| A limited number of patients with adult T cell leukemia/lymphoma (ATL) who received autologous stem cell transplantation (ASCT) have been reported. We report here a case of fatal systemic Candida krusei infection in a female patient with ATL undergoing ASCT. All of the eight patients (including seven patients in the literature) with ATL who received ASCT developed relapse of ATL or death due to ASCT complication, irrespective of subtype or remission state of ATL, source or selection of SCT or conditioning regimen. At present, ASCT appears to provide little benefit for ATL in contrast to that for other types of aggressive non-Hodgkin's lymphoma. ( info) |
2/1505. Systemic candidiasis with candida vasculitis due to Candida kruzei in a patient with acute myeloid leukaemia. Candida kruzei-related systemic infections are increasing in frequency, particularly in patients receiving prophylaxis with antifungal triazoles. A Caucasian male with newly diagnosed acute myeloid leukaemia (AML M1) developed severe and persistent fever associated with a micropustular eruption scattered over the trunk and limbs during induction chemotherapy. blood cultures grew Candida kruzei, and biopsies of the skin lesions revealed a candida vasculitis. He responded to high doses of liposomal amphotericin b and was discharged well from hospital. ( info) |
3/1505. Placental candidiasis: report of four cases, one with villitis. Four cases of placental candidiasis, an uncommon complication of rupture of the membranes, are presented. In addition to chorioamnionitis, in one of these cases villitis was also observed. Villitis is a rare occurrence in Candida infection and this represents only the second case in the literature. The involvement of villi may be suggestive of blood-borne infection. However, since neither the mother nor the foetus presented any signs of systemic dissemination, the authors suggest a hypothesis of contamination of the villi from foci of chorioamnionitis. ( info) |
| Liposomal amphotericin b (L-Amp B), a novel formulation of amphotericin b, is effective for the treatment of invasive fungal infections in children and adults and is associated with less toxicity than the conventional preparation. Data on the use of Liposomal amphotericin b in neonates is scarce. We describe the clinical course of two premature infants who were treated with Liposomal amphotericin b (one infant had candidemia, and the other had candidemia and meningitis), and provide a summary of previously published experience on this topic. Liposomal amphotericin b may be an option for therapy of invasive candidiasis in neonates who are at high risk of nephrotoxicity and other amphotericin-related reactions, but clinical trials are necessary to document its safety and efficacy in this age group. ( info) |
| A case of candida albicans spondylodiscitis in a 20-year-old female liver transplant recipient is reported. The patient was successfully treated with sequential therapy with liposomal amphotericin b and fluconazole. A review of the literature showed 10 cases of candida albicans spondylodiscitis successfully treated either with fluconazole alone or a sequential therapy with amphotericin b and fluconazole. If long-term amphotericin b therapy is not feasible, a prolonged course of fluconazole in a daily dose of 200-400 mg may be considered as an alternative. ( info) |
| A 60-year-old white man sustained a rupture of the renal artery 6 weeks after a cadaveric kidney transplantation. The bleeding site was repaired, and culture of the hematoma showed an isolated growth of candida albicans. blood and urine cultures were negative. Systemic antifungal therapy was initiated. Bleeding from the renal artery recurred, eventually requiring removal of the transplanted kidney. Histopathology of the resected specimen showed budding yeast in the wall of the renal artery, but no evidence of fungal invasion of the kidney. The patient received 6 weeks of amphotericin b therapy and currently remains on hemodialysis therapy. ( info) |
7/1505. renal artery rupture secondary to pretransplantation Candida contamination of the graft in two different recipients. Infected graft transplantation is an unwelcome complication that may lead to serious consequences in the immunosuppressed host. It can be caused by infection of the donor or by contamination of the organ during harvest, preservation and handling, or at transplantation. With current donor evaluation protocols, the risk of transmitting infections by exogenous contaminated grafts seems to be more frequent than true donor-transmitted infections. Nevertheless, although rare and usually free of clinically significant sequelae, if contamination is by some virulent organisms such as staphylococcus aureus, gram-negative bacilli, or fungi, severe complications may occur. We report the clinical outcome of liver, heart, and kidney recipients from a single donor. Both renal allografts had to be removed because of renal artery rupture secondary to candida albicans infection. Careful donor evaluation before transplantation, unusually early presentation of mycosis leading to anastomotic renal artery disruption, the histopathologic findings of the grafts, and the absence of Candida infection in the liver and heart recipients make us believe that exogenous contamination of the grafts occurred during donor procedure, kidney processing, or at transplantation. In summary, because infected grafts can lead to serious complications, besides careful donor screening, it is important to achieve early recognition of contaminated organs by culturing the perfusate to start specific antibiotic or antifungal therapy after transplantation if necessary and avoid the rare but, in this case, fatal consequences of these infections. ( info) |
8/1505. Bilateral emphysematous pyelonephritis caused by Candida infection. Emphysematous pyelonephritis is a rare, often severe infection of one or both kidneys that is most often caused by bacterial infection. Surgical intervention is often necessary. We describe a case of a diabetic patient with bilateral emphysematous pyelonephritis caused by Candida infection that was treated conservatively. Renal function recovered almost completely in spite of giving a potential nephrotoxic drug for 6 weeks. ( info) |
| The recently described species Candida dubliniensis has been recovered primarily from superficial oral candidiasis in hiv-infected patients. No clinically documented invasive infections were reported until now in this patient group or in other immunocompromised patients. We report three cases of candidemia due to this newly emerging Candida species in hiv-negative patients with chemotherapy-induced immunosuppression and bone marrow transplantation. ( info) |
10/1505. Surgical management of necrotizing Candida esophagitis. Invasive esophageal candidiasis produced transmural necrosis leading to perforation in 2 patients aged 10 and 27 years. Both patients survived after esophageal resection and complete diversion. One patient with acute leukemia and neutropenia experienced systemic candidiasis, which resolved after esophagectomy. esophagectomy and diversion for yeast-induced necrosis may lead to complete recovery and resolution of disseminated candidiasis when combined with systemic antifungal therapy. ( info) |