A study on the pathogenesis of visceral fungal infections. A risk index for visceral fungal infections in immunocompromised hosts. (1):A Risk Index for Visceral Fungal Infections in Immunocompromised Hosts (I)
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To establish a risk index to estimate the occurrence of visceral fungal infections in immunocompromised hosts, we performed a retrospective survey of various clinical data for 45 autopsy cases with carcinoma, malignant lymphoma or SLE and 15 clinical cases who received a renal transplant. Among the cases investigated, there were 31 cases with fungal infection of candidosis (18 cases), aspergillosis (9 cases), cryptococcosis (3 cases) and mixed fungal infection (one case). Peripheral leukocyte count, neutrophil count and lymphocyte count were markedly decreased in cases with fungal infection compared with cases without fungal infection. In addition, the number of consecutive clinical days in which the leukocyte count was below 3, 000/mm3 was greater in cases with fungal infection than in cases without.Consequently, the above-mentioned four factors were selected as infectious risk factors for an appropriate estimation of the occurrence of visceral fungal infections in immunocompromised hosts. A risk index was calculated by various points given to each risk factor.If a risk index was over 20 points, the occurrence of a visceral fungal infection was highly likely. Based on this assumption, the percentage of correctly predicted cases for visceral fungal infections using a risk index in carcinoma, malignant lymphoma, SLE and renal transplant cases was 80%, 83%, 57% and 75%, respectively. The percentage of falsely predicted cases was in 10%, 50%, 17% and 0%, respectively.We recognized that the survival rate and survival period of mice in experimental candidosis were also influenced by the peripheral leukocytes count and lymphocytic function.From these results, we conclude that a risk index will be very useful in the management of the clinical course in immunocompromised hosts and helpful in the diagnosis of fungal infection in the early clinical stage, except for cases with malignant lymphoma.
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