Diagnostic laparoscopy in patients with acute leukemia and suspected hepatic candidiasis

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.

Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy

“…Whether molecular methods improve this yield is not yet clear but they should be used in difficult cases 172 . False negative results have been described in samples obtained by needle aspiration of hepatic lesion in patients with hepatosplenic candidosis and laparoscopic guidance has been suggested to improve the rates of detection 173 . The sensitivity of biopsy might be highest during the first three weeks after bone marrow regeneration.…”

Diagnosis of chronic disseminated candidosis from liver biopsies by a novel PCR in patients with haematological malignancies

“…Fungi are usually microscopically visible in organ biopsies, but it has been often observed that yeast forms and pseudohyphae are seen only in the central area of the abscess. The abscess may be even missed if the liver biopsy is not taken targeted by laparoscopy [8].…”

Clinical characteristics of hepatosplenic fungal infection in pediatric patients

“…Because yielding rate of positive blood cultures is less than 50%, deep-tissue specimen may not always demonstrate fungal infection, and obtained tissue specimen is associated with relative high risk of complications. 11,14,15 The confirmation of microbiology pathogen was difficult. In our study, we confirmed 11 patients with definite pathogen, Candida species were the most common causative pathogen (90.9%).…”

“…As for imaging studies, computed tomography (CT) and magnetic resonance imaging (MRI) are superior to ultrasonography to detect hepatosplenic lesions. 11e13 Because blood culture was yielded in less than 50% of cases, deep-tissue specimen may not always demonstrate fungal infection 11,14,15 and the imaging studies usually revealed the lesions until the recovery of neutrophil counts, 16 early diagnosis of HSF was extremely difficult. In addition, the optimal treatment of HSF and the duration of treatment were still disputable.…”