Systemic Candida infection in pediatric BM autotransplantation: clinical signs, outcome and prognosis.
Of the 393 children who underwent BM autotransplantation in the pediatric oncology unit of the Institut Gustave Roussy between February 1979 and September 1991, 14 (3.56%) developed disseminated Candida infection within 3 months. This incidence was far lower than in other published series. Eleven of the 14 patients recovered from the infection, giving a far higher survival rate (78%) than among adult BM transplant recipients (usually < 30%). All 14 patients had four or more risk factors and persistent BM aplasia (median, 25 days); six had Candida tropicalis infection. Four cases of deep visceral involvement were documented, two of which were lethal. Clinical signs were relatively uniform and included secondary high-grade fever (> 40 degrees C) for 8 days; half the patients developed cardiovascular impairment, respiratory distress, neurological disturbances (altered consciousness or delirium) and severe diarrhoea, within as little as 10 days after transplantation. Blood cultures rapidly became positive after the onset of clinical signs and this permitted prompt treatment with a combination of amphotericin B and 5-fluorocytosine; in addition, central catheters were removed. Blood cultures became sterile within 4 days of treatment in 10 of the 14 cases. The generally favourable outcome in this series could be related to the young age of the patients, the absence of GVHD, the absence of total body irradiation in the conditioning regimen, and early antifungal treatment.
Besnard
M
M
Service de Pédiatrie, Institut Gustave Roussy, Villejuif, France.
Hartmann
O
O
Valteau-Couanet
D
D
Robert
M C
MC
Brugieres
L
L
Lemerle
J
J
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000666:Amphotericin B