Hepatosplenic candidiasis - A manifestation of chronic disseminated candidiasis

Hepatosplenic candidiasis, also chronic disseminated candidiasis, is differ entiated from acute disseminated candidiasis based on clinical presentation , risk factors, and natural history. The disease occurs almost exclusively in patients with leukemia and is characterized by fever after recovery from prolonged neutropenia, abdominal complaints, and abnormalities in liver fu nction. Although Candida albicans is the most common pathogen, non-albican Candida species and opportunistic fungi have been identified as causative a gents. Imaging techniques are valuable for diagnosis and management; althou gh diagnosis is difficult. Liver biopsy and culture may be the only method to establish diagnosis; however, the organism may not be cultured from live r tissue in 50% of patients. Antifungal therapy is complicated by the inter current immunosuppression related to chemotherapy and should be prolonged a nd tailored to the patient's individual response. Newer azoles and the lipi d formulations of amphotericin B are promising therapies and appear to be m ore efficacious than amphotericin B desoxycholate. The disease has been vir tually eliminated in institutions where fluconazole has been used prophylac tically in susceptible patients. Increased understanding of the pathophysio logy of this infection is needed to improve methods for diagnosis and manag ement.