Clinical characteristics of hepatosplenic fungal infection in pediatric patients

Abstract

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.

Fatal cryptococcosis presenting as hepatobiliary dysfunction in an ALL patient

“…Hepatobiliary dysfunction, a rare predominant feature of disseminated Cryptococcus in pediatric patients, has only been described seven times in the English literature [5]. While disseminated candidiasis presenting as hepatobiliary dysfunction in pediatric ALL patients has been described, no cases of disseminated cryptococcosis presenting as hepatobiliary dysfunction in pediatric ALL patients have been described [1,15,16]. Disseminated disease and sudden death of a pediatric ALL patient secondary to Cryptococcus neoformans while in remission without liver involvement has been described once [10].…”

“…Common presenting symptoms of pediatric patients found to have hepatosplenic fungal infections include fever, nausea and/or vomiting, hepatosplenomegaly, and jaundice. A retrospective 10-year review performed in a tertiary medical center in Taiwan from 1999-2009 investigated the clinical characteristics of 15 pediatric patients identified to have hepatosplenic fungal infections [15]. Ten patients had the diagnosis of acute leukemia (5 with acute myeloid leukemia, 5 with ALL).…”

“…The detection rate of computed tomography (15/15, 100%) was found superior to abdominal sonography (10/15, 67%, p = 0.01). Ten (91%) of the 11 patients with microbiologic evidence were infected by Candida species, the other organism identified was Aspergillus [15].…”

Imaging fungal infections in children

“…In clinical practice, medical imaging and noninvasive testing such as GM, BDG, and nucleic acid techniques are all part of the diagnostic pathway to track fungal infections, particularly for invasive aspergillosis [ 36 , 37 ]. Plain radiographs, ultrasound (US), conventional CT, HR CT, and MRI all play a role in the diagnosis and management of fungal infections [ 11 , 37 , 38 ], but all have their limitations. MRI is particularly useful for identifying infections in the central nervous system (CNS) and the facial sinuses, which can be rapidly fatal in acute sinusitis [ 12 ].…”

Imaging of multifocal liver lesions in children and adolescents

“…Pyogenic abscesses in children are often the result of portal venous seeding of bacteria from an intra-abdominal infectious source (e.g., an intra-abdominal abscess due to Crohn disease or chronic perforated appendicitis), ascending cholangitis, or chronic granulomatous disease [ 13 , 14 ] . Fungal hepatic abscesses are most commonly due to systemically disseminated Candida albicans , and are typically seen in immunosuppressed or neutropenic children, such as those with acute leukemia [ 14 , 15 ] . Fungal abscesses may also affect other organs, such as the spleen [ 14 , 16 ] .…”