Department of Pediatric Nephrology, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey.
Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behc¸et Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, Turkey.
J Pediatr Urol. 2021 Oct;17(5):738.e1-738.e5. doi: 10.1016/j.jpurol.2021.07.022. Epub 2021 Jul 27.
Imaging of the urinary tract by ultrasonography (USG) or computerized tomography scanning is recommended for detecting structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, or fungus ball formation. Limited studies on the epidemiology and the imaging results of candiduria were present in the children.
This study aimed to evaluate the results of renal ultrasonography imaging in hospitalized pediatric patients with candiduria.
In this descriptive study, we reviewed our ultrasonography findings with hospitalized children and infants who with candiduria. The study included the period between January 2012 and December 2019. Demographic data, the previous medical history, the clinical features of the patients, ultrasonographic findings of the urinary tract system, presence of an indwelling urinary catheter, type of urinary samplings, type of candida species were retrospectively recorded. The study was approved by Institutional Review Board with the registration number 2019/366.
During the study period, 220 children with nosocomial candiduria were evaluated. The most common isolated candida species was Candida albicans (68.2%) and followed by C. tropicalis (9.1%). Among all patients, 2 (0.9%) had renal fungal balls associated with C. Albicans. Twenty-five patients (11.4%) had findings including internal echogenicity in the bladder (n = 12), uroepithelial thickening of the kidney (n = 10), and sediments in the renal pelvis (n = 3).
Candida albicans was the most prominent candida isolated from the patients. The fungal ball is an uncommon infection especially in children and predominantly caused by Candida species. Fungal ball in the kidney was reported as case reports especially in neonates, in immunosupressed patients, and in patients who had undergone surgical procedures. In our study, none of the patients with the fungal ball were in the neonatal period, however, the patients with fungus ball had underlying disease or condition. Our study has several limitations including a retrospective study, and the USG were not performed by a single radiologist. Besides these limitations, our findings are important to give information about the place of USG for diagnosis of the renal fungal ball in children adding valuable information to a topic in which data came from mainly case reports.
Despite the low incidence of fungal balls reported, considering the high consequences of missing a fungal ball and elimination of it, a non-invasive method such as the renal bladder USG is still necessary for detection of fungal ball especially. More prospective studies are required for high risk groups to establish the diagnostic value of renal USG.
超声检查（USG）或计算机断层扫描成像用于检测结构异常、肾积水、脓肿、气肿性肾盂肾炎或真菌球形成，推荐用于检查泌尿道。目前，有关儿童尿念珠菌病的流行病学和影像学结果的研究有限。
本研究旨在评估住院患儿尿念珠菌病的肾脏超声成像结果。
在这项描述性研究中，我们回顾了 2012 年 1 月至 2019 年 12 月期间因尿念珠菌病住院的儿童和婴儿的超声检查结果。记录了人口统计学数据、既往病史、患者的临床特征、尿路系统的超声检查结果、留置导尿管的存在、尿液样本类型、念珠菌种类等。本研究得到了机构审查委员会的批准，注册号为 2019/366。
在研究期间，评估了 220 例医院获得性尿念珠菌病患儿。最常见的分离念珠菌为白色念珠菌（68.2%），其次为热带念珠菌（9.1%）。所有患者中，有 2 例（0.9%）存在与白色念珠菌相关的肾脏真菌球。25 例（11.4%）患者的膀胱内回声增强（n=12）、肾脏尿路上皮增厚（n=10）和肾盂沉积物（n=3）等发现。
白色念珠菌是从患者中分离出的最主要的念珠菌。真菌球是一种不常见的感染，尤其是在儿童中，主要由念珠菌引起。肾脏真菌球在新生儿中很少见，在免疫抑制患者和接受过手术的患者中更为常见。在我们的研究中，真菌球患者均不在新生儿期，但均有基础疾病或状况。本研究有几个局限性，包括回顾性研究和 USG 并非由同一位放射科医生进行。除了这些局限性，我们的发现对于提供关于 USG 诊断儿童肾脏真菌球的信息很重要，为这一主要基于病例报告的主题提供了有价值的信息。
尽管报告的真菌球发病率较低，但考虑到漏诊真菌球的后果严重，对于检测真菌球，仍需要一种非侵入性的方法，如肾脏膀胱 USG。需要对高危人群进行更多的前瞻性研究，以确定肾脏 USG 的诊断价值。
