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Hepatosplenic yeast infection in patients with acute leukemia: a diagnostic problem
V J Anttila1, P Ruutu, S Bondestam
1Second Department of Medicine, Helsinki University Central Hospital, Finland.
Abstract:
The occurrence of hepatosplenic candidiasis following prolonged neutropenic periods has emerged as a major problem for patients with leukemia. In order to evaluate the diagnostic value of various available procedures, we analyzed our findings regarding 26 leukemic patients with hepatosplenic candidiasis. A significantly increased level (> 50 mg/L) of serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was > 37.5 degrees C) or raised levels of liver enzymes (serum alanine transferase, aspartate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in > 90% of the patients examined by computed tomography (CT) but in < 50% of those examined by ultrasonography. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was the basis of the diagnosis for only five patients. In conclusion, monitoring the S-CRP level after a patient's recovery from neutropenia is useful in that its elevation is cause for early suspicion of hepatosplenic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressive collection of samples for microscopy is essential.
Insights
Elevated serum C-reactive protein (S-CRP) aids early detection of hepatosplenic candidiasis in leukemia patients. Computed tomography (CT) is superior to ultrasonography for identifying liver and spleen lesions.
Area of Science:
- Medical Mycology
- Hematology
- Diagnostic Imaging
Background:
- Hepatosplenic candidiasis is a significant complication in leukemia patients experiencing prolonged neutropenia.
- Early and accurate diagnosis is crucial for effective management and improved patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic utility of various methods for detecting hepatosplenic candidiasis in leukemic patients.
- To compare the effectiveness of computed tomography (CT) and ultrasonography in identifying focal lesions.
- To assess the role of serum C-reactive protein (S-CRP) levels in early disease suspicion.
Main Methods:
- Analysis of data from 26 leukemic patients diagnosed with hepatosplenic candidiasis.
- Comparison of clinical findings including fever, liver enzymes, and serum C-reactive protein (S-CRP) levels.
- Evaluation of imaging techniques: computed tomography (CT) and ultrasonography.
- Assessment of diagnostic yield from invasive sampling for microscopy versus fungal cultures.
Main Results:
- Significantly elevated serum C-reactive protein (S-CRP) levels (> 50 mg/L) were more common than fever or elevated liver enzymes.
- Computed tomography (CT) detected focal changes in the liver, spleen, or kidneys in over 90% of patients, compared to less than 50% with ultrasonography.
- Invasive microscopy provided definitive diagnoses in 17 cases, while fungal cultures were positive in only five.
Conclusions:
- Monitoring serum C-reactive protein (S-CRP) levels post-neutropenia can prompt early suspicion of hepatosplenic candidiasis.
- CT is a more sensitive imaging modality than ultrasonography for detecting hepatosplenic candidiasis foci.
- Aggressive collection of samples for microscopy is essential for establishing a specific diagnosis of invasive fungal infections.