DEEP CANDIDA INFECTION IN CHILDREN WITH LEUKEMIA - CLINICAL PRESENTATIONS, DIAGNOSIS AND OUTCOME

Objectives: To analyse the clinical features associated with deep Cand ida infection (DCI) and the outcome in children with leukaemia, and to evaluate. various diagnostic methods. Materials and methods: Serum sa mples were analysed to determine Candida IgA, IgM and IgG antibodies a nd detect free C, albicans glucoprotein antigen and C. enolase antigen in eight children who had nine episodes of DCI and six with suspected DCI. Results: DCI occurred shortly after the leukaemia diagnosis (med ian 40 days) or after the leukaemia relapse (median 30 days). Children with DCI had fever (100%), skin lesions/exanthema (45%), oral thrush (45%), oesophagitis (22%) and laryngo-tracheitis (22%). Candida endoca rditis, arthritis and hepatic candidosis were diagnosed in one patient each. Two children with disseminated candidosis died in leukaemia rel apse. in patients with C. albicans infections serology had a sensitivi ty of 83%. However, in patients with C. parapsilosis infection antibod y detection was negative. As the patients were cured of their Candida infection, the IgG antibodies disappeared and the IgM and IgA antibodi es fell within the normal range for age. Conclusion: DCI in children o ccurs shortly after the leukaemia diagnosis or shortly after relapse o f leukaemia. The clinical features are many. Candida serology may help to diagnose or confirm DCI. The dynamics of antibody titres may help to establish the efficacy of antifungal treatment.