Hepatic Candidiasis in Cancer Patients: The Evolving Picture of the Syndrome

Thaler, Michael; Pastakia, Behram; Shawker, Thomas H.; O'leary, Timothy; Pizzo, Philip A.

doi:10.7326/0003-4819-108-1-88

Cited by 361 publications

(173 citation statements)

References 26 publications

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“…However, this disease can also be acquired by fungemia from the portal vein [1,4] or an ascending retrograde infection from the biliary tree [5,6] , which is the proposed route of infection, as the patient had a biliary stricture, and the infection was localized in the liver and gallbladder, but negative in other parts and without candidemia. Biliary stricture may lead to cholestasis, which in turn can allow micro-organisms from the gut to ascend into the biliary tract.…”

Section: Discussionmentioning

confidence: 99%

“…Biliary stricture may lead to cholestasis, which in turn can allow micro-organisms from the gut to ascend into the biliary tract. In patients with hematologic malignancies, the yield of positive culture is often less than 50%, with the diagnosis usually based on microscopic examination or histopathological finding from deep tissues [1,3,4,7] . Nevertheless, fungal cultures had repeatedly been positive in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Candidal liver abscess is a rare disease, and most of the reported cases have been diagnosed in patients with hematologic malignancies during periods of neutropenia resolution [1,2] . In a review by Thaler et al, only 8 of 73 patients had an underlying disease other than a malignancy.…”

Section: Introductionmentioning

confidence: 99%

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Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

Lai

Chen²,

Chen³

et al. 2005

WJG

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We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

Lai

Chen²,

Chen³

et al. 2005

WJG

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“…[1][2][3][4][5] However, clinical and radiological manifestations of IFI are nonspecific, and seldom apparently early, current laboratory diagnostic techniques are insensitive and the performance of invasive diagnostic procedures is often precluded by profound cytopenia. [6][7][8][9][10] This diagnostic uncertainty has led to the widespread use of empirical antifungal therapy in patients with antibiotic-resistant neutropenic fever (ARNF). 11 However, fever is a nonspecific sign with multiple aetiologies and this strategy results in unnecessary treatment with potentially toxic and prohibitively expensive antifungal therapy.…”

mentioning

confidence: 99%

A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients

Jordanides

Allan

McLintock

et al. 2005

Bone Marrow Transplant

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Summary:A blinded prospective study was performed to determine whether screening of whole blood using a real-time, panfungal polymerase chain reaction (PCR) technique could predict the development of invasive fungal infection (IFI) in immunocompromised haemato-oncology patients. In all, 78 patients (125 treatment episodes) were screened twice weekly by real-time panfungal PCR using LightCyclert technology. IFI was documented in 19 treatment episodes (five proven, three probable and 11 possible), and in 12, PCR was sequentially positive. PCR positivity occurred in: 4/5 proven; 2/3 probable; 6/11 possible; and 29/106 with no IFI. In 8/12 with IFI and sequentially positive PCR results, PCR positivity occurred before (median 19.5 days) and in 4/12 (median 10.5 days) after the initiation of empirical antifungal therapy. Based on sequential positive results for proven/probable IFI sensitivity, specificity, positive predictive value and negative predictive value were 75, 70, 15 and 98%, respectively. Real-time panfungal PCR is a sensitive tool for the early diagnosis of IFI in immunocompromised haemato-oncology patients. It may be most useful as a screening method in high-risk patients, either to direct early pre-emptive antifungal therapy or to determine when empirical antifungal therapy can be withheld in patients with antibiotic-resistant neutropenic fever. However, these strategies require further assessment in comparative clinical trials.

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“…A review of the world literature has demonstrated that, for example, only 8.3% of patients with hepatosplenic candidiasis were found to be fungemic. 12 Molecular diagnostic tools such as immunological methods, DNA/RNA probe technologies and polymerase chain reaction (PCR) amplification of fungal nucleic acid sequences are more specific, faster and more accurate than clinical imaging techniques. 13 Immunological techniques rely on the recognition, by antibodies, of specific antigens either secreted by pathogens or present on their surfaces.…”

Section: Current Tools For Fungal Disease Diagnosismentioning

confidence: 99%

Nonribosomal cyclic peptides: specific markers of fungal infections

Jegorov¹,

Hajdúch

Šulc

et al. 2006

J. Mass Spectrom.

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Some cyclic peptides and depsipeptides are synthesized in microorganisms by large multienzymes called nonribosomal peptide synthetases. The structures of peptide products originating in this way are complex and diverse and are microorganism-specific. This work proposes the use of fungal cyclic peptides and depsipeptides as extremely specific markers of fungal infections. Since a reliable molecular tool for diagnosing fungal infections at an early stage is still missing, we present mass spectrometry as a new, modern, broadband (with respect to fungal strain) and specific tool for clinical mycologists. More than 40 different fungal species can be rapidly characterized according to specific families of cyclic peptides, and in some cases, a particular fungal strain can be identified on the basis of its cyclopeptide profile. This paper is also aimed at initiating discussion on the biological role of these secondary metabolites, especially of those synthesized by medically important strains. Proven cytotoxic, anti-inflammatory or immunosuppressive activities of some cyclic peptides indicate that these molecules may contribute to the synergistic array of fungal virulence factors and support microbial invasion during fungal infection. In addition to an overview on recent mass spectrometric protocols for cyclic peptide sequencing, the structures of new peptides from Paecilomyces and Pseudallescheria are presented.

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Hepatic Candidiasis in Cancer Patients: The Evolving Picture of the Syndrome

Cited by 361 publications

References 26 publications

Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients

Nonribosomal cyclic peptides: specific markers of fungal infections

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