Boussen Inès, Lisan Quentin, Raffoux Emmanuel, Di Blasi Roberta, Boissel Nicolas, Oksenhendler Eric, Adès Lionel, Xhaard Aliénor, Bretagne Stéphane, Alanio Alexandre, Molina Jean-Michel, Denis Blandine
Department of Infectious Diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France.
Université de Paris, Paris, France.
Open Forum Infect Dis. 2022 Mar 7;9(4):ofac088. doi: 10.1093/ofid/ofac088. eCollection 2022 Apr.
Hepatosplenic candidiasis (HSC) used to be reported in patients with acute myeloid leukemia (AML) without antifungal prophylaxis. The aim was to describe the clinical features and outcomes of HSC over the last 13 years in a single French hematology center.
All patients diagnosed with HSC between 2008 and 2020 were included in a single-center retrospective cohort study. Data were collected from patient charts, and HSC was classified according to the 2020 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definitions.
Sixty patients were included, with 18.3% proven, 3.3% probable, and 78.3% possible HSC according to the 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group classification. Among them, 19 patients were treated for acute myeloid leukemia (AML), 21 for lymphomas, and 14 for acute lymphoblastic leukemia. HSC occurred in 13 patients after autologous stem cell transplantation for lymphoma. At HSC diagnosis, 13 patients were receiving antifungal prophylaxis. colonization was present in 84.2%, with prior candidemia in 36.7% of cases. β-D-glucans was positive in 55.8%, and 45.8% of tissue biopsies were contributive. First-line antifungal therapy was azoles in 61.7%, and steroids were associated in 45% of cases. At 3 months of follow-up, partial response to antifungal therapy was 94.2%. At last follow-up (mean, 22.6 months), 41 patients (68.3%) presented a complete hematological remission and 22 patients were deceased, none because of HSC.
The epidemiology of HSC has changed in the last decade, with fewer cases occurring in the AML setting. A better identification of patients at risk could lead to specific prophylaxis and improved diagnosis.
肝脾念珠菌病（HSC）过去常在未接受抗真菌预防治疗的急性髓系白血病（AML）患者中报道。目的是描述过去13年在法国一家血液学中心HSC的临床特征和结局。
将2008年至2020年间所有诊断为HSC的患者纳入一项单中心回顾性队列研究。从患者病历中收集数据，HSC根据2020年欧洲癌症研究与治疗组织/真菌病研究组的定义进行分类。
根据2020年欧洲癌症研究与治疗组织真菌病研究组的分类，纳入60例患者，其中确诊的占18.3%，很可能的占3.3%，可能的占78.3%。其中，19例患者接受急性髓系白血病（AML）治疗，21例接受淋巴瘤治疗，14例接受急性淋巴细胞白血病治疗。13例患者在淋巴瘤自体干细胞移植后发生HSC。在HSC诊断时，13例患者正在接受抗真菌预防治疗。84.2%存在定植，36.7%的病例既往有念珠菌血症。β-D-葡聚糖阳性率为55.8%，45.8%的组织活检有诊断价值。一线抗真菌治疗中61.7%使用唑类药物，45%的病例联合使用类固醇。在随访3个月时，抗真菌治疗的部分缓解率为94.2%。在最后一次随访（平均22.6个月）时，41例患者（68.3%）出现完全血液学缓解，22例患者死亡，均非死于HSC。
在过去十年中，HSC的流行病学发生了变化，AML患者中的病例数减少。更好地识别高危患者可能会带来特异性预防措施并改善诊断。
