Hepatosplenic Yeast Infection in Patients with Acute Leukemia: A Diagnostic Problem

Abstract

The occurrence of hepatosplenic candidiasis following prolonged neutropenic periods has emerged as a major problem for patients with leukemia. In order to evaluate the diagnostic value of various available procedures, we analyzed our findings regarding 26 leukemic patients with hepatosplenic candidiasis. A significantly increased level (> 50 mg/L) of serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was > 37.5 degrees C) or raised levels of liver enzymes (serum alanine transferase, aspartate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in > 90% of the patients examined by computed tomography (CT) but in < 50% of those examined by ultrasonography. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was the basis of the diagnosis for only five patients. In conclusion, monitoring the S-CRP level after a patient's recovery from neutropenia is useful in that its elevation is cause for early suspicion of hepatosplenic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressive collection of samples for microscopy is essential.

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

“…Biliary stricture may lead to cholestasis, which in turn can allow micro-organisms from the gut to ascend into the biliary tract. In patients with hematologic malignancies, the yield of positive culture is often less than 50%, with the diagnosis usually based on microscopic examination or histopathological finding from deep tissues [1,3,4,7] . Nevertheless, fungal cultures had repeatedly been positive in our patient.…”

Efficacy of combination immunotherapy of IgM MAb B6.1 and amphotericin B against disseminated candidiasis

“…This fungal pathogen causes a clinical significant problem in immunocompromised patients [1][2][3][4][5]. To the patients who were treated with antifungal drugs, disseminated candidiasis due to C. albicans can be a serious cause which often leads to death [6]. Besides the disseminated disease, this fungus causes local infections like vulvovaginal candidiasis in which C. albicans is the most common etiological agent and thrush [7,8].…”

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

“…This diagnosis poses a challenge and requires a high degree of suspicion from clinicians involved in the care of patients with acute leukemia [5, 6]. Liver biopsy demonstrating the presence of pseudohyphae and yeast forms is important to establish the diagnosis of HSC.…”