Hepatosplenic Candidiasis Without Prior Documented Candidemia: An Underrecognized Diagnosis?
| العنوان: | Hepatosplenic Candidiasis Without Prior Documented Candidemia: An Underrecognized Diagnosis? |
|---|---|
| المؤلفون: | Joffrey van Prehn, C. Willemien Menke-van der Houven van Oordt, Madelon L. De Rooij, Karin van Dijk, Marije K. Bomers, Ellen Meijer |
| المساهمون: | Medical Microbiology and Infection Prevention, CCA - Imaging and biomarkers, CCA - Cancer Treatment and quality of life, Internal medicine, Hematology, AII - Infectious diseases |
| المصدر: | The Oncologist van Prehn, J, van Oordt, C W M V D H, De Rooij, M L, Meijer, E, Bomers, M K & van Dijk, K 2017, ' Hepatosplenic candidiasis without prior documented candidemia : An underrecognized diagnosis? ', Oncologist, vol. 22, no. 8, pp. 990-994 . https://doi.org/10.1634/theoncologist.2017-0019Test Oncologist, 22(8), 990-994. AlphaMed Press |
| بيانات النشر: | AlphaMed Press, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | 0301 basic medicine, Adult, Male, Cancer Research, medicine.medical_specialty, Neutropenia, Fever, medicine.medical_treatment, 030106 microbiology, Splenectomy, 03 medical and health sciences, Internal medicine, hemic and lymphatic diseases, medicine, Humans, Hepatosplenic candidiasis, Intensive care medicine, Fluconazole, Candida, Aged, Chemotherapy, Leukopenia, business.industry, Candidiasis, food and beverages, Candidemia, hemic and immune systems, Middle Aged, Disseminated Candidiasis, medicine.disease, equipment and supplies, bacterial infections and mycoses, Transplantation, Invasive candidiasis, Oncology, Liver, Symptom Management and Supportive Care, Female, Differential diagnosis, medicine.symptom, business, Spleen, medicine.drug, Stem Cell Transplantation |
| الوصف: | Hepatosplenic candidiasis (HSC) often occurs without prior documented candidemia. Underrecognized HSC can be mistaken for metastases and can have serious consequences for patients, especially when additional, inappropriate treatment, such as surgery and chemo‐ or immunotherapy, is initiated. To emphasize the importance of diagnosing HSC without prior documented candidemia, three illustrative cases and a review of the literature on HSC and candidemia are presented. Introduction. Patients with a history of chemotherapy or stem cell transplantation (SCT) and prolonged neutropenia are at risk for hepatic and/or splenic seeding of Candida. In our experience, hepatosplenic candidiasis (HSC) without documented candidemia often remains unrecognized. Case presentations. We describe three cases of HSC without documented candidemia and the challenges in establishing the diagnosis and adequately treating this condition. The first patient had a history of SCT for treatment of breast cancer and was scheduled for hemihepatectomy for suspected liver metastasis. A second opinion at our institute resulted in the diagnosis of hepatic candidiasis without prior documented candidemia, for which she was treated successfully with fluconazole. The second case demonstrates the limitations of (blood and tissue) cultures and the value of molecular methods to confirm the diagnosis. Case 3 illustrates treatment challenges, with ongoing dissemination and insufficient source control despite months of antifungal therapy, eventually resulting in a splenectomy. Literature review. A structured literature search was performed for articles describing any patient with HSC and documented blood culture results. Thirty articles were available for extraction of data on candidemia and HSC. Seventy percent (131/187) of patients with HSC did not have documented candidemia. The majority of HSC events were described in hematologic patients, although some cases were described in patients with solid tumors treated with SCT (n = 1) or chemotherapy and a history of leukopenia (n = 2). Current guidelines and practices for diagnosis and treatment are described. Conclusion. Clinicians should be aware that HSC most often occurs without documented candidemia. In case of persistent or unexplained fever or lesions in the liver and/or spleen, a history of neutropenia should place disseminated candidiasis in the differential diagnosis. HSC is not limited to hematological patients and may occur in patients with solid tumors treated with bone marrow‐suppressing chemotherapy or SCT. In the latter group, HSC as alternative diagnosis for hepatic metastasis should be considered when lesions are not typical for metastasis. This might prevent unnecessary surgery or inappropriate treatment. Implications for Practice. Timely diagnosis of hepatosplenic candidiasis (HSC) is challenging, but can prevent further complications and dissemination, and may even prevent unnecessary invasive procedures. Clinicians should realize that HSC often occurs without documented candidemia and that sensitivity of blood cultures for candidemia is limited. HSC is not strictly limited to hematologic patients and might also occur in patients with solid tumors treated with intensive chemotherapy or stem cell transplantation. Increased awareness for HSC in patients with any history of neutropenia is of importance to increase detection and prevent serious sequelae. |
| اللغة: | English |
| تدمد: | 1549-490X 1083-7159 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6071fa3d3731a505c47c0c07e19ef63fTest http://europepmc.org/articles/PMC5553951Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....6071fa3d3731a505c47c0c07e19ef63f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1549490X 10837159 |
|---|