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Volume 44, Number 4, August 2011

Clinical characteristics of hepatosplenic fungal infection in pediatric patients


Ting-Yu Yen, Li Min Huang, Ping-Ing Lee, Chun-Yi Lu, Pei-Lan Shao, Luan-Yin Chang


Received: April 20, 2010    Revised: June 25, 2010    Accepted: August 12, 2010   

 

Corresponding author:

Department of Pediatric, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 8, Chung-Shan South Rd, Taipei 10016, Taiwan. E-mail addresses: ly7077@tpts6.seed.net.tw, lychang@ntu.edu.tw (L.-Y. Chang



 

Background and purpose: 

Hepatosplenic fungal infection (HSF) is a distinct form of invasive fungal infection with main involvement of the liver, spleen, and occasionally the kidney. In this study, we investigated the clinical characteristics and outcomes of patients with HSF in childhood.



 

Methods:

We retrospectively reviewed pediatric patients with the diagnosis of HSF in a tertiary medical center in Taiwan between July 1999 and June 2009. The definition of HSF included imaging studies demonstrating multiple focal lesions in the liver and/or spleen with or without a microbiologic evidence for fungal infection. The clinical characteristics and outcomes were analyzed.



 

Results:

We identified 15 pediatric patients with HSF. Eleven patients had diagnosis of hemato-oncologic malignancy, and two patients had severe aplastic anemia. All patients had fever, and most patients had abdominal pain, nausea, vomiting, and hepatosplenomegaly. The detection rate of computed tomography scan (15/15, 100%) was superior to abdominal sonography (10/15, 67%, p = 0.01). Ten (91%) of the 11 patients with microbiologic evidence were infected by Candida species. Neither recurrence nor breakthrough fungal infection was noted when the patients underwent further chemotherapy and stem cell transplantation. Six patients (40%) died before the end of the study, but no mortality was directly related to HSF.



 

Conclusion:

Candida species was the major pathogen for HSF, and computed tomography scan was a good diagnostic tool to detect the multiple focal lesions. Under adequate antifungal treatment, HSF could be cured without recurrence in spite of further chemotherapy and stem cell transplantation.



 

Key words:

Childhood, Hematopoietic stem cell transplantation, Hepatosplenic fungal infection