title: Fungemia in children infected with the human immunodeficiency virus: new epidemiologic patterns, emerging pathogens, and improved outcome with antifungal therapy.
abstract: We characterized 27 episodes of fungemia in 22 children infected with the human immunodeficiency virus (HIV). Fungemia in these patients presented as a community-acquired infection in the setting of outpatient total parenteral nutrition or intravenous antibiotic therapy through a chronically indwelling central venous catheter (CVC). Fungemia developed only in patients with CVCs (P < .001). Non-albicans Candida species, Torulopsis glabrata, Rhodotorula rubra, and Bipolaris spicifera constituted 52% of all causes. Fungemia was detected early, within a median of 2.4 days after the onset of new fever, which permitted prompt administration of amphotericin B (mean dosage, 0.7 mg/[kg.day]; median duration, 19 days). CVCs were removed in 23 (85%) of the episodes. We conclude that fungemia in HIV-infected children often presents as a community-acquired infection, is frequently due to newly emerging opportunistic fungi, and can be managed, with a high level of success (95% survival with no posttherapeutic sequelae), by early diagnosis, prompt initiation of amphotericin B therapy, and removal of the CVC.
authors.affiliation: Infectious Diseases Section, National Cancer Institute, Bethesda, Maryland 20892, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez
authors.forename: E
authors.initials: E
authors.lastname: Roilides
authors.forename: B U
authors.initials: BU
authors.lastname: Mueller
authors.forename: N
authors.initials: N
authors.lastname: Ali
authors.forename: L L
authors.initials: LL
authors.lastname: Lewis
authors.forename: T O
authors.initials: TO
authors.lastname: Whitcomb
authors.forename: D J
authors.initials: DJ
authors.lastname: Marshall
authors.forename: P A
authors.initials: PA
authors.lastname: Pizzo
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D016469:Fungemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents