Document 0206
 DOCN  M95A0206
 TI    Fungemia in children infected with the human immunodeficiency virus: new
       epidemiologic patterns, emerging pathogens, and improved outcome with
       antifungal therapy.
 DT    9510
 AU    Walsh TJ; Gonzalez C; Roilides E; Mueller BU; Ali N; Lewis LL; Whitcomb
       TO; Marshall DJ; Pizzo PA; Infectious Diseases Section, National Cancer
       Institute, Bethesda,; Maryland 20892, USA.
 SO    Clin Infect Dis. 1995 Apr;20(4):900-6. Unique Identifier : AIDSLINE
       MED/95315395
 AB    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.
 DE    Antifungal Agents/THERAPEUTIC USE  Catheterization, Central
       Venous/ADVERSE EFFECTS  Child  Child, Preschool  Community-Acquired
       Infections/COMPLICATIONS/DRUG THERAPY/  EPIDEMIOLOGY  Female
       *Fungemia/COMPLICATIONS/DRUG THERAPY/EPIDEMIOLOGY/MICROBIOLOGY  Human
       *HIV Infections/COMPLICATIONS/EPIDEMIOLOGY/MICROBIOLOGY  Infant  Male
       Treatment Outcome  CLINICAL TRIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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