title: Clinical characteristics of hepatosplenic fungal infection in pediatric patients.
abstract: BACKGROUND
  Hepatosplenic fungal infection (HSF) is a distinct form of invasive fungal infection with main involvement of the liver, spleen, and occasionally the kidney. In this study, we investigated the clinical characteristics and outcomes of patients with HSF in childhood.
  
  
  METHODS
  We retrospectively reviewed pediatric patients with the diagnosis of HSF in a tertiary medical center in Taiwan between July 1999 and June 2009. The definition of HSF included imaging studies demonstrating multiple focal lesions in the liver and/or spleen with or without a microbiologic evidence for fungal infection. The clinical characteristics and outcomes were analyzed.
  
  
  RESULTS
  We identified 15 pediatric patients with HSF. Eleven patients had diagnosis of hemato-oncologic malignancy, and two patients had severe aplastic anemia. All patients had fever, and most patients had abdominal pain, nausea, vomiting, and hepatosplenomegaly. The detection rate of computed tomography scan (15/15, 100%) was superior to abdominal sonography (10/15, 67%, p = 0.01). Ten (91%) of the 11 patients with microbiologic evidence were infected by Candida species. Neither recurrence nor breakthrough fungal infection was noted when the patients underwent further chemotherapy and stem cell transplantation. Six patients (40%) died before the end of the study, but no mortality was directly related to HSF.
  
  
  CONCLUSIONS
  Candida species was the major pathogen for HSF, and computed tomography scan was a good diagnostic tool to detect the multiple focal lesions. Under adequate antifungal treatment, HSF could be cured without recurrence in spite of further chemotherapy and stem cell transplantation.
authors.affiliation: Department of Pediatric, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Yen
authors.forename: Li Min
authors.initials: LM
authors.lastname: Huang
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Lu
authors.forename: Pei-Lan
authors.initials: PL
authors.lastname: Shao
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000188:drug therapy / Q000382:microbiology*; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy / Q000382:microbiology*; D008107:Liver Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents