• Chronic disseminated candidiasis
• Hematological disorder
• Hepatosplenic candidiasis
• Invasive candidiasis

• Humans
• Male
• Female
• Middle Aged
• Adult
• Aged
• Retrospective Studies
• Antifungal Agents/therapeutic use
• Treatment Outcome
• Candidiasis/drug therapy
• Candidiasis/complications
• Candidiasis/mortality
• Candidiasis/diagnosis
• Hematologic Diseases/complications
• Young Adult
• Neutropenia/complications
• Chronic Disease
• Caspofungin/therapeutic use
• Hematologic Neoplasms/complications
• Adolescent

• 2021-I2M-1-060 Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
• 2021-I2M-1-017 Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
• YKK21273 Special Fund Project for Science and Technology Innovation Strategy of Nanjing
• CZXM-GSP-RC20 Research Personnel Cultivation Programme of Zhongda Hospital Southeast University
• 21JCZDJC01170 Tianjin Municipal Science and Technology Commission Grant
• Y-SYBLD2022RWR-0017 Beijing Xisike Clinical Oncology Research Foundation

• Diagnostic gold standard
• PCR
• antigen biomarkers
• culture
• invasive fungal infections
• microscopy
• mold infections
• yeast infections

• Humans
• Invasive Fungal Infections/diagnosis
• Invasive Fungal Infections/microbiology
• Sensitivity and Specificity
• Molecular Diagnostic Techniques
• Immunocompromised Host
• Practice Guidelines as Topic
• Candidiasis, Invasive/diagnosis
• Candidiasis, Invasive/drug therapy
• Candidiasis, Invasive/microbiology
• Mycoses/diagnosis
• Mycoses/microbiology

• Humans
• Retrospective Studies
• Prognosis
• Male
• Female
• Middle Aged
• Candidiasis/diagnosis
• Adult
• Young Adult
• Splenic Diseases/diagnosis
• Splenic Diseases/microbiology
• Splenic Diseases/etiology
• Adolescent
• Aged
• Hematopoietic Stem Cell Transplantation
• Hematologic Diseases/complications
• Liver Diseases/microbiology
• Liver Diseases/diagnosis

• Chronic disseminated candidiasis
• Hematopoietic stem cell transplant
• Hepatosplenic candidiasis
• Immunocompromised
• Neutropenia
• Neutropenic fever

• Female
• Humans
• Adolescent
• Leukemia, Myeloid, Acute
• Candidiasis/diagnosis
• Candidiasis/drug therapy
• Hematologic Neoplasms
• Neutropenia

• drug delivery
• extracellular vesicles
• fungi
• host-microbe interaction
• immunity
• therapy
• vaccine
• yeast

• Animals
• Fungal Proteins/metabolism
• Extracellular Vesicles/metabolism
• Yeasts/metabolism
• Drug Delivery Systems
• Virulence
• Mammals/metabolism

• acute lymphoblastic leukemia
• chronic disseminated candidiasis
• corticosteroids
• hepatosplenic candidiasis
• immune reconstitution inflammatory syndrome
• invasive fungal infection

Hepatosplenic candidiasis (HSC) used to be reported in patients with acute myeloid leukemia (AML) without antifungal prophylaxis. The aim was to describe the clinical features and outcomes of HSC over the last 13 years in a single French hematology center.

All patients diagnosed with HSC between 2008 and 2020 were included in a single-center retrospective cohort study. Data were collected from patient charts, and HSC was classified according to the 2020 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definitions.

Sixty patients were included, with 18.3% proven, 3.3% probable, and 78.3% possible HSC according to the 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group classification. Among them, 19 patients were treated for acute myeloid leukemia (AML), 21 for lymphomas, and 14 for acute lymphoblastic leukemia. HSC occurred in 13 patients after autologous stem cell transplantation for lymphoma. At HSC diagnosis, 13 patients were receiving antifungal prophylaxis. Candida colonization was present in 84.2%, with prior candidemia in 36.7% of cases. β-D-glucans was positive in 55.8%, and 45.8% of tissue biopsies were contributive. First-line antifungal therapy was azoles in 61.7%, and steroids were associated in 45% of cases. At 3 months of follow-up, partial response to antifungal therapy was 94.2%. At last follow-up (mean, 22.6 months), 41 patients (68.3%) presented a complete hematological remission and 22 patients were deceased, none because of HSC.

The epidemiology of HSC has changed in the last decade, with fewer cases occurring in the AML setting. A better identification of patients at risk could lead to specific prophylaxis and improved diagnosis.

• (1,3)-β-D-glucan
• Chronic disseminated candidiasis
• Corticosteroid therapy
• Immune reconstitution inflammatory syndrome

• Hematopoietic Stem Cell Transplantation/adverse effects
• Humans
• Transplantation Conditioning
• Transplantation, Homologous/adverse effects
• Ultrasonography/methods

• immune reconstitution inflammatory syndrome
• interferon gamma
• invasive candidiasis

Hepatic candidiasis is a manifestation of disseminated candidiasis, which typically presents in immunocompromised patients. Focal hepatic candidiasis in immunocompetent patients, however, is infrequent/extremely rare. We present the case of an immunocompetent female patient who presented with respiratory distress and right-sided pleural effusion. The pleural fluid tap did not grow anything, and a contrast-enhanced computed tomography (CT) scan revealed a right liver lobe subcapsular collection. CT-guided aspiration and culture resulted in Candida albicans growth. The patient responded to oral fluconazole, and a follow-up CT scan demonstrated resolution of the collection. Although hepatic candidiasis rarely occurs in immunocompetent patients, it should be included in the differential diagnosis of hepatic abscesses, as timely diagnosis and management are crucial in conferring a good prognosis.

• candidiasis
• computed tomography abdomen
• hepatic abscess
• immunocompetent

• Fungi
• Helminths
• Immunocompromised
• Parasites
• Protozoa

• Autosomal dominant polycystic kidney disease
• Candida albicans
• Candida famata
• Cyst infection
• Double infection
• Staphylococcus lugdunensis

• Cancer
• Children
• Fungal infections

• chronic disseminated candidiasis (CDC)
• hepatosplenic candidiasis (HSC)
• hepatosplenic fungal infection (HSFI)
• paediatric haematological malignancies

The present meta-analysis examined the diagnostic accuracy of T2 Candida for candidiasis.

The literature databases, such as PubMed, Embase, DVIO, Cochrane library, Web of Science, and CNKI, were searched on T2 Candida detection.

A total of 8 articles, comprising of 2717 research subjects, were included in the study. The pooled sensitivity and specificity were 0.91 (95% confidence interval (CI): 0.88–0.94) and 0.94 95% CI: 0.93–0.95), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 10.16 (95% CI: 2.75–37.50) and 0.08 (95% CI: 0.02–0.35), respectively. The combined diagnostic odds ratio is 133.65 95% CI: 17.21–1037.73), and the AUC of SROC is 0.9702 [(SE = 0.0235), Q* = 0.9201(SE = 0.0381)].

The current evidence supported that T2 Candida has high accuracy and sensitivity and is of major clinical significance in the diagnosis of Candida infection.

• Candida infection
• Diagnosis
• Meta-analysis
• T2 Candida

• acute myeloid leukemia
• candida tropicalis
• invasive candidal infections
• muscle abscesses

• Abscess/etiology
• Amphotericin B/therapeutic use
• Antifungal Agents/therapeutic use
• Antineoplastic Agents/adverse effects
• Candida tropicalis/isolation & purification
• Candidiasis/diagnosis
• Candidiasis/drug therapy
• Candidiasis/etiology
• Caspofungin/therapeutic use
• Flucytosine/therapeutic use
• Humans
• Immunocompromised Host
• Leg/microbiology
• Leukemia, Myeloid, Acute/drug therapy
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Muscle, Skeletal/microbiology
• Muscular Diseases/microbiology
• Opportunistic Infections/diagnosis
• Opportunistic Infections/drug therapy
• Tomography, X-Ray Computed

• anidulafungin
• candidemia
• caspofungin
• micafungin

• Histopathological diagnosis
• In situ hybridization
• Invasive fungal infection
• Polymerase chain reaction

• Candida
• PCR
• candidiasis
• diagnosis
• molecular-based tools

• Aspergillus
• Candida
• blastomycosis
• histoplasmosis
• mucormycosis

Hepatosplenic candidiasis (HSC) often occurs without prior documented candidemia. Underrecognized HSC can be mistaken for metastases and can have serious consequences for patients, especially when additional, inappropriate treatment, such as surgery and chemo‐ or immunotherapy, is initiated. To emphasize the importance of diagnosing HSC without prior documented candidemia, three illustrative cases and a review of the literature on HSC and candidemia are presented.

Patients with a history of chemotherapy or stem cell transplantation (SCT) and prolonged neutropenia are at risk for hepatic and/or splenic seeding of Candida. In our experience, hepatosplenic candidiasis (HSC) without documented candidemia often remains unrecognized.

We describe three cases of HSC without documented candidemia and the challenges in establishing the diagnosis and adequately treating this condition. The first patient had a history of SCT for treatment of breast cancer and was scheduled for hemihepatectomy for suspected liver metastasis. A second opinion at our institute resulted in the diagnosis of hepatic candidiasis without prior documented candidemia, for which she was treated successfully with fluconazole. The second case demonstrates the limitations of (blood and tissue) cultures and the value of molecular methods to confirm the diagnosis. Case 3 illustrates treatment challenges, with ongoing dissemination and insufficient source control despite months of antifungal therapy, eventually resulting in a splenectomy.

A structured literature search was performed for articles describing any patient with HSC and documented blood culture results. Thirty articles were available for extraction of data on candidemia and HSC. Seventy percent (131/187) of patients with HSC did not have documented candidemia. The majority of HSC events were described in hematologic patients, although some cases were described in patients with solid tumors treated with SCT (n = 1) or chemotherapy and a history of leukopenia (n = 2). Current guidelines and practices for diagnosis and treatment are described.

Clinicians should be aware that HSC most often occurs without documented candidemia. In case of persistent or unexplained fever or lesions in the liver and/or spleen, a history of neutropenia should place disseminated candidiasis in the differential diagnosis. HSC is not limited to hematological patients and may occur in patients with solid tumors treated with bone marrow‐suppressing chemotherapy or SCT. In the latter group, HSC as alternative diagnosis for hepatic metastasis should be considered when lesions are not typical for metastasis. This might prevent unnecessary surgery or inappropriate treatment.

Timely diagnosis of hepatosplenic candidiasis (HSC) is challenging, but can prevent further complications and dissemination, and may even prevent unnecessary invasive procedures. Clinicians should realize that HSC often occurs without documented candidemia and that sensitivity of blood cultures for candidemia is limited. HSC is not strictly limited to hematologic patients and might also occur in patients with solid tumors treated with intensive chemotherapy or stem cell transplantation. Increased awareness for HSC in patients with any history of neutropenia is of importance to increase detection and prevent serious sequelae.

• Candida
• Candidemia
• Hepatosplenic candidiasis
• Invasive candidiasis

• Adult
• Aged
• Candida/pathogenicity
• Candidemia/diagnosis
• Candidemia/drug therapy
• Candidemia/microbiology
• Candidemia/pathology
• Candidiasis/diagnosis
• Candidiasis/drug therapy
• Candidiasis/microbiology
• Candidiasis/pathology
• Female
• Fever/drug therapy
• Fever/microbiology
• Fever/pathology
• Fluconazole/administration & dosage
• Humans
• Liver/microbiology
• Liver/pathology
• Male
• Middle Aged
• Neutropenia/complications
• Neutropenia/microbiology
• Neutropenia/pathology
• Spleen/microbiology
• Spleen/pathology
• Stem Cell Transplantation/adverse effects

We describe a case of breakthrough Candida parapsilosis fungemia in an 80-year-old woman with pyoderma gangrenosum and rheumatoid arthritis. C. parapsilosis was detected in blood culture while the patient was treated with micafungin for a Candida glabrata bloodstream infection. The breakthrough infection was successfully treated with liposomal amphotericin B.

• Breakthrough infection
• Candida glabrata
• Candida parapsilosis
• Micafungin
• Pyoderma gangrenosum

Hepatosplenic candidiasis is a fungal infection, which mostly affects patients with hematologic malignancies such as leukemia. The pathogenesis of this infection is not clear yet, and the liver is the most commonly affected organ. Diagnosis of hepatosplenic candidiasis can be only established via biopsy, since computed tomography (CT) scan, ultrasonography, and magnetic resonance imaging (MRI) yield non-specific results. The role of fluorine-18 fluorodeoxyglucose positron emission tomography /computed tomography (¹⁸F-FDG PET/CT) in diagnosis of hepatosplenic candidiasis remains undetermined, considering a few evidences in the literature. In this case report, we present the case of a 47-year-old patient, affected by acute myeloid leukemia, which was treated with three cycles of chemotherapy, resulting in the development of neutropenia and fever following the last cycle. The ¹⁸F-FDG PET/CT scan showed some foci of intense FDG uptake in the liver and spleen. The subsequent diagnostic investigations (i.e., abdominal CT scan and biopsy) were suggestive of hepatosplenic candidiasis. The patient was started on antifungal treatment with fluconazole. After one month, the clinical conditions were resolved, and the subsequent abdominal CT scan was negative.

• 18F-FDG-PET/CT
• Acute myeloid leukemia
• Hepatosplenic candidiasis

• azoles
• candidemia
• echinocandins
• fungal diagnostics
• invasive candidiasis

• Animals
• Antifungal Agents/administration & dosage
• Antifungal Agents/therapeutic use
• Candidiasis/diagnosis
• Candidiasis/drug therapy
• Candidiasis/microbiology
• Humans

• antifungal therapy
• candidiasis
• consensus guidelines
• cryptococcosis
• yeasts

• Invasive aspergillosis
• beta-d-glucan
• haematological malignancy
• invasive candidiasis

• Contrast media
• Microbubbles
• Pyogenic liver abscess
• Sulfur hexafluoride

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Contrast Media
• Female
• Humans
• Image Enhancement/methods
• Liver/diagnostic imaging
• Liver Abscess, Pyogenic/diagnostic imaging
• Male
• Microbubbles
• Middle Aged
• Phospholipids
• Reproducibility of Results
• Retrospective Studies
• Sulfur Hexafluoride
• Ultrasonography
• Young Adult

• Candida
• Neonatal candidiasis
• Premature infants
• Risk factors

• Antifungal Agents/therapeutic use
• Candidiasis, Invasive/diagnosis
• Candidiasis, Invasive/epidemiology
• Candidiasis, Invasive/prevention & control
• Catheter-Related Infections/diagnosis
• Catheter-Related Infections/epidemiology
• Catheter-Related Infections/prevention & control
• Chemoprevention
• Culture Techniques
• Gestational Age
• Humans
• Infant
• Infant, Newborn
• Infant, Premature
• Intensive Care Units, Neonatal

• K24 HD058735 NICHD NIH HHS
• R01 HD057956 NICHD NIH HHS
• HHSN275201000003I NICHD NIH HHS
• UL1 TR001117 NCATS NIH HHS
• T32 HD060558 NICHD NIH HHS

An 11-year-old boy with acute lymphocytic leukemia (ALL) contracted disseminated candidiasis during induction therapy, which was complicated with rupture of a fungal cranial aneurysm. Ventricular drainage and coil embolization of a residual aneurysm in combination with intensive antifungal therapy rescued the patient. Although clinical improvement was achieved, high fever and elevated levels of C-reactive protein and β-D-glucan continued for more than 10 mo. One year later, the ALL relapsed during maintenance therapy with methotrexate and 6-mercaptopurine. After salvage chemotherapy, the patient received unrelated bone marrow transplantation (BMT) in a non-complete remission condition and survived. During subsequent chemotherapy and BMT, no recurrence of the fungal infection was observed under the prophylactic anti-fungal therapy with micafungin.

• Disseminated candidiasis
• β-D-glucan
• Fungal cranial aneurysm
• Acute lymphocytic leukemia
• Bone marrow transplantation

• ABCD
• ABLC
• AMMI
• AmB
• AmB deoxycholate
• AmB-d
• Association of Medical Microbiology and Infectious Disease
• BSI
• C. albicans germ-tube antibodies
• CAGTA
• Candida
• Candidiasis
• ECCMID
• ECIL4
• EORTC/MSG
• European Congress of Clinical Microbiology and Infectious Diseases
• European Council on Infections in Leukaemia
• European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group
• Guidelines
• ICU
• IDSA
• Infectious Disease Society of America
• L-AmB
• LFAmB
• Middle East
• Treatment
• amphotericin B
• amphotericin B colloidal dispersion
• amphotericin B lipid complex
• blood stream infection
• intensive care unit
• lipid formulation AmB
• liposomal AmB

Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. Candida species are by far the predominant agent of fungal sepsis accounting for 10% to 15% of health-care associated infections, about 5% of all cases of severe sepsis and septic shock and are the fourth most common bloodstream isolates in the United States. One-third of all episodes of candidemia occur in the intensive care setting. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. Unfortunately, risk factors, clinical and radiological manifestations are quite unspecific and conventional culture methods are suboptimal. Non-culture based methods (such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction) have emerged but remain investigational or require additional testing in the ICU setting. Few prophylactic or pre-emptive studies have been performed in critically ill patients. They tended to be underpowered and their clinical usefulness remains to be established under most circumstances. The antifungal armamentarium has expanded considerably with the advent of lipid formulations of amphotericin B, the newest triazoles and the echinocandins. Clinical trials have shown that the triazoles and echinocandins are efficacious and well tolerated antifungal therapies. Clinical practice guidelines for the management of invasive candidiasis have been published by the European Society for Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of North America.

• Candida albicans
• candidiasis
• echinocandin
• risk factors
• sepsis

Infections are one of the most common complications in patients diagnosed with leukemia and serve as a major obstacle to treatment. Through the early 1970s, infections were the most common cause of death in patients diagnosed with acute leukemia, but improvement in treatment and supportive care over the past few decades, coupled with expanded prophylaxis and prevention regimens, have led to reduction in both the frequency and severity of infections. Regardless, due in part to an aging cancer population and the diversity of cancer treatments and procedures, infectious diseases remain a major cause of morbidity and mortality in patients with leukemia.