1. Adjuvant corticosteroid therapy for chronic disseminated candidiasis
- Author
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Olivier Lortholary, Erianna Bellaton, Bertrand Dupont, Marc Lecuit, Faezeh Legrand, Pierre-Simon Rohrlich, Michel Huerre, Service d'hématologie et immunologie pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Service d'hématologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Microorganismes et Barrières de l'Hôte (Equipe avenir), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Histotechnologie et Pathologie, Institut Pasteur [Paris] (IP), Service d'hémato-onco-pédiatrie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) (RIGHT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Mycologie moléculaire, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Institut Pasteur [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Université de Franche-Comté (UFC), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Saas, Philippe, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 ( UPD7 ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -hopital Jean Minjoz, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Equipe avenir Microorganismes et Barrières de l'Hôte, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098) ( HOTE GREFFON ), Université de Franche-Comté ( UFC ) -Etablissement français du sang [Bourgogne-France-Comté] ( EFS [Bourgogne-France-Comté] ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS )
- Subjects
Male ,Abdominal pain ,MESH : Retrospective Studies ,MESH: Spleen ,medicine.medical_treatment ,MESH : Aged ,MESH : Immune Reconstitution Inflammatory Syndrome ,MESH: Length of Stay ,MESH : Child ,Adrenal Cortex Hormones ,MESH: Child ,[ SDV.IMM ] Life Sciences [q-bio]/Immunology ,Medicine ,Child ,0303 health sciences ,MESH: Middle Aged ,Candidiasis ,MESH : Chemotherapy, Adjuvant ,3. Good health ,MESH : Length of Stay ,C-Reactive Protein ,Child, Preschool ,MESH : Fever ,Microbiology (medical) ,medicine.medical_specialty ,[SDV.IMM] Life Sciences [q-bio]/Immunology ,MESH : Abdominal Pain ,Liver Abscess ,MESH : Adrenal Cortex Hormones ,MESH: Adrenal Cortex Hormones ,03 medical and health sciences ,MESH : Adolescent ,MESH: Fever ,Humans ,MESH : Middle Aged ,Mycosis ,Aged ,Retrospective Studies ,MESH: Adolescent ,MESH: Humans ,030306 microbiology ,MESH : Humans ,MESH : Leukemia ,MESH : Liver Abscess ,MESH: Child, Preschool ,MESH: Retrospective Studies ,MESH: Adult ,Length of Stay ,medicine.disease ,MESH: Antifungal Agents ,MESH: Abdominal Pain ,MESH: Fibrinogen ,MESH: Female ,Antifungal Agents ,Time Factors ,MESH : Fibrinogen ,MESH : Child, Preschool ,MESH : Candidiasis ,Prednisone ,Immune Reconstitution Inflammatory Syndrome ,MESH : Female ,MESH: Aged ,Acute leukemia ,Leukemia ,MESH : Adult ,Middle Aged ,MESH: Candidiasis ,Infectious Diseases ,Chemotherapy, Adjuvant ,MESH: Chemotherapy, Adjuvant ,MESH: Immune Reconstitution Inflammatory Syndrome ,Corticosteroid ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Female ,medicine.symptom ,MESH : Time Factors ,medicine.drug ,MESH : Spleen ,Adult ,Adolescent ,Fever ,medicine.drug_class ,MESH : Male ,MESH : Antifungal Agents ,MESH: Liver Abscess ,Immune reconstitution inflammatory syndrome ,Internal medicine ,MESH: Leukemia ,MESH: C-Reactive Protein ,030304 developmental biology ,Chemotherapy ,business.industry ,MESH: Time Factors ,Fibrinogen ,Retrospective cohort study ,MESH : C-Reactive Protein ,MESH: Male ,Surgery ,Abdominal Pain ,business ,Spleen - Abstract
International audience; BACKGROUND: Chronic disseminated candidiasis (CDC) is typically observed during neutrophil recovery in patients with acute leukemia and requires protracted antifungal therapy. OBJECTIVE: Our objective was to document the efficacy and tolerance of corticosteroid therapy (CST) in patients with symptomatic CDC, including those who experienced fever and abdominal pain despite ongoing antifungal therapy. METHODS: We performed a retrospective, multicenter study involving 10 pediatric and adult patients who experienced ongoing symptomatic CDC despite receipt of appropriate antifungal therapy for whom adjuvant oral CST was initiated. RESULTS: All cases of CDC were proven or probable, as determined on the basis of the European Organization for Research and Treatment of Cancer-Mycosis Study Group definition criteria, and occurred in patients with leukemia. CDC-attributable clinical symptoms resolved with CST, which was started a mean of 33.8 days after antifungal therapy had been initiated. Fever and abdominal pain disappeared a median of 4-5 days, and serum fibrinogen and C-reactive protein levels returned to normal values within 14-30 days. The median duration of hospitalization after CST initiation was 8.8 days. Hepatosplenic microabscesses decreased or disappeared within a mean period of 107 days (range, 30-210 days). No relapses of CDC were observed during a median duration of follow-up of 6.5 years (range, 4-9 years). CONCLUSIONS: In children and adults who experience persistently symptomatic CDC despite ongoing receipt of antifungal therapy, CST involving a prednisone equivalent at a dosage of > or =0.5 mg/kg per day for at least 3 weeks is associated with a prompt resolution of symptoms and of inflammatory response. These findings support the pathophysiological hypothesis that CDC belongs to the spectrum of fungus-related immune reconstitution inflammatory syndrome.
- Published
- 2008