Flynn P M, Shenep J L, Crawford R, Hughes W T
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Clin Infect Dis. 1995 Apr;20(4):964-70. doi: 10.1093/clinids/20.4.964.
Disseminated fungal infection (DFI) is an important cause of morbidity and mortality among immunosuppressed patients with cancer. To determine the role of abdominal computed tomography (CT) in the diagnosis and management of DFI, we studied the records of patients treated in a pediatric oncology center over an 11-year period. A total of 35 children had CT findings compatible with fungal abscesses in the liver, spleen, and/or kidneys and had fungal infection confirmed by culture, biopsy, or at autopsy. Patients were treated with antifungal agents (median duration of treatment, 57 days) until fever resolved and repeated CT scans demonstrated that the lesions had disappeared, regressed, or stabilized. The 3-month survival rate was 86%. An additional 29 patients with similar characteristics and risk factors had characteristic CT findings, but DFI was not documented with other procedures. These patients were empirically treated for presumed DFI; their courses and outcomes were similar to those for patients with documented DFI. These results suggest that it is reasonable to make a presumptive diagnosis of DFI for patients with characteristic CT findings and clinical features. With appropriate therapy, the prognosis for pediatric patients with cancer and documented or presumed DFI is good.
播散性真菌感染（DFI）是免疫抑制的癌症患者发病和死亡的重要原因。为了确定腹部计算机断层扫描（CT）在DFI诊断和管理中的作用，我们研究了一家儿科肿瘤中心11年间治疗的患者记录。共有35名儿童的CT检查结果显示肝脏、脾脏和/或肾脏有符合真菌性脓肿的表现，且通过培养、活检或尸检确诊为真菌感染。患者接受抗真菌药物治疗（中位治疗持续时间为57天），直到发热消退，重复CT扫描显示病变消失、缩小或稳定。3个月生存率为86%。另外29名具有相似特征和风险因素的患者有典型的CT表现，但其他检查未记录DFI。这些患者因疑似DFI接受经验性治疗；他们的病程和结局与确诊DFI的患者相似。这些结果表明，对于具有典型CT表现和临床特征的患者，做出DFI的推定诊断是合理的。经过适当治疗，患有癌症且确诊或疑似DFI的儿科患者预后良好。
