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Colomba C, Campa L, Siracusa L, Giordano S, Vella MC, Corsello G, Giuffrè M, Cascio A. Candida thrombophlebitis in children: a systematic review of the literature. Ital J Pediatr 2020; 46:145. [PMID: 33023609 PMCID: PMC7539504 DOI: 10.1186/s13052-020-00913-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To describe a case of thrombophlebitis associated with Candida infection and to analyze other published reports to define clinical characteristics, prognostic data, diagnostic and therapeutic strategies. Study design A computerized search was performed without language restriction using PubMed and Scopus databases. An article was considered eligible for inclusion if it reported cases with Candida thrombophlebitis. Our case was also included in the analysis. Results A total of 16 articles reporting 27 cases of Candida thrombophlebitis were included in our review. The median age of patients was 4 years. In 10 cases there was a thrombophlebitis of peripheral veins; in the remaining cases the deep venous circle was interested. Candida albicans was the most frequently involved fungal species. The most recurrent risk factors were central venous catheter (19/28), broad spectrum antibiotics (17/28), intensive care unit (8/28), surgery (3/28), mechanical assisted ventilation (5/28), total parenteral nutrition (8/28), cancer (2/28), premature birth (6/28), cystic fibrosis (2/28). Fever was the most frequent clinical feature. All children with peripheral and deep thrombophlebitis were given antifungal therapy: amphotericin B was the most used, alone or in combination with other antifungal drugs. Heparin was most frequently used as anticoagulant therapy. Illness was fatal in two cases. Conclusion Candida thrombophlebitis is a rare but likely underdiagnosed infectious complication in pediatric critically ill patients. It is closely connected to risk factors such as central venous catheter, hospitalization in intensive care unit, prematurity, assisted ventilation, chronic inflammatory diseases. Antifungal therapy and anticoagulant drugs should be optimized for each patient and surgical resection is considered in the persistence of illness.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Luigi Campa
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Lucia Siracusa
- Pediatric Infectious Diseases Unit, "G. Di Cristina" Hospital, ARNAS Civico, Palermo, Italy
| | - Salvatore Giordano
- Pediatric Infectious Diseases Unit, "G. Di Cristina" Hospital, ARNAS Civico, Palermo, Italy
| | - Maria C Vella
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Giuffrè
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Anil Kumar V, Francis E, Sreehari S, Raj B. Tricuspid valve mycetoma in an infant successfully treated by excision and complex tricuspid valve repair followed by fluconazole therapy. Surg Infect (Larchmt) 2013; 15:134-40. [PMID: 24116856 DOI: 10.1089/sur.2013.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fungal valve endocarditis in children is an uncommon and lethal disease. The risk increases with use of central venous catheters (CVC), total parenteral nutrition (TPN), and use of broad-spectrum antibiotics during the neonatal period. Due to high mortality, a combination of surgery and antifungal therapy is usually recommended for treatment. METHODS Case report and review of the literature. RESULTS We present a case of an asymptomatic infant with multiple Candida tricuspid valve mycetomas. Complete cure was achieved by combined tricuspid valve repair and fluconazole therapy. We also review 26 cases of tricuspid valve Candida endocarditis in children published in the literature. CONCLUSION From being uniformly fatal five decades ago to a current survival rate of 64% to 100%, the prognosis of Candida endocarditis has changed dramatically with the use of antifungal therapy alone or in combination with surgery. Our case re-emphasizes the role of valve-sparing debridement with repair of the native valve using autologous pericardium in combination with long-term antifungal therapy as a feasible option in managing tricuspid valve Candida endocarditis.
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Affiliation(s)
- V Anil Kumar
- 1 Department of Microbiology, Amrita Institute of Medical Sciences , Kerala, India
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Leon LR, Patel J, Labropoulos N, Rodriguez HE. Excision of internal jugular vein for catheter-related thrombophlebitis. Ann Vasc Surg 2005; 20:117-9. [PMID: 16362464 DOI: 10.1007/s10016-005-4651-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report describes a case of internal jugular vein (IJV) thrombophlebitis refractory to intravenous (IV) antibiotics and anticoagulation managed with ligation and excision of the vein. Our patient was immunosuppressed for a transplanted organ and developed a catheter-related infection following major pelvic surgery. His symptoms worsened, and failure of medical management prompted operative intervention. Excision of the inflamed, thrombosed vein led to complete resolution of his symptoms.
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Affiliation(s)
- Luis R Leon
- Vascular Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
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González Santacruz M, Tarazona Fargueta JL, Muñoz Alvarez P, Mira Navarro J, Jiménez Cobo B. Tratamiento con somatostatina en cinco recién nacidos con quilotórax de diferentes etiologías. An Pediatr (Barc) 2005; 63:244-8. [PMID: 16219278 DOI: 10.1157/13078488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The addition of somatostatin to the conventional treatment of neonatal chylothorax has been described in isolated cases. OBJECTIVE To describe the results obtained in a series of five patients with neonatal chylothorax treated with somatostatin. PATIENTS Five neonates (gestational age range: 29-39 weeks) diagnosed with chylothorax of various etiologies were included. Chylothorax was congenital in two neonates, secondary to congenital diaphragmatic hernia repair in two neonates and secondary to thrombosis in the superior vein cava in one neonate. All the neonates were started on conservative therapy and intravenous somatostatin in distinct doses ranging from a bolus of 2 microg/kg/12 h to continuous perfusion at 10 microg/kg/h. RESULTS In all patients the chylous drainage was stopped. No adverse effects were observed. CONCLUSIONS Somatostatin can be a safe and effective option in the treatment of both primary and secondary neonatal chylothorax refractory to conservative treatment.
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Abstract
Fungal endocarditis in the neonate and pediatric population is associated with a high degree of morbidity and mortality, with diagnosis in the majority of cases made postmortem. The aim of this article is to review published literature on fungal endocarditis in children and to discuss the incidence due to a wide range of fungi, primarily Aspergillus and Candida species, as well as its diagnosis, including the importance of molecular-based approaches and various treatment regimes.
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Affiliation(s)
- B C Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD, Northern Ireland, UK
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Steinbach WJ, Perfect JR, Cabell CH, Fowler VG, Corey GR, Li JS, Zaas AK, Benjamin DK. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect 2004; 51:230-47. [PMID: 16230221 DOI: 10.1016/j.jinf.2004.10.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 10/25/2004] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The optimal management of Candida infective endocarditis (IE) is unknown. METHODS We reviewed all 879 cases of Candida IE reported from 1966-2002 in the peer-reviewed literature to better understand the role of medical and surgical therapies. This review included 163 patients from 105 reports that met our inclusion criteria: 31 cases treated with antifungal monotherapy, 25 cases treated with medical antifungal combination therapy, and 107 cases treated with adjunctive surgical plus medical antifungal therapy. We also used meta-analytic techniques to evaluate 22 observational case-series (72 patients) of the 105 reports with two or more patients with definite Candida IE. RESULTS We found that in patients who underwent adjunctive surgery there was a lower reported proportion of deaths [prevalence odds ratio (POR)=0.56; 95% confidence interval (CI)=0.16, 1.99)]. Higher mortality was noted in patients treated prior to 1980 (POR=2.03; 95% CI=0.55, 7.61), treated with antifungal monotherapy (POR=1.49; 95% CI=0.39, 5.81), infected with Candida parapsilosis (POR=1.51; 95% CI=0.41, 5.52), or with left-sided endocarditis (POR=2.36; 95% CI=0.55, 10.07). CONCLUSIONS Medical antifungal therapy of Candida IE is poorly characterized, and recent antifungal developments lend promise for those patients who cannot undergo surgery.
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Affiliation(s)
- William J Steinbach
- Division of Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC 27710, USA.
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Chakrabarti C, Sood SK, Parnell V, Rubin LG. Prolonged candidemia in infants following surgery for congenital heart disease. Infect Control Hosp Epidemiol 2004; 24:753-7. [PMID: 14587937 DOI: 10.1086/502126] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe a group of infants with complex congenital heart disease (CCHD) who had candidemia postoperatively and to perform a case-control study of risk factors. DESIGN Descriptive and case-control study. SETTING Tertiary-care medical centers. PATIENTS Infants with CCHD who underwent cardiac surgery and developed candidemia. Controls were matched for congenital heart disease lesions, age, and postoperative hospital stay. RESULTS Of 95 infants younger than 6 months with CCHD who underwent cardiac surgery between January 1999 and April 2001, 6 (6.3%) developed candidemia with 5 different species. The candidemia was prolonged (range, 12 to 32 days; median, 17 days). The interval between cardiac surgery and onset of candidemia was 12 to 57 days (median, 24 days). All had a central venous catheter inserted 8 to 50 days prior to the onset of candidemia. The mortality rate was 83%, compared with 13% for the group without candidemia. A univariate analysis of the potential risk factors revealed that duration of total parenteral nutrition (TPN), duration of antibiotics, intraoperative cardiopulmonary bypass time, and documentation of an intravascular thrombus were associated with candidemia. In multivariate analysis, long duration of TPN and documentation of a thrombus were associated with candidemia. CONCLUSIONS Candidemia following cardiac surgery for infants with CCHD was persistent and associated with high mortality. The variety of species indicates that this was not a common-source outbreak. Risk factors associated with candidemia were duration of TPN and documentation of an intravascular thrombus.
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Affiliation(s)
- Chandrama Chakrabarti
- Department of Pediatrics Schneider Children's Hospital, New Hyde Park, New York 11040, USA
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Melamed R, Leibovitz E, Abramson O, Levitas A, Zucker N, Gorodisher R. Successful non-surgical treatment of Candida tropicalis endocarditis with liposomal amphotericin-B (AmBisome). SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2000; 32:86-9. [PMID: 10716084 DOI: 10.1080/00365540050164281] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Fungal endocarditis in children is most commonly a complication of palliative or curative surgery for congenital heart disease, rheumatic valvulitis and prolonged indwelling central venous and umbilical catheters. We describe here the case of a 3-y-old patient with chronic diarrhoea and prolonged total parenteral alimentation who developed severe C. tropicalis endocarditis and was treated successfully using a liposomal preparation of amphotericin-B (AmBisome) without surgical intervention.
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Affiliation(s)
- R Melamed
- Pediatric Infectious Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Witt MD, Imhoff T, Li C, Bayer AS. Comparison of fluconazole and amphotericin B for treatment of experimental Candida endocarditis caused by non-C. albicans strains. Antimicrob Agents Chemother 1993; 37:2030-2. [PMID: 8239628 PMCID: PMC188117 DOI: 10.1128/aac.37.9.2030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Amphotericin B and fluconazole were compared for the treatment of experimental Candida endocarditis caused by Candida tropicalis and C. parapsilosis. Rabbits received no therapy, amphotericin B (1 mg/kg of body weight per day intravenously), or fluconazole (100 mg/kg/day intraperitoneally) for either 11 or 21 days. Against both species, amphotericin B and fluconazole were equally effective overall; however, amphotericin B was more rapidly fungicidal than fluconazole in vivo against C. tropicalis.
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Affiliation(s)
- M D Witt
- Division of Adult Infectious Diseases, Harbor-UCLA Medical Center, Torrance 90509
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12
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Nagar H. Mycotic infection and the pediatric surgeon. Mycopathologia 1990; 112:147-55. [PMID: 2089256 DOI: 10.1007/bf00436645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The incidence of major fungal infection in recent years has paralleled increasing use of immunosuppressive drugs, broad spectrum antibiotics and implantable catheters and prostheses. The pediatric surgeon encounters fungi as agents of perioperative infection and anatomic disease requiring surgical intervention. Clinical mycology is increasingly challenged by a wide spectrum of unfamiliar fungi, fungal infections and antimycotic drugs. An overview of the expanding role of surgical mycosis in children is presented.
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Affiliation(s)
- H Nagar
- Department of Pediatric Surgery, Tel-Aviv Medical Center, Israel
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13
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Kovar IZ, Morgan JB. Parenteral nutrition in the preterm infant. Clin Nutr 1990; 9:57-63. [PMID: 16837333 DOI: 10.1016/0261-5614(90)90054-v] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/1988] [Accepted: 03/08/1989] [Indexed: 11/25/2022]
Affiliation(s)
- I Z Kovar
- Departments of Child Health, Charing Cross and Westminster Medical School, London, UK
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14
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Ingram L, Rivera GK, Shapiro DN. Superior vena cava syndrome associated with childhood malignancy: analysis of 24 cases. MEDICAL AND PEDIATRIC ONCOLOGY 1990; 18:476-81. [PMID: 2233519 DOI: 10.1002/mpo.2950180608] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty-four children with superior vena cava obstruction at initial presentation or associated with disease recurrence were treated at St. Jude Children's Research Hospital from 1973 to 1988. Of the 16 patients with superior vena cava syndrome at presentation, eight had non-Hodgkin's lymphoma, four had acute lymphoblastic leukemia, two had Hodgkin's disease, one had neuroblastoma, and one had a yolk sac tumor. Their clinical condition at presentation was often critical and required rapid treatment. In all cases, histopathologic diagnosis was obtained without complication by either bone marrow aspiration, lymph node biopsy, thoracentesis, or thoracotomy prior to the initiation of definitive therapy. Eight children had superior vena cava syndrome as a late complication during the course of their therapy. None had an antecedent history of superior vena cava obstruction. In contrast to the patients with superior vena cava obstruction at presentation, this group was composed predominantly of patients with recurrent solid tumors. Other causes included disseminated candidiasis and superior vena cava thrombosis, thus underscoring the importance of recognizing the etiology of superior vena cava syndrome to facilitate proper treatment.
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Affiliation(s)
- L Ingram
- Department of Hematology-Oncology St. Jude Children's Research Hospital, Memphis, Tennessee 38105
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Lacey SR, Zaritsky AL, Azizkhan RG. Successful treatment of Candida-infected caval thrombosis in critically ill infants by low-dose streptokinase infusion. J Pediatr Surg 1988; 23:1204-9. [PMID: 3236190 DOI: 10.1016/s0022-3468(88)80345-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic central venous catheters are an important component in the management of chronically ill infants and children. Sepsis and thrombosis are common complications of these catheters. When the combination of Candida sepsis and caval thrombosis occurs, the prognosis is very poor. Lysis of the thrombus is critical to effective therapy and allows preservation of vascular access. We report the successful treatment of four critically ill infants with Candida-infected caval thrombosis treated with low-dose infusion of streptokinase combined with standard antimicrobial therapy. All four infants survived, and in all cases thrombolysis was complete and Candida sepsis resolved. Each of the infants required continued central venous access, which was made possible by resolution of the caval thrombosis. There were no hemorrhagic or other complications of the therapy.
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Affiliation(s)
- S R Lacey
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
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16
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Dhekne RD, Moore WH, Peters C, Dudrick SJ, Long SE. Upper extremity radionuclide venography in the diagnosis and management of venous disease associated with intravenous catheters. Angiology 1988; 39:907-14. [PMID: 3177956 DOI: 10.1177/000331978803901008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The utility of upper extremity radionuclide venography (RNV) in the assessment of suspected catheter-related central venous thrombosis (CRVT) was evaluated in 40 patients with subclavian venous catheters. Twenty normal patients (Group A) served as controls and their venographic patterns were analyzed by using four criteria: (1) delayed tracer transit time, (2) nonuniformity of flow and venous pooling, (3) jugular venous reflux, and (4) collateral venous filling. Control studies displayed no collaterals as a distinguishing characteristic but demonstrated the other three features to a variable degree. Of 106 extremities suspected of CRVT, 67 (Group B) were initially considered to have normal RNV findings (no collaterals). Contrast venography confirmed a normal pattern in 3 but identified CRVT with collaterals in 3 others. Retrospective review of the RNV studies confirmed faint collaterals in these latter 3. The 39 remaining extremities (Group C) showed abnormal RNV findings; contrast venography and postmortem studies confirmed the presence of venous disease in 5 patients. The authors believe that RNV is a reliable, noninvasive procedure for early diagnosis of venous occlusion associated with subclavian venous catheters.
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Affiliation(s)
- R D Dhekne
- St. Luke's Episcopal Hospital, Baylor College of Medicine, Houston, Texas
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17
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Hoffman MJ, Greenfield LJ. Central venous septic thrombosis managed by superior vena cava Greenfield filter and venous thrombectomy: A case report. J Vasc Surg 1986. [DOI: 10.1016/0741-5214(86)90177-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abstract
To determine the risk of complication associated with Broviac central venous catheterization in neonates, we reviewed the records of 107 infants who were catheterized an average of 5 weeks after birth and cared for in our neonatal intensive care unit. Forty-five of the 107 neonates (42%) had one or more catheter-related complications. Infants with complications had significantly lower birth weights and gestational age, longer duration of catheterization, and more repeat catheterizations than infants without complications. The mortality rate in infants with complications was not different than that of infants without complications. The most common complications were thrombosis (23 neonates) and infection (20 neonates). The birth weight and the number of catheterizations were the best predictors of the risk of complications as determined by multiple regression analysis. We conclude that the risk of complication associated with central venous catheterization is high in our population of predominantly premature neonates; that the risk of complication is increased in neonates weighing less than 1,000 g or requiring more than one catheter; and that despite the high complication rate central venous catheterization was not associated with increased mortality in this population.
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Atkinson JB, Robinowitz M, McAllister HA, Forman MB, Virmani R. Cardiac Infections in the Immunocompromised Host. Cardiol Clin 1984. [DOI: 10.1016/s0733-8651(18)30718-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bellini F, Beluffi G, Principi N. Total intravenous hyperalimentation (TIH) complications in childhood: a radiological survey. Pediatr Radiol 1984; 14:6-10. [PMID: 6420762 DOI: 10.1007/bf02386721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sixty consecutive patients, except for one 7-year-old patient, their ages varying from 1 day to 12 months received total intravenous hyperalimentation (TIH). It was possible to observe non-pathological catheter malpositions and, in 14 patients, other complications. The most serious complications observed included the following: thrombus and pericatheter thrombus calcification; superior vena cava thrombotic occlusion; hydrothorax; mediastinal effusion; generalized septic arthritis; venous transfixion with flooding of the soft tissues of the neck; vein wall lesions; collateral vertebral circulation; and a catheter tip blocked in vein. A brief comment is given on the use of this procedure and what may happen.
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Mollitt DL, Golladay ES. Complications of TPN catheter-induced vena caval thrombosis in children less than one year of age. J Pediatr Surg 1983; 18:462-7. [PMID: 6413671 DOI: 10.1016/s0022-3468(83)80201-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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23
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Janin Y, Becker J, Wise L, Schneider K, Schwartz D, So H. Superior vena cava syndrome in childhood and adolescence: a review of the literature and report of three cases. J Pediatr Surg 1982; 17:290-5. [PMID: 7108716 DOI: 10.1016/s0022-3468(82)80015-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Obstruction of the superior vena cava is rare in childhood and adolescence. Its etiology is now mainly iatrogenic. Mediastinal tumors are the main primary causes of the superior vena cava syndrome (SVCS) in childhood and adolescence. The most common mediastinal tumors presenting with the SVCS are the lymph node tumors and especially the lymphosarcomas. About 50% of the mediastinal tumors are primary in the mediastinum. Early treatment is designed to cause a rapid shrinking of the tumor and should not be delayed by an overly diligent pursuit of the diagnosis. Treatment should consist of a combination of radiation therapy, chemotherapy, and steroids. Surgery should be limited to obtaining tissue for diagnosis, except when the tumor is localized to the mediastinum and is completely resectable. One hundred and seventy two children and adolescents with the SVCS are reviewed and three patients are added.
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Crowley DC, Rosenthal A. Superior vena cava obstruction: complication of pulmonary artery ectasia in levo-transposition of the great arteries. Cardiovasc Intervent Radiol 1981; 4:27-9. [PMID: 7249006 DOI: 10.1007/bf02552403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Obstruction of the superior vena cava developed in a 13-year-old child with levo-transposition of the great arteries and pulmonary artery hypertension. Obstruction was due to extrinsic compression of the superior vena cava by an ectatic mainpulmonary artery.
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Walsh TJ, Hutchins GM. Postoperative Candida infections of the heart in children: clinicopathologic study of a continuing problem of diagnosis and therapy. J Pediatr Surg 1980; 15:325-31. [PMID: 7381669 DOI: 10.1016/s0022-3468(80)80148-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Fungal infections of the heart are infrequent postoperative complications in children, yet, when present are often fatal. Children autopsied at The Johns Hopkins Hospital from 1889 to the present were studied for cardiac fungal infection. Among the 14 children so identified, 8 developed cardiac fungal infection after surgery. All postoperative cardiac infections were caused by Candida species. All were autopsied since 1959. Gastrointestinal surgery was performed in 6 patients and cardiac surgery in 2. Candida infection was not confined to the endocardium; endocarditis developed in 2 patients, pericarditis in 1, and myocarditis in 5. None received cytotoxic agents or corticosteroids. Two patients died from direct cardiac involvement. Other deaths were related to Candida sepsis or bronchopneumonia. A clinical diagnosis of cardiac fungal infection was never made. Prolonged administration of multiple antibiotics, central venous catheterization, prematurity and immune deficiency predisposed to cardiac and systemic candidiasis. Clinical features facilitating early diagnosis are discussed. Removal of central venous catheters infected with Candida did not eliminate the source of continued sepsis, since Candida-laden vegetations related to the catheter adhered to the superior vena cava and endocardial surface. Postoperative cardiac candidiasis is a relatively new and persistent problem of early diagnosis and therapy. The post-surgical pediatric patient has major predisposing factors for cardiac candidiasis, which, if unrecognized, may be a source for continued dissemination or may in itself be the cause of death.
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Yousefzadeh DK, Jackson JH. Neonatal and infantile candidal arthritis with or without osteomyelitis: a clinical and radiographical review of 21 cases. Skeletal Radiol 1980; 5:77-90. [PMID: 6769164 DOI: 10.1007/bf00347327] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Four cases of candidal arthritis and osteomyelitis are presented and 17 others are reviewed from the literature. The clinical and radiographic aspects of the entity are discussed in detail and compared with those of bacterial septic arthritis. The role of predisposing factors are elaborated. An increase in the incidence of the disease is anticipated and the diagnostic difficulties are enumerated.
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Gartenberg G, Einstein K, Jagirdar J. Superior vena cava syndrome caused by invasive aspergillosis. Chest 1978; 74:671-2. [PMID: 282977 DOI: 10.1378/chest.74.6.671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 37-year-old man with blastic crisis of chronic myelogenous leukemia was admitted for chemotherapy. After treatment with an infusion of vincristine, he became leukopenic and febrile. Two episodes of gram-negative septicemia were treated with prolonged courses of antibiotics; however, fever persisted, and the patient developed the superior vena cava syndrome. Despite therapy with amphotericin B, the patient died. At autopsy a thrombus of Aspergillus was found completely occluding the superior vena cava.
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Vain NE, Georgeson KE, Cha CC, Swarner OW. Central parenteral alimentation in newborn infants: a new technique for catheter placement. J Pediatr 1978; 93:864-6. [PMID: 101648 DOI: 10.1016/s0022-3476(78)81103-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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