4 years ago

Acute disseminated candidiasis with skin lesions: a systematic review

Neutropenic patients developing acute disseminated candidiasis may present with skin lesions. Aims To evaluate the epidemiology of acute disseminated candidiasis with skin lesions in neutropenic patients, taking into consideration changes caused by different prophylactic strategies. Sources A systematic review of English articles using PubMed (1963-2016) was performed. We asked the following questions: (1) What Candida species are more frequently involved in this syndrome? (2) Has antifungal prophylaxis changed the species causing skin lesions? (3) What are the typical patterns of skin lesions? (4) What is the frequency of skin lesions in neutropenic patients with candidemia or acute disseminated candidiasis? (5) Has antifungal prophylaxis decreased the incidence of acute disseminated candidiasis with skin lesions? Content Among 183 studies, 33 were selected, reporting 100 cases of acute disseminated candidiasis with skin lesions in neutropenic patients. It occurred more frequently in the setting of induction therapy for de novo or relapsed acute leukemia, and the most frequent species were C. tropicalis (68%) and C. krusei (15%). Diffuse maculopapular lesions predominated in cases caused by C. tropicalis and nodular and papular lesions in cases caused by C. krusei. Prophylaxis with fluconazole was reported in six cases; C. krusei in five, and C. ciferri in one. The death rate was 46.3%. Implications Two patterns were recognized: disseminated maculopapular lesions caused by C. tropicalis in patients not receiving fluconazole prophylaxis, occurring in 39-44% of neutropenic patients with acute disseminated candidiasis, and nodular lesions caused by C. krusei in patients on fluconazole prophylaxis, occurring less frequently.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304627

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