OBJECTIVES: To investigate the clinical characteristics and prognosis of chronic disseminated candidiasis (CDC) in children with acute leukemia (AL) following chemotherapy. METHODS: A retrospective analysis was conducted on children diagnosed with CDC (including confirmed, clinically diagnosed, and suspected cases) after AL chemotherapy from January 2015 to December 2023 at Fujian Medical University Union Hospital, Zhangzhou Municipal Hospital, and Quanzhou First Hospital Affiliated to Fujian Medical University. Clinical characteristics and prognosis were analyzed. RESULTS: The incidence of CDC in children with AL following chemotherapy was 1.92% (32/1 668). Among the children with acute lymphoblastic leukemia, the incidence of CDC in the high-risk group was significantly higher than in the low-risk group (P=0.002). All patients presented with fever unresponsive to antibiotics during the neutropenic period, with 81% (26/32) involving the liver. C-reactive protein (CRP) levels were significantly elevated (≥50 mg/L) in 97% (31/32) of the patients. The efficacy of combined therapy with liposomal amphotericin B and caspofungin or posaconazole for CDC was 66% (19/29), higher than with caspofungin (9%, 2/22) or liposomal amphotericin B (18%, 2/11) monotherapy. The overall cure rate was 72% (23/32). The proportion of patients with CRP ≥50 mg/L and/or a positive β-D-glucan test for more than 2 weeks and breakthrough infections during caspofungin treatment was significantly higher in the treatment failure group compared to the successful treatment group (P<0.05). CONCLUSIONS CDC in children with AL after chemotherapy may be associated with prolonged neutropenia due to intensive chemotherapy. Combination antifungal regimens based on liposomal amphotericin B have a higher cure rate, while persistently high CRP levels and positive β-D-glucan tests may indicate poor prognosis.
Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Antifungal Agents/therapeutic use* ; Candidiasis/diagnosis* ; Chronic Disease ; Leukemia/complications* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications* ; Prognosis ; Retrospective Studies

Intra-abdominal candidiasis (IAC) is the most common invasive candidiasis, with a high incidence among critically ill patients, which can significantly increase medical costs and affect prognosis. In order to standardize the diagnosis and treatment of IAC in critically ill patients, experts in related fields were organized by the Peking University Critical Care Medicine (PKUCCM), Committee of Critical Care Medicine and Organ Support, China Association for Promotion of Health Science and Technology organized experts in related fields to initiate and form a working group. Expert writers drafted the consensus based on evidence-based medical evidence. A committee composed of critical care physicians, infectious disease physicians, surgeons, dermatologists specializing in antifungal fields, and clinical pharmacists discussed and revised the consensus draft through a standardized process, and finally formulated this consensus. This consensus contains a total of 20 core recommendations, mainly focusing on the epidemiology, high-risk factors, diagnostic techniques and methods (including traditional microbiological culture techniques, clinical risk prediction tools, serological tests, molecular biological tests, and histopathological examinations) of IAC, diagnostic criteria, stratified treatment strategies, antifungal drug selection, control the sources of infection, combined treatment, de-escalation strategies, drug treatment courses, prognosis, and special types of IAC. The aim is to provide expert guidance for the standardized clinical diagnosis and treatment of IAC in critically ill patients, with a view to improving prognosis of patients.
Humans ; Critical Illness ; Intraabdominal Infections/therapy* ; Antifungal Agents/therapeutic use* ; Consensus ; Candidiasis/drug therapy* ; Critical Care ; Candidiasis, Invasive/diagnosis*

Candida vertebral osteomyelitis (CVO) is a rare disease that is a complication of intravenous drug use, but recently it has been recognized as mostly an opportunistic infection. Because CVO appears to mimic pyogenic spondylodiscitis in terms of the clinical and radiologic presentations, it is often neglected in a usual clinical setting. The clinical, radiological, and biological characteristics of CVO are often used to make a differential diagnosis with vertebral osteomyelitis from other etiologies. Once an initial proper diagnosis was performed, the treatment relies on the prompt initiation of appropriate pharmacotherapy and serial monitoring of the clinical progress. This paper report late-onset CVO in two young patients who underwent a heart transplant surgery and had postoperative systemic candidiasis. These two cases are a good reminder of the potential of CVO in immunosuppressive patients treated with anti-fungal agents. This paper presents these two cases with a review of the relevant literature.
Candida ; Candidiasis ; Diagnosis ; Diagnosis, Differential ; Discitis ; Drug Therapy ; Heart Transplantation ; Heart ; Humans ; Opportunistic Infections ; Osteomyelitis ; Population Characteristics ; Rare Diseases

Chronic mucocutaneous candidiasis (CMC) is characterized by increased susceptibility to chronic and recurrent infections of the skin, mucous membranes, and nails by Candida species. It is a primary immunodeficiency disorder that is difficult to diagnose because of its heterogeneous clinical manifestations and genetic background. A 20-month-old boy who did not grow in height for 3 months was diagnosed as having hypothyroidism and he had hepatitis which was found at 5 years old. He presented with persistent oral thrush and vesicles on the body, the cause of which could not be identified from laboratory findings. No microorganism was detected in the throat culture; however, the oral thrush persisted. Immunological tests showed that immunoglobulin (Ig) subclass IgG and cluster of differentiation (CD)3, CD4, and CD8 levels were within normal limits. We prescribed oral levothyroxine and fluconazole mouth rinse. The patient was examined using diagnostic exome sequencing at the age of 6 years, and a c.1162A>G (p.K388E) STAT1 gene mutation was identified. A diagnosis of CMC based on the STAT1 gene mutation was, thus, made. At the age of 8 years, the boy developed a malar-like rash on his face. We conducted tests for detection of antinuclear antibodies and anti-dsDNA antibodies, which showed positive results; therefore, systemic lupus erythematosus (SLE) was also suspected. Whole exome sequencing is important to diagnose rare diseases in children. A STAT1 gene mutation should be suspected in patients with chronic fungal infections with a thyroid disease and/or SLE.
Antibodies ; Antibodies, Antinuclear ; Candida ; Candidiasis ; Candidiasis, Chronic Mucocutaneous* ; Candidiasis, Oral ; Child ; Diagnosis ; Exanthema ; Exome ; Fluconazole ; Genetic Background ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Hypothyroidism* ; Immunoglobulin G ; Immunoglobulins ; Immunologic Tests ; Infant ; Lupus Erythematosus, Systemic* ; Male ; Mouth ; Mucous Membrane ; Pharynx ; Rare Diseases ; Skin ; Thyroid Diseases ; Thyroxine

Candidiasis ; diagnosis ; Cervical Vertebrae ; surgery ; Esophageal Diseases ; diagnosis ; microbiology ; Esophagus ; microbiology ; Humans ; Postoperative Complications ; microbiology ; Spinal Fusion ; adverse effects

Balanitis ; diagnosis ; Candida ; Candidiasis ; diagnosis ; Diagnosis, Differential ; Humans ; Hyperplasia ; Male ; Vascular Neoplasms ; diagnosis

We describe a case of non-tuberculous mycobacterial infection of the larynx in a previously well, immunocompetent young woman. Laryngeal mycobacterial infection is rare and currently accounts for less than 1% of all cases. A diagnostic dilemma often occurs because it may mimic laryngeal carcinoma, chronic laryngitis, or laryngeal candidiasis. This case highlights the importance of considering non-tuberculous mycobacterial infection in the differential diagnosis of laryngeal lesions.
Candidiasis ; Diagnosis, Differential ; Female ; Humans ; Hypopharynx* ; Laryngitis ; Larynx ; Nontuberculous Mycobacteria ; Pharynx ; Ulcer*

OBJECTIVES: Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana. MATERIALS AND METHODS: A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance. RESULTS: Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions. CONCLUSION: From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.
Acquired Immunodeficiency Syndrome ; Candidiasis, Oral ; CD4 Lymphocyte Count* ; Cell Count ; Classification ; Cross-Sectional Studies ; Diagnosis ; European Union ; Female ; Ghana* ; Gingivitis ; HIV ; Hospitals, Teaching ; Humans ; Hyperpigmentation ; Immune System ; Immunosuppression ; Leukoplakia, Hairy ; Male ; Medical Records ; Opportunistic Infections ; Oral Manifestations* ; Periodontitis ; Prospective Studies ; Statistics as Topic ; Xerostomia

Candida exists in the oral cavity as normal flora, which is cultured in 7% of the population. And the development of candidiasis is usually related to the systemic or local immunosuppressed status such as diabetes, long-term antibiotics, steroid, radiation therapy or chemotherapy. However, isolated laryngeal candidiasis in immunocompetent patients is a rare entity with fewer than 40 cases reported in the world. Symptoms of laryngeal candidiasis are variable such as hoarseness, dysphagia, or odynophagia according to its extent, but it has clinical importance because of its resemblance with laryngeal premalignant or malignant lesions. Diagnosis is made by biopsy under direct laryngoscopy with special staining to identify the hyphae. In this article, we report a case of laryngeal candidiasis presented as leukoplakia localized on vocal fold with literature reviews.
Anti-Bacterial Agents ; Biopsy ; Candida ; Candidiasis* ; Deglutition Disorders ; Diagnosis ; Drug Therapy ; Hoarseness ; Humans ; Hyphae ; Laryngoscopy ; Larynx ; Leukoplakia* ; Mouth ; Vocal Cords

Candidiasis is a common fungal infection that usually affects the oral cavity. It is occasionally difficult to diagnose candidiasis because of its various clinical manifestations. Moreover, chronic inflammation of the lips can obscure clarification of its disease entity in patients with chronic cheilitis. Here we aimed to investigate patients with refractory chronic cheilitis who were initially diagnosed with candidiasis. We screened patients with lip lesions that were clinically suspected to have candidiasis. Our two 65-year-old patients with refractory chronic cheilitis were initially diagnosed with candidal infection. Punch biopsies were performed of the lesions and a diagnosis of actinic cheilitis was made in both patients. Since we did not note prominent improvement after conservative treatment and cryotherapy, we applied 0.015% ingenol mebutate gel for further treatment and then observed significant improvement.
Actins* ; Aged ; Biopsy ; Candidiasis ; Cheilitis* ; Cryotherapy ; Diagnosis ; Humans ; Inflammation ; Lip ; Mouth