Invasive Fungal Diseases in Children with Acute Leukemia and Severe Aplastic Anemia

Area of Science:

• Pediatric Hematology
• Infectious Diseases
• Mycology

Background:

• Infectious complications remain a major concern for pediatric patients with leukemia and severe aplastic anemia (SAA), despite improved treatment outcomes.
• Invasive fungal diseases (IFDs) are a leading cause of infectious-related mortality in patients experiencing prolonged neutropenia.

Purpose of the Study:

• To investigate the prevalence, characteristics, and outcomes of IFDs in pediatric patients with hematological diseases in Thailand.
• To evaluate the impact of antifungal prophylaxis on IFD incidence in these vulnerable patient groups.

Main Methods:

• Retrospective study of 241 pediatric patients diagnosed with acute leukemia or SAA at Siriraj Hospital, Thailand.
• Data collected included patient demographics, diagnosis, IFD occurrence, causative organisms, infection sites, and case-fatality rates.
• Analysis included comparison of IFD incidence between patients who received and did not receive fungal prophylaxis.

Main Results:

• The overall IFD prevalence was 10.7%, with higher rates in relapsed leukemia (19.3%) and SAA (16%) patients.
• Pulmonary invasive aspergillosis was the most common IFD (38.5%), followed by candidemia (34.6%), with *Candida tropicalis* being the most frequent Candida species.
• The overall case-fatality rate was 38.5%, reaching 75% in relapsed leukemia patients. Antifungal prophylaxis was associated with lower IFD incidence in SAA patients (P=0.04).

Conclusions:

• IFDs are prevalent and associated with high mortality in Thai children with hematological diseases.
• Antifungal prophylaxis should be strongly considered for patients with SAA to mitigate the risk of IFDs.
• Further research into optimal antifungal strategies for pediatric hematology patients is warranted.