Adjuvant Corticosteroid Therapy for Chronic Disseminated Candidiasis

Abstract

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.

Immune reconstitution inflammatory syndrome following allo-SCT in a patient with Dipodascus capitatus spondylodiscitis

“…8 IRIS has been also reported in neutropenic patients with exacerbation of invasive aspergillosis and in chronic disseminated candidiasis. 9,10 In the present case, D. capitatus grew in respiratory samples and was initially recovered as the sole pathogen. Given the concurrent findings of clinical pneumonia and radiological features observed on the chest CT scan, this condition most likely suggests a lower respiratory tract infection due to D. capitatus and we considered it as probable specific pneumonia.…”

Trichosporon: another yeast‐like organism responsible for immune reconstitution inflammatory syndrome in patients with hematological malignancy

“…The rapid relief of an effective immune response, combined with immunomodulatory effects linked to some pathogens' antigens, and to antimicrobials by themselves may lead to severe clinical pictures [9]. While mimicking treatment failure, the chronology of the symptoms, the persistently negative cultures and the potential benefit of limiting the immune response, either by delaying the ARV therapy or even adding corticosteroid therapy, support this difficult-to-prove diagnosis [4]. While the effect of corticosteroids is doubtful in patient 1, it seems truly efficient in case 2, where the discontinuation led to the recurrence of the fever.…”

“…Indeed, Cryptococcus neoformans, Pneumocystis jiroveci, Aspergillus fumigatus and Histoplasma capsulatum have been associated with IRIS too [11][12][13]. Recently, some reports suggest that chronic disseminated candidiasis, so-called hepato-splenic candidiasis, because of the organs usually involved, should be considered as an IRIS [4]. Indeed, concomitantly with the recovery of neutrophils, some patients, previously neutropenic and having undergone a Candida bloodstream disseminated infection, documented or not with positive blood cultures, develop abscesses in the liver, the spleen or more rarely the kidneys [4,14].…”

“…Recently, some reports suggest that chronic disseminated candidiasis, so-called hepato-splenic candidiasis, because of the organs usually involved, should be considered as an IRIS [4]. Indeed, concomitantly with the recovery of neutrophils, some patients, previously neutropenic and having undergone a Candida bloodstream disseminated infection, documented or not with positive blood cultures, develop abscesses in the liver, the spleen or more rarely the kidneys [4,14]. Our observations are highly suggestive of such a phenomenon induced by Trichosporon infection.…”

“…Such clinical forms due to Candida are well known and are considered as immune reconstitution inflammatory syndromes and as such can benefit from corticosteroid therapy [4].…”