Chronic disseminated candidiasis in patients with acute leukemia: emphasis on diagnostic definition and treatment
Section snippets
Incidence and risk factors
Controlled or multi-institutional studies that evaluate the incidence and prevalence of CDC are presently unavailable. The reported frequency of CDC ranges between 3 and 29% depending on the diagnostic criteria used by different investigators. For example, Grois et al. demonstrated the presence of sonographic evidence of CDC in 16 (29%) of the 55 patients with acute leukemia who were screened for this complication regardless of their presentation [9]. Histopathologic proof of the infection,
Presentation and diagnosis
Approximately 85% of the patients with CDC and underlying acute leukemia are in remission at the time of diagnosis [11]. The most common manifestation of CDC is persistent fever not responsive to conventional antibiotics. There may be more than one spike of fever per day associated with chills and rigors with temperature exceeding 40 °C in some patients [1], [2], [3], [11], [26], [28]. Right upper quadrant or abdominal pain is the second most common finding following fever reported by most
Treatment
Because most of the patients are in remission at the time of diagnosis of CDC, the usual dilemma is whether to delay further treatment, i.e., consolidation or maintenance, or to hold further chemotherapy until the infection is completely eradicated. This is an extremely important issue since several months of antifungal treatment may be required to efficiently control this type of invasive candidiasis [11], [43], [44]. The duration of therapy of CDC in relation to the administration of
Conclusion
Infection is the most common complication and likely the most common cause of death in patients with hematologic malignancies. The improvement in supportive care and antibiotic therapy have caused substantial reduction in the morbidity and mortality of these infectious complications. On the other hand, the introduction of more aggressive chemotherapeutic regimens and BMT have resulted in the appearance or the increase in incidence of certain infections with unknown natural history. Among these
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