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Published on: July 1, 2020
Invasive fungal diseases in children with hematologic disorders
Birol Baytan1, Adalet Meral Güneş, Solmaz Çelebi
1Uludag University, Children's Hematology Field 16059 Bursa, Turkey Phone: +90 224 295 04 31
Objective:
Fungal infection is a significant problem, causing of infective deaths of leukemic patients. The situation in developing countries is not well documented. The purpose of this study was characterizing IFD by analyzing data retrospectively to determine the incidence, predisposing factors, diagnostic methods, efficacy of treatment, and the outcome in pediatric patients with hematological disorders.
Methods:
There were 160 children with leukemia (22 AML, 129 ALL) and 9 with aplastic anemia (AA). The diagnostic criteria for IFD were defined according to the EORTC/MSG, 2008. IFD was classified as proven or probable. Empiric antifungal treatment with L-AmB was commenced by day 5-7 of persistent fever. Patients with invasive aspergillosis (IA) who were refractory to primary treatment were commenced on voriconazole (VCZ). Salvage therapy as combination of VCZ and caspofungin was given to those with progressive infection.
Results:
The incidence of IFD was found 23 (14.3%). 19 with leukemia (14 ALL, 5 AML) and 4 with aplastic anemia were diagnosed as IFD. IA was the dominant cause of infection (n=17) and the rest (n: 6) had candidiasis. Ten children had "proven" infection and 13 children were defined as "probable". The most frequent site of infection was lungs. In our series, the most frequently used diagnostic methods were clinical findings (100%) and radiologic methods (84%). The success rate of treatment for candidiasis and IA were found 60%, 71% respectively. IFD related death rate was found 30%.
Conclusion:
IFD is still a major morbidity and mortality reason in children with hematologic disorders. However, the availability of new antifungal treatments and diagnostic tests will improve the survival rates in these children.
Insights
Invasive fungal infections (IFD) affect 14.3% of pediatric hematology patients, with a 30% mortality rate. Early diagnosis and new antifungal treatments are crucial for improving survival in these vulnerable children.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Mycology
Background:
- Invasive fungal infections (IFD) are a significant cause of mortality in pediatric leukemia patients, particularly in developing nations.
- Characterizing IFD is essential for understanding predisposing factors, diagnostic challenges, and treatment outcomes in immunocompromised children.
Purpose of the Study:
- To retrospectively analyze the incidence, predisposing factors, diagnostic methods, treatment efficacy, and outcomes of IFD in pediatric patients with hematological disorders.
- To provide data on IFD in a developing country context.
Main Methods:
- Retrospective analysis of 160 children with leukemia and 9 with aplastic anemia.
- IFD diagnosis based on EORTC/MSG 2008 criteria (proven or probable).
- Antifungal treatment included liposomal amphotericin B (L-AmB), voriconazole (VCZ), and caspofungin.
Main Results:
- The incidence of IFD was 14.3% (23/169 patients), predominantly invasive aspergillosis (IA).
- Pulmonary infections were most common; clinical and radiologic findings were primary diagnostic tools.
- Treatment success rates were 60% for candidiasis and 71% for IA, with an overall IFD-related mortality of 30%.
Conclusions:
- IFD remains a significant cause of morbidity and mortality in pediatric hematologic disorders.
- Advancements in diagnostic tools and novel antifungal therapies hold promise for improving survival rates.
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