Diagnostic-driven antifungal approach in neutropenic patients at high risk for chronic disseminated candidiasis: preliminary observations on the role of 1,3-β-D-glucan antigenemia and multiphasic contrast-enhanced computed tomography
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Chronic disseminated candidiasis (CDC) is a critical form of invasive fungal infection (IFI) that affects mainly the liver, spleen, and, occasionally, kidneys . Typical clinical, microbiological, and/or radiological manifestations have late onset, leading frequently to misdiagnosis [1, 2]. A late diagnosis leads to a delay in starting an effective antifungal therapy against Candida infection resulting in a severe morbidity and high mortality . Recent studies have shown effective alternatives to traditional microbiological and radiological procedures for the diagnosis of CDC, in particular, 1,3-β-D-glucan (BDG) antigenemia and contrast-enhanced computed tomography (CE-CT) [4, 5]. The preemptive approach, based on the routine surveillance with serum BDG and hepatosplenic CE-CT, has been proposed for obtaining a reliable and early diagnosis of CDC, and for establishing a proper antifungal treatment . However, guidelines give moderate evidence to support...
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