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A prospective study on fungal infection in children with cancer
H A El-Mahallawy1, I Attia1, N H Ali-El-Din1
1Chest Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Abstract:
A prospective study was conducted in 1999 at the National Cancer Institute, Cairo University, to estimate the incidence, morbidity and mortality of fungal infections along with the evaluation of risk factors influencing outcome of infections among paediatric cancer patients. Of 1917 infectious episodes, the fungal infection rate as documented both clinically and microbiologically was 3.7% (70 cases). Fungal pathogens isolated were yeasts in 55 patients (78.6%) and moulds in 15 patients (21.11%). Among yeasts, Candida parapsilosis was the commonest, followed by C. tropicalis. Pneumonia was the most common fungal infection (n = 25, 35.7%), followed by fungaemia (n = 18, 25.7%). The overall mortality rate was 40% (n = 28), with an infection-related mortality of 28.5% (n = 20). Risk factors that accompanied mortality were relapsing or recurrent disease, profound neutropenia, ADE (Ara-C, daunorubocin and etoposide) protocol of chemotherapy, C. tropicalis isolated and fungaemia as a site of infection. Early use of empirical antifungal therapy (day 4) was not associated with a better outcome. In the light of the poor outcome of patients with fungaemia and fungal pneumonia, every effort should be made to prevent these infections in paediatric cancer patients.
Insights
Fungal infections are a serious threat to children with cancer, causing significant mortality. Prevention strategies are crucial, especially for invasive candidiasis and fungal pneumonia in this vulnerable population.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Mycology
Background:
- Fungal infections pose a significant threat to pediatric cancer patients.
- Estimating incidence, morbidity, and mortality is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence, morbidity, and mortality of fungal infections in pediatric cancer patients.
- To identify risk factors associated with poor outcomes in these infections.
Main Methods:
- A prospective study conducted at the National Cancer Institute, Cairo University.
- Inclusion of 1917 infectious episodes in pediatric cancer patients.
- Clinical and microbiological documentation of fungal infections.
Main Results:
- Fungal infection rate was 3.7% (70 cases), with yeasts (Candida parapsilosis, C. tropicalis) being predominant.
- Pneumonia (35.7%) and fungemia (25.7%) were the most common fungal infections.
- Overall mortality was 40%, with infection-related mortality at 28.5%.
Conclusions:
- Relapsing disease, neutropenia, specific chemotherapy protocols, Candida tropicalis, and fungemia were linked to mortality.
- Early empirical antifungal therapy did not improve outcomes.
- Preventing fungal pneumonia and fungemia is critical for improving survival in pediatric cancer patients.