Chronic disseminated candidiasis in patients with hematologic malignancies. Clinical features and outcome of 29 episodes

Livio Pagano, Luca Mele, Luana Fianchi, Lorella Melillo, Bruno Martino, Domenico D'Antonio, Maria Elena Tosti, Brunella Posteraro, Maurizio Sanguinetti, Giulio Trapè, Francesco Equitani, Francesco Nobile, Mario Carotenuto, Giuseppe Leone

Research output: Contribution to journalArticle

Abstract

Background and Objectives. To evaluate the characteristics of patients affected by hematologic malignancies who developed a chronic disseminated candidiasis (CDC), and to ascertain the factors that influenced the outcome, in a retrospective study conducted between January 1990 and December 2000, in 4 Hematology Divisions. Design and Methods. CDC was diagnosed by clinical features combined with radiological and/or histologic and/or microbiological data. Results. Twenty-eight patients (male/female 14/14; average age 42 years, range 12-67) developed a CDC. Twenty had acute myeloid leukemia, 5 had acute lymphocytic leukemia and 3 had non-Hodgkin's lymphoma. All patients received chemotherapy, including cytarabine for 21 of them (75%). Before the infection, 22 patients (79%) were neutropenic (absolute neutrophil count 9/L) for an average of 20 days (8-36), but at CDC diagnosis only 3 patients (11%) were neutropenic. Twenty-two patients (75%) received antifungal prophylaxis for an average of 15 days (10-60). Before diagnosis of CDC, 9 patients (32%) had a candidemia. The sites compromised by CDC were: liver in 27 patients (96%) and/or spleen in 11 patients (38%). Ten patients had other organs involved: lung in 6 patients (21%), kidney in 4 patients (14%), other sites 2 patients (7%). Abdominal ultrasonography was positive in 96% of patients (27/28), and abdominal computed tomography-scan was positive in 100% of cases in which it was performed (21/21). Liver biopsy was positive in 10/15 patients (67%). The main signs and symptoms were: fever 86%, abdominal pain 54%, diarrhea 32%, tenderness 25%, vomiting 25%, jaundice 29%, dysphagia 7%. Among chemical analyses, the most sensitive test was alkaline phosphatase, with a 3-5-fold increase in 24 patients (86%); an increase of liver transaminases and γ-glutamyl transferase was observed in less than 50% of patients. By 30 days after diagnosis 4 patients had died, 1 from infection, and 3 progression of the hematologic malignancy without signs of active CDC. Within 3 months from diagnosis 14 out of the remaining 24 patients (58%) received further chemotherapy: in particular, 2 patients underwent transplantation procedures. Interpretation and Conclusions. In our experience CDC is not a fatal complication of patients with hematologic malignancy, on the contrary to that observed for other fungal infections (i.e. aspergillosis, candidemia), characterized by a higher mortality rate. The major problem of this fungal complication is correlated to the delay in the following treatment for the hematologic malignancy with a high risk of progression of malignancy.

Original languageEnglish
Pages (from-to)535-541
Number of pages7
JournalHaematologica
Volume87
Issue number5
Publication statusPublished - 2002

    Fingerprint

Keywords

  • Abscesses
  • Candida
  • Leukemia
  • Lymphoma

ASJC Scopus subject areas

  • Hematology

Cite this

Pagano, L., Mele, L., Fianchi, L., Melillo, L., Martino, B., D'Antonio, D., Tosti, M. E., Posteraro, B., Sanguinetti, M., Trapè, G., Equitani, F., Nobile, F., Carotenuto, M., & Leone, G. (2002). Chronic disseminated candidiasis in patients with hematologic malignancies. Clinical features and outcome of 29 episodes. Haematologica, 87(5), 535-541.