Anttila V J, Ruutu P, Bondestam S, Jansson S E, Nordling S, Färkkilä M, Sivonen A, Castren M, Ruutu T
Second Department of Medicine, Helsinki University Central Hospital, Finland.
Clin Infect Dis. 1994 Jun;18(6):979-81. doi: 10.1093/clinids/18.6.979.
The occurrence of hepatosplenic candidiasis following prolonged neutropenic periods has emerged as a major problem for patients with leukemia. In order to evaluate the diagnostic value of various available procedures, we analyzed our findings regarding 26 leukemic patients with hepatosplenic candidiasis. A significantly increased level (> 50 mg/L) of serum C-reactive protein (S-CRP) was significantly more common than a daily fever (for which the mean temperature peak was > 37.5 degrees C) or raised levels of liver enzymes (serum alanine transferase, aspartate transferase, or alkaline phosphatase). Focal changes in the liver, spleen, or kidneys were detected in > 90% of the patients examined by computed tomography (CT) but in < 50% of those examined by ultrasonography. Seventeen diagnoses were based on the findings from microscopy of samples obtained invasively, whereas a positive fungal culture was the basis of the diagnosis for only five patients. In conclusion, monitoring the S-CRP level after a patient's recovery from neutropenia is useful in that its elevation is cause for early suspicion of hepatosplenic candidiasis. In detection of the hepatosplenic foci, CT is superior to ultrasonography. For establishing the specific diagnosis, aggressive collection of samples for microscopy is essential.
长期中性粒细胞减少期后发生的肝脾念珠菌病已成为白血病患者的一个主要问题。为了评估各种现有检查方法的诊断价值，我们分析了26例患有肝脾念珠菌病的白血病患者的检查结果。血清C反应蛋白（S-CRP）水平显著升高（>50 mg/L）比每日发热（平均体温峰值>37.5℃）或肝酶水平升高（血清丙氨酸转氨酶、天冬氨酸转氨酶或碱性磷酸酶）更为常见。通过计算机断层扫描（CT）检查的患者中，超过90%在肝脏、脾脏或肾脏发现局灶性改变，但通过超声检查的患者中这一比例不到50%。17例诊断基于侵入性获取样本的显微镜检查结果，而只有5例患者的诊断依据是真菌培养阳性。总之，在患者从中性粒细胞减少症恢复后监测S-CRP水平是有用的，因为其升高是早期怀疑肝脾念珠菌病的原因。在检测肝脾病灶方面，CT优于超声检查。为了做出明确诊断，积极采集样本进行显微镜检查至关重要。
