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Mun YS, Lee MS, Park JS, Lee JW, Jung SY, Yoon HJ, Han HY. An unusual case of candidemia presenting as acute respiratory distress syndrome after a small bowel bezoar removal operation. Ann Surg Treat Res 2014; 88:48-51. [PMID: 25553325 PMCID: PMC4279988 DOI: 10.4174/astr.2015.88.1.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022] Open
Abstract
We report a rare case of sepsis with acute respiratory distress syndrome (ARDS) caused by Candida parapsilosis and Candida famata after a small bowel bezoar operation. The patient was successfully treated with intensive care including mechanical ventilation and systemic antifungal therapy. A strong association was observed between the intestinal obstruction caused by the bezoar and candidemia presenting as ARDS. This is the first case in which candidemia has led to ARDS after a bezoar removal operation in a patient who was neither immunocompromised nor self-administering an illicit intravenous drug.
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Affiliation(s)
- Yun Su Mun
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joo Seung Park
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun Wan Lee
- Emergency ICU, Chungnam National University Hospital, Daejeon, Korea
| | - Sun-Young Jung
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hee Jung Yoon
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hyun-Young Han
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
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Bianchi D, Vespasiani G, Bove P. Acute kidney injury due to bilateral ureteral obstruction in children. World J Nephrol 2014; 3:182-192. [PMID: 25374811 PMCID: PMC4220350 DOI: 10.5527/wjn.v3.i4.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/28/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.
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Ben Ameur S, Hentati Y, Ben Dhaoui M, Weli M, Kamoun T, Mnif Z, Mhiri R, Hachicha M. [Neonatal renal candidiasis: a case report]. Arch Pediatr 2014; 21:287-90. [PMID: 24457108 DOI: 10.1016/j.arcped.2013.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/02/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Neonatal renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. CASE REPORT a female infant was born by cesarian section at 30 weeks' gestation to a mother whose pregnancy had been complicated by rupture of membranes for 5 days. The infant was admitted at birth, maternofetal bacterial infection was suspected, and intravenous antibiotics were prescribed. The patient developed sepsis caused by Klebsiella pneumoniae at the age of 13 days. She was referred to our hospital at the age of 50 days because of renal abscess. At admission, the baby presented with hypothermia and abdominal distention. Renal ultrasonography findings were compatible with fungal disease. Blood, urine, and cerebrospinal fluid cultures were negative for fungi; however, galactomannan antigen blood levels were increased. Amphotericin B was administered for 6 weeks. End-organ evaluation of the heart, brain, and eyes did not demonstrate disseminated infection. The patient was discharged with a prescription for oral fluconazole and remained well at follow-up.
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Affiliation(s)
- S Ben Ameur
- Service de pédiatrie générale, CHU Hédi Chaker, route El Ain Km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, Sfax, Tunisie.
| | - Y Hentati
- Faculté de médecine de Sfax, Sfax, Tunisie; Service d'imagerie médicale, CHU Hédi Chaker, Sfax, Tunisie
| | - M Ben Dhaoui
- Faculté de médecine de Sfax, Sfax, Tunisie; Service de chirurgie pédiatrie, CHU Hédi Chaker, Sfax, Tunisie
| | - M Weli
- Service de pédiatrie générale, CHU Hédi Chaker, route El Ain Km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, Sfax, Tunisie
| | - T Kamoun
- Service de pédiatrie générale, CHU Hédi Chaker, route El Ain Km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, Sfax, Tunisie
| | - Z Mnif
- Faculté de médecine de Sfax, Sfax, Tunisie; Service d'imagerie médicale, CHU Hédi Chaker, Sfax, Tunisie
| | - R Mhiri
- Faculté de médecine de Sfax, Sfax, Tunisie; Service de chirurgie pédiatrie, CHU Hédi Chaker, Sfax, Tunisie
| | - M Hachicha
- Service de pédiatrie générale, CHU Hédi Chaker, route El Ain Km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, Sfax, Tunisie
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Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infections--treatment. Clin Infect Dis 2012; 52 Suppl 6:S457-66. [PMID: 21498839 DOI: 10.1093/cid/cir112] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In many instances a report from the clinical laboratory indicating candiduria represents colonization or procurement contamination of the specimen and not invasive candidiasis. Even if infection of the urinary tract by Candida species can be confirmed, antifungal therapy is not always warranted. Further investigation may reveal predisposing factors, which if corrected or treated, result in the resolution of the infection. For those with symptomatic urinary tract infections (UTIs), the choice of antifungal agent will depend upon the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent. Because of its safety, achievement of high concentrations in the urine, and availability in both an oral and intravenous formulation, fluconazole is preferred for the treatment of Candida UTIs. Flucytosine is concentrated in urine and has broad activity against Candida spp, but its use requires caution because of toxicity. Low-dose amphotericin B may be useful for Candida UTIs in selected patients. The role of echinocandins and azoles that do not achieve measurable concentrations in the urine is not clear. Small case series note some success, but failures have also occurred. Irrigation of the bladder with antifungal agents has limited utility. However, with fungus balls, irrigation of the renal pelvis through a nephrostomy tube can be useful in combination with systemic antifungal agents.
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Affiliation(s)
- John F Fisher
- Section of Infectious Diseases, Medical College of Georgia, Augusta, Georgia, USA.
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Bisht V, Voort JV. Clinical practice: Obstructive renal candidiasis in infancy. Eur J Pediatr 2011; 170:1227-35. [PMID: 21695474 DOI: 10.1007/s00431-011-1514-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/07/2011] [Indexed: 11/24/2022]
Abstract
Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.
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Affiliation(s)
- Veena Bisht
- Department of Paediatric Nephrology, University Hospital of Wales, Cardiff CF14 4XW, UK.
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Fredj N, Touffahi M, Saidi R, Lefi M, Achour A, Gahbiche M, Hafsa C, Zakhama A, Saad H. Anurie obstructive par “fungus balls”: A propos de 3 cas. AFRICAN JOURNAL OF UROLOGY 2008. [DOI: 10.1007/bf02994514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Renal candidial infections have been described in the literature in susceptible populations of all age groups. Systemic antifungal agents have been successful in treating these patients, but in the presence of an obstructed kidney, antegrade (perurethral) or retrograde (percutaneous) drainage of the pelvicaliceal system is mandatory to salvage the kidney. An aggressive percutaneous endoscopic approach for the management of such a case in a young diabetic patient with multiple comorbidities is described here with initial success.
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Affiliation(s)
- Sudhanshu V Chitale
- Department of Urology, Norfolk & Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, U.K.
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Muro D, Sangüesa C, Torres D, Berbel O, Andrés V. Ecografía en el diagnóstico de la candidiasis renal neonatal. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77847-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kabaalioğlu A, Bahat E, Boneval C. Renal candidiasis in a 2-month-old infant: treatment of fungus balls with streptokinase. AJR Am J Roentgenol 2001; 176:511-2. [PMID: 11227094 DOI: 10.2214/ajr.176.2.1760511] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Kabaalioğlu
- Department of Radiology, Akdeniz University Medical Faculty, Arapsuyu, Antalya, Turkey
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Abstract
BACKGROUND A persistently positive culture >24 h after starting antibiotic therapy has been correlated with adverse outcome in several invasive bacterial infections, but few reports address persistent positivity and outcome in infections caused by fungi and other pathogens that replicate more slowly and therefore may succumb less quickly to therapy. METHODS To assess whether positive culture >24 h after achieving target doses (amphotericin > or =0.5 mg/kg/day or fluconazole > or =6 mg/kg/day) of systemic antifungal therapy predicts focal infectious complication(s) or death from infection, we compared neonatal intensive care unit infants who had persistent (P+) or nonpersistent (P-) positive cultures with invasive candidiasis (clinical signs of infection and recovery of Candida from a normally sterile site) at this center from January 1, 1981, through June 30, 1999. Infants who died < or = 24 h after attaining target dosing, recovered without therapy, had a focal infectious complication already present at the time target dosing was achieved or were diagnosed with invasive candidiasis only postmortem were excluded. RESULTS We identified 58 P+ (29, 12 and 7 had positive cultures for >7, >14 and > or =21 days, respectively) and 38 P- infants. No differences were found between P+ and P- for birth weight; gestational age; gender; onset age; central vascular catheters; necrotizing enterocolitis, surgery or bacterial sepsis; or duration of parenteral nutrition, antibiotics, tracheal intubation or postnatal steroids. P+ were more likely to have blood or cerebrospinal fluid involvement (68 vs. 45%, P = 0.03). Distribution of Candida species was similar (albicans in 53 vs. 63% for P+ vs. P-). P+ were significantly more likely to develop later "fungus ball" uropathy (16 of 56 vs. 2 of 32, P = 0.01), to develop renal infiltration (11 of 56 vs. 1 of 32, P = 0.03) and to die from invasive candidiasis (11 of 58 vs. 0 of 38, P = 0.003) than P-. P+ were also more likely to develop endocarditis, abscess, ventriculitis and invasive dermatitis, although P > 0.05. Focal complication increased as duration of P+ increased (48, 55, 67 and 71% at >1, >7, >14 and > or =21 days, P = 0.06). When comparing only those with positive blood and/or cerebrospinal fluid culture, similar patterns were observed, although only death and focal complication or death from invasive candidiasis attained significance. CONCLUSIONS These observations suggest that in neonatal invasive candidiasis: (1) cultures usually remain positive >24 h after attaining target antifungal doses; (2) aggressive imaging for focal complications may be reserved for infants with persistently positive cultures after several days of antifungal therapy at target doses or have signs strongly suggestive of focal complication; (3) focal complications and/or death from candidiasis increase with persistence; (4) focal complications increase with duration of persistence; (5) serial culture of infected site(s) helps predict outcome and the need for aggressive surveillance and intervention for focal complications.
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Affiliation(s)
- R L Chapman
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor 48109-0254, USA
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Abstract
BACKGROUND Candida species commonly cause urinary tract infection in infants admitted to neonatal intensive care units. The purpose of this study was to describe the natural history of renal candidiasis as evidenced by sonography in infants with candiduria. METHODS The medical records of all infants who developed candiduria during their neonatal intensive care hospitalization between 1982 and 1993 were reviewed. Candiduria was defined as the isolation of Candida from (1) one or more specimens obtained by bladder catheterization or suprapubic aspiration, (2) one or more voided specimens and concurrent positive cultures from another sterile body site or (3) one or more voided specimens and changes on renal ultrasound consistent with renal candidiasis. Renal ultrasounds were retrospectively reviewed by one pediatric radiologist. Nonshadowing echogenic foci were considered evidence of renal fungus balls. RESULTS Forty-one infants with candiduria were identified. Thirty-six infants underwent 1 or more renal imaging studies (ultrasonography, 35; computerized tomography, 1). The incidence of renal candidiasis in neonates with candiduria, defined as renal fungus balls or renal fungal abscess, was 42%. Of the 13 patients who had sonographic abnormalities suggestive of renal fungus balls, 7 had abnormalities on the first ultrasound obtained after the discovery of candiduria, whereas 6 patients developed abnormalities between 8 and 39 days later. CONCLUSIONS Serial renal ultrasounds are required to reliably detect late appearing renal fungus balls in neonates with candiduria. Complications requiring surgical intervention, like urinary tract obstruction, were uncommon.
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Affiliation(s)
- K Bryant
- Department of Pediatrics, University of Louisville School of Medicine, KY, USA
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Abstract
After 25 years, there is enough clinical outcome experience to determine appropriate use of home parenteral nutrition in different disease states and age groups. Information regarding how to avoid complications and how patients and families can find necessary psychosocial support is provided in this article. Currently, small bowel transplantation is not a safer choice, unless there is severe liver disease caused by home parenteral nutrition or lack of central intervenous access.
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Affiliation(s)
- L Howard
- Department of Medicine, Albany Medical College, New York, USA
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Zia-ul-Miraj M, Mirza I. Fluconazole for treatment of fungal infections of the urinary tract in children. Pediatr Surg Int 1997; 12:414-6. [PMID: 9244113 DOI: 10.1007/bf01076953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two children with fungal urinary tract infections (UTI) were treated with fluconazole. One had bilateral megaureters, an almost non-functioning right kidney, and a moderately functioning left kidney because of severe vesicoureteric reflux. He underwent a ureteric reimplantation procedure but developed a fungal UTI postoperatively. The other child had bilateral refluxing megaureters, one of which appeared to open ectopically into the urethra. He acquired a fungal infection during intensive and prolonged antibiotic therapy for a bacterial UTI and septicaemia in the neonatal period. Both fungal infections were cured successfully. We recommend fluconazole as a safe and effective antifungal agent that may be used as a drug of choice for this difficult problem.
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Affiliation(s)
- M Zia-ul-Miraj
- Department of Paediatric Urology, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
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