Hepatosplenic candidiasis in patients with acute leukaemia

Abstract

Summary. A retrospective study of 23 patients with acute leukaemia and hepatosplenic candidiasis (HSC) was conducted to evaluate clinical treatment characteristics in terms of amount and duration of antifungal agents and to assess treatment outcome.Patients were admitted to two major tertiary care centres between 1990 and 1998. The diagnosis of HSC was based on clinical, blood cultures, histologic and imaging studies. Patients were treated with amphotericin B without interruption of the planned chemotherapy regimens. Serial magnetic resonance imaging (MRI) studies were the main tool for following patients' response and activity of the fungal lesions in conjunction with clinical and laboratory parameters.Treatment with amphotericin B was continued until resolution of all clinical symptoms and signs attributable to HSC, obtaining negative blood cultures and the appearance of at least healed lesions on MRI. Amphotericin B was discontinued in four patients because of severe nephrotoxicity (two patients), or continuous fever and persistent fungal lesions on MRI (two patients). Amphotericin B lipid complex (ABELCET) was successfully used as salvage therapy for these refractory patients. Four patients died with evidence of HSC despite treatment and supportive measures. The response rate for treatment of HSC was 82%. The mean total dose of amphotericin B including empirical treatment was 4 g and the median duration of treatment for responding patients was 112 d. The median number of days of antifungal treatment before the disappearance of fever was 19 d.Our results con®rmed the need for protracted courses of antifungal agents for the successful eradication of HSC. Chemotherapy for the underlying disorder should not be interrupted or delayed in order to treat HSC.

Analysis of factors related to the occurrence of chronic disseminated candidiasis in patients with acute leukemia in a non-bone marrow transplant setting

“…Detailed clinical and laboratory information of the patients with CDC have been reported previously. 4 Of the 23 patients, 20 patients were in remission, whereas 3 patients had recurring leukemia diagnosed at the time of CDC. Table 1 depicts the characteristics of all patients in this study.…”

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

“…In fact, Domagk et al [8] also reported a case of common bile duct candidiasis caused simultaneously by C. albicans and C. glabrata. For patients with hematologic malignancies who have suffered from candidal liver abscesses, higher cumulative dosages of AmB (2-9 g) are recommended by most experts, because some evidence reveals that a cumulative dose of less than 2 g AmB correlated with residual lesions at autopsy [1,4,9] . Cases of hepatosplenic candidiasis that were successfully treated with fluconazole have been reported by Kauffman et al The symptoms improved within 3-8 wk, but resolution of lesions on CT scan was noted after at least 1 mo of flu conazole therapy [10 ] .…”

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

“…Treatment experience is mainly available for D-AmB and fluconazole, showing response rates of more than 50% of cases [1,3,15,21,74,98], but caspofungin is today accepted as alternative therapy when the Candida species is not identified [77,105]. If Candida spp.…”