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HEPATOSPLENIC CANDIDIASIS

2000; Elsevier BV; Volume: 14; Issue: 3 Linguagem: Inglês

10.1016/s0891-5520(05)70128-8

1557-9824

Dimitrios P. Kontoyiannis, Mario A. Luna, Barry I. Samuels, Gerald P. Bodey,

Fungal Infections and Studies

Invasive candidiasis is a major cause of morbidity and mortality in patients with hematologic malignancies and a frequent cause of failure of the initial remission induction chemotherapy in this patient population.12, 25 Candidemia in neutropenic patients with leukemia is associated with disseminated organ infection in most cases.12, 53 The syndrome of acute disseminated candidiasis (ADC) in patients with acute leukemia, increasingly recognized since the 1950s,11, 45 has a predictable prognosis that depends on the recovery of the neutrophil count: If the patients achieve remission of their underlying leukemia and their neutrophil counts recover, then they usually recover with therapy unless the infection is overwhelming. If the neutropenia remains refractory, then the outcome, despite treatment with antifungals, is fatal.12 During the last three decades, a chronic form of disseminated candidiasis has been recognized with increasing frequency.9, 32, 74 Bodey et al first reported chronic hepatosplenic candidiasis with hypersplenism in a patient with leukemia who had achieved a complete remission after chemotherapy.10 The patient developed a refractory fever of unknown cause associated with persistent pancytopenia despite normal findings on bone marrow biopsy.10 The patient's spleen was removed and was found to contain multiple abscesses containing Candida spp. After treatment with amphotericin B, the patient fully recovered.10 This syndrome subsequently was described in more detail in the early 1980s1, 32, 36, 46, 49, 50, 73, 74 and is often referred as hepatosplenic candidiasis,67 chronic systemic candidiasis,9 or chronic disseminated candidiasis (CDC). We believe that the last is the most appropriate term, because it describes a chronic infection that may involve other organs in addition to the liver and spleen.