lesions in haematology patients with neutropenic sepsis may be a much more important early sign of C tropicalis candidiasis than is currently recognised.…”

Section: Discussionmentioning

confidence: 98%

“…A recent systematic review included 33 studies reporting 100 acute candidiasis cases with skin lesions in neutropenic patients. Skin lesions were most commonly seen with C tropicalis (68%) followed by C krusei (15%) . Diffuse maculopapular lesions were more common in C tropicalis cases in comparison with a nodular rash seen with C krusei .…”

Section: Discussionmentioning

confidence: 99%

Investigation of a healthcare‐associatedCandida tropicaliscandidiasis cluster in a haematology unit and a systematic review of nosocomial outbreaks

Barać

Çevik

Čolović

et al. 2020

Summary Background Non‐albicans Candida spp. are an emerging cause of hospital‐acquired bloodstream infections, associated with high mortality due to the challenges in diagnosis and delayed treatment. Objectives We aimed to investigate a cluster of healthcare‐associated invasive candidiasis caused by C tropicalis and review the literature of healthcare‐associated outbreaks or clusters caused by C tropicalis. Methods An investigation was performed to determine clinical presentation, treatment outcomes and the factors contributing to C tropicalis candidemia occurrence. We searched the Medline database via PubMed and Ovid using the keywords of “Candida tropicalis” combined with “outbreak” or “clustering” or “clusters,” and we limited the search to studies conducted from January 1989 to January 2019. Results We report two related cases of C tropicalis candidemia among patients with AML following a period of neutropenia, who had erythematous skin rash as a first manifesting sign of candidiasis. C tropicalis was isolated from blood and skin cultures of both patients, which were identical by pulsed‐field gel electrophoresis typing. Our systematic review of outbreaks caused by C tropicalis suggests that (a) most reported outbreaks have occurred in neonatal and adult ICUs; (b) patients who receive total parenteral therapy, antibiotics and those who have indwelling catheters and recent surgery are at high risk of infection; and (c) environmental and healthcare personnel surveillance suggest that cross‐contamination is a major risk factor. Conclusion Control of nosocomial outbreaks caused by C tropicalis should include better infection control measures, education of healthcare professionals especially working in adult and neonatal intensive care and haematology units.