ABSTRACT
BACKGROUND: Sometimes, in pediatric oncology, it is difficult to differentiate the relapse of primary tumor from other diagnoses such as post-ischemic lesions or fungal abscess, without performing an organ biopsy. In addition, patients frequently are not under clinical conditions to be biopsied, mainly due to febrile neutropenia. A growing number of studies has focused on the use of Positron emission tomography/computed tomography with 18 Fluorodeoxyglucose ([(18)F]FDG-PET/CT) to distinguish tumor relapse from infectious lesions in patients with febrile neutropenia. CASE PRESENTATION: This case report describes a 6 years-old girl with febrile neutropenia during the treatment of neuroblastoma. Blood culture showed Candida sp. Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [(18)F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis. Patient was then treated with systemic antifungal agent. After the recovery from febrile neutropenia, a spleen biopsy was performed, confirming the diagnosis of fungal abscess. Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions. CONCLUSION: This case provides an excellent example in which the use of [(18)F]FDG-PET/CT is valuable in helping to localize potential sites of disseminated fungal infection to be diagnosed within clinical context. [(18)F]FDG-PET /CT seems to have a role in the evaluation of pediatric patients with febrile neutropenia.
Subject(s)
Abscess/diagnostic imaging , Adrenal Gland Neoplasms/diagnostic imaging , Candidiasis/diagnostic imaging , Neuroblastoma/diagnostic imaging , Positron-Emission Tomography , Splenic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Abscess/drug therapy , Candidiasis/drug therapy , Child , Diagnosis, Differential , Female , Fluorodeoxyglucose F18 , Humans , Male , Multimodal Imaging , Neutropenia/complications , Radiopharmaceuticals , Splenic Diseases/drug therapyABSTRACT
Pretendeu-se avaliar as condições do diagnóstico da toxoplasmose na gestante e sua relação com a infecção do recém-nascido em serviço de referência, em Belo Horizonte. Trata-se de estudo retrospectivo de 86 pares de mãe-filho, sendo as crianças suspeitas de toxoplasmose congênita devido a sorologia positiva de suas mães. O diagnóstico de toxoplasmose congênita foi excluído em 67 crianças e confirmado em 19. Nesses casos, a IgM positiva (p=0,28) e o ultra-som alterado (p=0,23), na gestação, não estiveram associados à infecção congênita. Em 27 gestantes foi realizada pesquisa do T. gondii no líquido amniótico, positiva em oito casos. O valor preditivo positivo do teste foi baixo (37,5%). Análise univariada mostrou que o tratamento da gestante por mais de três meses protegeu a criança da infecção (p=0,001). Cerca de 60% dos RN infectados estavam assintomáticos ao nascimento. Entre os parâmetros utilizados como preditores de infecção congênita, a pesquisa do T. gondii em liquido amniótico mostrou-se promissora. O diagnóstico e o tratamento precoces na gestante podem diminuir a ocorrência de infecção congênita.
This study discusses diagnostic procedures in pregnant women and its relation with congenital infection in a reference center in Belo Horizonte/MG, Brasil. A total of 86 mother-child couples were enrolled in this retrospective study. These children were suspected for congenital toxoplasmosis based on positive mother's serology. 19 kids were diagnosed and 67 were excluded for congenital infection. Positive IgM (p = 0,28) and alterations on ultrassonography (p = 0,23) during pregnancy had no association with congenital toxoplasmosis between the infected ones. Polymerase chain reaction (PCR) for T.gondii in amniotic fluid was performed in 27 pregnant, resulting positive in 8 but with a very low positive predictive value (37,5%). Univariable analisis shows that pregnant's treatment for at least 3 months protected Children from infection (p = 0,001). About 60% of newborns were clinically asymptomatic. PCR for T. gondii in amniotic fluid is promising as a diagnostic test. Early diagnosis and treatment of mothers may decrease occurrence of congenital infection.
