title: Deep Candida infection in children with leukaemia: clinical presentations, diagnosis and outcome.
abstract: OBJECTIVE
  To analyse the clinical features associated with deep Candida infection (DCI) and the outcome in children with leukaemia, and to evaluate various diagnostic methods.
  
  
  METHODS
  Serum samples were analysed to determine Candida IgA, IgM and IgG antibodies and defect free C. albicans glucoprotein antigen and C. enolase antigen in eight children who had nine episodes of DCI and six with suspected DCI.
  
  
  RESULTS
  DCI occurred shortly after the leukaemia diagnosis (median 40 days) or after the leukaemia relapse (median 30 days). Children with DCI had fever (100%), skin lesions/exanthema (45%), oral thrush (45%), oesophagitis (22%) and laryngo-tracheitis (22%). Candida endocarditis, arthritis and hepatic candidosis were diagnosed in one patient each. Two children with disseminated candidosis died in leukaemia relapse. In patients with C. albicans infections serology had a sensitivity of 83%. However, in patients with C. parapsilosis infection antibody detection was negative. As the patients were cured of their Candida infection, the IgG antibodies disappeared and the IgM and IgA antibodies fell within the normal range for age.
  
  
  CONCLUSIONS
  DCI in children occurs shortly after the leukaemia diagnosis or shortly after relapse of leukaemia. The clinical features are many. Candida serology may help to diagnose or confirm DCI. The dynamics of antibody titres may help to establish the efficacy of antifungal treatment.
authors.affiliation: Department of Paediatrics, Karolinska Institute, Danderyd Hospital, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Klingspor
authors.forename: G
authors.initials: G
authors.lastname: Stintzing
authors.forename: J
authors.initials: J
authors.lastname: Tollemar
mesh_terms: D000293:Adolescent; D000908:Antibodies, Fungal / Q000097:blood; D002175:Candida / Q000276:immunology; D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007938:Leukemia / Q000150:complications*; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology*; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D000908:Antibodies, Fungal; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M