Disseminated fungal infections in children infected with human immunodeficiency virus.
A retrospective review of charts of 156 human immunodeficiency virus-infected children cared for during a 7.5-year period revealed 11 episodes of disseminateed candidiasis (DC) occurring in 11 patients (7%). All 11 patients developed the fungal infection in the context of advanced human immunodeficiency virus infection. All but one were hospital-acquired, occurring at a mean of 2.3 months after admission. Ten patients had been febrile for more than 14 days before diagnosis. Previous oral thrush and central venous catheters (73 and 82% of patients) represented major predisposing factors for development of DC. Neutropenia (2 of 11 patients) did not represent a major risk factor for DC. Candida albicans was isolated in 9 patients, Rhodotorula minuta in 1 patient and 1 fungal isolate could not be identified. Sources of isolation were blood (8 of 11 patients), central venous catheters (3 of 11) and urine (2 of 11). Lungs (6 of 11 patients), esophagus (5 of 11) and brain, heart and kidneys (3 patients each) were the organs most often involved in DC. Antemortem diagnosis was achieved in only 7 (64%) patients; none of the 4 patients with DC diagnosed postmortem had been treated before death. Seven patients were treated with amphotericin B; 6 of them died but only 3 were treated for more than 7 days of therapy. The overall mortality was 90% (10 of 11 patients). In all 20% of the 50 human immunodeficiency virus-infected children who died at our hospital during the study period had an episode of DC in close proximity to their death. DC was considered the direct cause of death in 4 of 10 children.