Diagnosis and Monitoring Response to Treatment of Hepatosplenic Candidiasis in Patients with Acute Leukemia Using Magnetic Resonance Imaging

Abstract

Hepatosplenic candidiasis (HSC) is a morbid complication encountered in immunocompromised individuals, especially, those being treated with intensive chemotherapy protocols for acute leukemia. Immediate recognition of this complication and initiation of appropriate treatment is crucial in order to control the infection, decrease the morbidity and mortality, and avoid delays in treatment of the underlying condition. The definitive diagnosis requires either positive blood cultures for yeasts in the presence of abnormal findings on imaging studies consistent with HSC, or liver biopsy demonstrating yeast forms or pseudohyphae. We describe our experience in the evaluation of 15 patients with HSC using magnetic resonance imaging (MRI) as a diagnostic and follow-up tool. The diagnosis of HSC was established by liver biopsy in 11 patients (73%), and by positive blood cultures for Candida in 4 patients (27%). All patients had MRI findings consistent with HSC during the study period. Amphotericin B was administered intravenously to all 15 patients (median duration of treatment, 62 days). Repeat MR images were obtained at 2 weeks, 6 weeks and then at monthly intervals until the resolution of abnormalities. The median time for the disappearance of MRI lesions was 9 weeks. Alterations in the appearance of lesions on MRI were noted throughout chemotherapy in all the 13 (86.6%) responding patients. Our results suggest that MRI when used in patients with high clinical suspicion for HSC provide an alternative for liver biopsy or other invasive diagnostic procedures and that appropriate response to treatment can be safely monitored by obtaining sequential MRI studies.

Combined detection of mannanaemia and anti-mannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species

“…Diagnosis is generally supported by a compendium of clinical [46], radiological [47][48][49] and mycological evidence [50]. Efforts made to include the results of serological tests in this compendium have generally failed, despite consistent improvements in the sensitivity and specificity of these tests, particularly those detecting candidaderived molecules such as D-arabinitol [26], glucans [25] and mannan [24,51].…”

Diagnosis of invasive fungal infections in immunocompromised children

“…Biphasic liver CT scan as an alternative shows lesions with typical central contrast enhancement and a peripheral double ring in the arterial phase in adults [17]. As radiation exposure should be considered, particularly in children, high-resolution ultrasonography is a reasonable initial alternative for screening, despite a lower level of sensitivity than those of CT and MRI [18][19][20][21]. As the lesions of disseminated candidiasis are more readily observed when associated with inflammation, imaging modalities are best performed in oncology patients and haematopoietic stem cell transplant recipients after recovery from neutropenia.…”

Clinical characteristics of hepatosplenic fungal infection in pediatric patients

“…Although MRI achieved higher diagnostic accuracy of HSF than CT and ultrasonography in previous studies, 12,13,24 CT scan and ultrasonography are more widely used and more cost-effective in Taiwan. Karthaus et al 25,26 reported serial ultrasonography up to twice a week had the same detection rate and reliability of hepatosplenic abscess compared with CT scan and MRI.…”