Hepatosplenic candidiasis in the era of new antifungal drugs: a study in Paris 2000-2007

Abstract

We report a retrospective study of 24 patients with haematological malignancy and hepatosplenic candidiasis. Clinical and biological features were similar to previous reports. No patient previously received antifungal prophylaxis. Liver or spleen histological examination revealed yeasts in 6/24 patients (25%) on direct examination but all cultures were negative. After a median duration of 7 months, antifungal treatment was discontinued in 58% of the patients with no relapse. Eleven (46%) patients died during follow up. After multivariate analysis, independent factors associated with death were the duration of neutropenia (p 0.022) and relapsing haematological malignancy (p 0.015).

Usefulness of ß-D-glucan for diagnosis and follow-up of invasive candidiasis in onco-haematological patients

“…We also show that the overall mortality rate, below 20%, is lower than expected according to previous studies. 4,7,9 Current mycological tools for the diagnosis of these infections are unsatisfactory 10,11 and evaluation of a new promising biomarker such as BDG is always desirable. Nevertheless, our study has some limitations.…”

“…2,[4][5][6] Many case reports and some series of CDC have been published but, to the best of our knowledge, incidence rates are lacking for this clinical entity. [7][8][9] The diagnosis of candidemia and CDC may be difficult. 10 Candidemic patients usually present without specific clinical sign, and even fever may be inconstant.…”

Diagnosis and treatment of invasive Candida infections – a review article

“…The symptoms occur following return of neutrophils and persist for a long time unless treatment is initiated (53). Organ changes in the course of candidiasis can be visualized in imaging such as ultrasonography, computed tomography, magnetic resonance imaging or positron emission tomography-CT (15). The diagnosis of probable hepatosplenic candidiasis requires the presence of typical clinical symptoms and imaging indings, as well as an episode of candidemia within the preceding 2 weeks.…”

The Role of PET in Monitoring Therapy in Fungal Infections

“…It may also present with a blood culture negative syndrome with disseminated (hepatosplenic) candidiasis or deep seated infections in distant organs in patients with hematologic cancer or other hematological disorders [30]. Monitoring therapy in the blood culture negative group is a challenging task and DG PET may have added value under such circumstances [39].…”