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Disseminated fungal infections in children infected with human immunodeficiency virus
E Leibovitz1, M Rigaud, S Chandwani
1Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, NY 10016.
Insights
Disseminated candidiasis (DC) is a severe fungal infection in children with advanced human immunodeficiency virus (HIV). Hospital-acquired infections, central lines, and oral thrush are key risk factors, with a high mortality rate of 90%.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- HIV/AIDS Research
Background:
- Disseminated candidiasis (DC) is a serious opportunistic infection in children with advanced human immunodeficiency virus (HIV).
- Understanding risk factors and outcomes is crucial for improving patient management.
Purpose of the Study:
- To investigate the incidence, predisposing factors, clinical presentation, and outcomes of disseminated candidiasis in human immunodeficiency virus-infected children.
- To identify key risk factors and assess the impact of treatment on mortality.
Main Methods:
- Retrospective chart review of 156 human immunodeficiency virus-infected children over 7.5 years.
- Analysis of 11 episodes of disseminated candidiasis, focusing on patient demographics, clinical course, diagnostic methods, and treatment outcomes.
Main Results:
- 11 episodes of DC occurred in 7% of HIV-infected children, primarily hospital-acquired in those with advanced HIV.
- Major predisposing factors included previous oral thrush (73%) and central venous catheters (82%).
- Mortality was high at 90%, with only 64% of cases diagnosed antemortem and limited treatment success with amphotericin B.
Conclusions:
- Disseminated candidiasis poses a significant threat to HIV-infected children, often associated with hospital acquisition and specific predisposing conditions.
- Early diagnosis and effective treatment strategies are urgently needed to reduce the high mortality associated with DC in this vulnerable population.
Abstract:
A retrospective review of charts of 156 human immunodeficiency virus-infected children cared for during a 7.5-year period revealed 11 episodes of disseminateed candidiasis (DC) occurring in 11 patients (7%). All 11 patients developed the fungal infection in the context of advanced human immunodeficiency virus infection. All but one were hospital-acquired, occurring at a mean of 2.3 months after admission. Ten patients had been febrile for more than 14 days before diagnosis. Previous oral thrush and central venous catheters (73 and 82% of patients) represented major predisposing factors for development of DC. Neutropenia (2 of 11 patients) did not represent a major risk factor for DC. Candida albicans was isolated in 9 patients, Rhodotorula minuta in 1 patient and 1 fungal isolate could not be identified. Sources of isolation were blood (8 of 11 patients), central venous catheters (3 of 11) and urine (2 of 11). Lungs (6 of 11 patients), esophagus (5 of 11) and brain, heart and kidneys (3 patients each) were the organs most often involved in DC. Antemortem diagnosis was achieved in only 7 (64%) patients; none of the 4 patients with DC diagnosed postmortem had been treated before death. Seven patients were treated with amphotericin B; 6 of them died but only 3 were treated for more than 7 days of therapy. The overall mortality was 90% (10 of 11 patients). In all 20% of the 50 human immunodeficiency virus-infected children who died at our hospital during the study period had an episode of DC in close proximity to their death. DC was considered the direct cause of death in 4 of 10 children.