title: Candida tropicalis fungaemia in adult patients with haematological malignancies: clinical features and risk factors.
abstract: Candida tropicalis fungaemia is a serious opportunistic infection. Eighteen consecutive patients with C. tropicalis fungaemia diagnosed within a five-year period were studied retrospectively. All patients had haematological malignancies treated by chemotherapy or bone marrow transplantation (BMT). Antifungal prophylaxis included nystatin (20 mg daily) for patients receiving chemotherapy, and fluconazole (200 mg daily) for patients undergoing BMT. Sixteen patients had refractory and advanced haematological malignancies. All patients were neutropenic, had central venous catheters, and were receiving treatment with broad-spectrum antibiotics at the time of fungaemia. Septic shock with skin emboli were the most common presenting features. In seven cases, fungaemia was preceded by a positive culture of C. tropicalis in the urine. Concomitant bacteraemia was found in 11 cases, of which six cases were due to Staphylococcus aureus. The overall mortality rate was 56%. The predominance of chemotherapy-treated patients developing fungaemia in this series might be attributable to the omission of fluconazole prophylaxis. The clinicopathologic features and risk factors identified in this study may help design better treatment strategies for this often-lethal complication.
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong. ylkwong@hkucc.hku.hk
authors.forename: A Y H
authors.initials: AY
authors.lastname: Leung
authors.forename: C S
authors.initials: CS
authors.lastname: Chim
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: V C C
authors.initials: VC
authors.lastname: Cheng
authors.forename: K Y
authors.initials: KY
authors.lastname: Yuen
authors.forename: A K W
authors.initials: AK
authors.lastname: Lie
authors.forename: W Y
authors.initials: WY
authors.lastname: Au
authors.forename: R
authors.initials: R
authors.lastname: Liang
authors.forename: Y L
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications; D002177:Candidiasis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D016469:Fungemia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents