Fungemia in Children Infected With the Human Immunodeficiency Virus: New Epidemiologic Patterns, Emerging Pathogens, and Improved Outcome With Antifungal Therapy

Clin Infect Dis. 1995 Apr;20(4):900-6. doi: 10.1093/clinids/20.4.900.

Abstract

We characterized 27 episodes of fungemia in 22 children infected with the human immunodeficiency virus (HIV). Fungemia in these patients presented as a community-acquired infection in the setting of outpatient total parenteral nutrition or intravenous antibiotic therapy through a chronically indwelling central venous catheter (CVC). Fungemia developed only in patients with CVCs (P < .001). Non-albicans Candida species, Torulopsis glabrata, Rhodotorula rubra, and Bipolaris spicifera constituted 52% of all causes. Fungemia was detected early, within a median of 2.4 days after the onset of new fever, which permitted prompt administration of amphotericin B (mean dosage, 0.7 mg/[kg.day]; median duration, 19 days). CVCs were removed in 23 (85%) of the episodes. We conclude that fungemia in HIV-infected children often presents as a community-acquired infection, is frequently due to newly emerging opportunistic fungi, and can be managed, with a high level of success (95% survival with no posttherapeutic sequelae), by early diagnosis, prompt initiation of amphotericin B therapy, and removal of the CVC.

Publication types

  • Clinical Trial

MeSH terms

  • Antifungal Agents / therapeutic use
  • Catheterization, Central Venous / adverse effects
  • Child
  • Child, Preschool
  • Community-Acquired Infections / complications
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / epidemiology
  • Female
  • Fungemia* / complications
  • Fungemia* / drug therapy
  • Fungemia* / epidemiology
  • Fungemia* / microbiology
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • HIV Infections* / microbiology
  • Humans
  • Infant
  • Male
  • Treatment Outcome

Substances

  • Antifungal Agents