|Title:||Clinical characteristics of hepatosplenic fungal infection in pediatric patients||Authors:||TING-YU YEN
|Issue Date:||2011||Journal Volume:||44||Journal Issue:||4||Start page/Pages:||296-302||Source:||Journal of Microbiology, Immunology and Infection||Abstract:||
Background: Hepatosplenic fungal infection (HSF) is a distinct form of invasive fungal infection with main involvement of the liver, spleen, and occasionally the kidney. In this study, we investigated the clinical characteristics and outcomes of patients with HSF in childhood. Methods: We retrospectively reviewed pediatric patients with the diagnosis of HSF in a tertiary medical center in Taiwan between July 1999 and June 2009. The definition of HSF included imaging studies demonstrating multiple focal lesions in the liver and/or spleen with or without a microbiologic evidence for fungal infection. The clinical characteristics and outcomes were analyzed. Results: We identified 15 pediatric patients with HSF. Eleven patients had diagnosis of hemato-oncologic malignancy, and two patients had severe aplastic anemia. All patients had fever, and most patients had abdominal pain, nausea, vomiting, and hepatosplenomegaly. The detection rate of computed tomography scan (15/15, 100%) was superior to abdominal sonography (10/15, 67%, p = 0.01). Ten (91%) of the 11 patients with microbiologic evidence were infected by Candida species. Neither recurrence nor breakthrough fungal infection was noted when the patients underwent further chemotherapy and stem cell transplantation. Six patients (40%) died before the end of the study, but no mortality was directly related to HSF. Conclusion: Candida species was the major pathogen for HSF, and computed tomography scan was a good diagnostic tool to detect the multiple focal lesions. Under adequate antifungal treatment, HSF could be cured without recurrence in spite of further chemotherapy and stem cell transplantation. ? 2011.
|ISSN:||1684-1182||DOI:||10.1016/j.jmii.2010.08.005||SDG/Keyword:||amphotericin B; amphotericin B lipid complex; antineoplastic agent; caspofungin; fluconazole; voriconazole; abdominal pain; acute granulocytic leukemia; acute lymphoblastic leukemia; adolescent; antifungal activity; aplastic anemia; article; cancer chemotherapy; candidiasis; child; clinical article; clinical feature; computer assisted tomography; diagnosis; echography; female; hematologic malignancy; hepatosplenic fungal infection; hepatosplenomegaly; human; infant; liver injury; male; mortality; mycosis; nausea; neuroblastoma; nonhuman; outcome assessment; pediatrics; preschool child; recurrent disease; retrospective study; school child; spleen injury; stem cell transplantation; Taiwan; tertiary health care; vomiting; Adolescent; Anemia, Aplastic; Antifungal Agents; Antineoplastic Agents; Candida; Chi-Square Distribution; Child; Child, Preschool; Female; Humans; Infant; Leukemia; Liver Diseases; Male; Mycoses; Retrospective Studies; Splenic Diseases; Tomography, X-Ray Computed; Treatment Outcome
|Appears in Collections:||醫學系|
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