Hepatosplenic candidiasis in patients with acute leukaemia

被引:51
作者
Sallah, S
Semelka, RC
Wehbie, R
Sallah, W
Nguyen, NP
Vos, P
机构
[1] Univ Tennessee, Coll Med, Dept Med, Div Hematol Oncol, Memphis, TN 38163 USA
[2] Univ N Carolina, Dept Radiol, Chapel Hill, NC USA
[3] Univ N Carolina, Div Hematol Oncol, Chapel Hill, NC USA
[4] St Elizabeth Hosp, Div Infect Dis, Youngstown, OH 44501 USA
[5] E Carolina Univ, Dept Radiat Oncol, Greenville, NC USA
[6] E Carolina Univ, Dept Biostat, Greenville, NC USA
关键词
acute leukaemia; complications; hepatosplenic; invasive; Candida;
D O I
10.1046/j.1365-2141.1999.01592.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 confirmed 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.
引用
收藏
页码:697 / 701
页数:5
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