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Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell
Serap Karaman1, Rejin Kebudi2, Hande Kizilocak3
1Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University.
Background:
Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines.
Materials And Methods:
In this multicenter retrospective study, 51 pediatric patients with leukemia, 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combination with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links.lww.com/JPHO/A541 ).
Results:
Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus . Sixteen patients received single-agent, 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died, 29 of the CNSFI episodes recovered with a 20% neurological sequelae.
Conclusion:
CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes.
Insights
Central nervous system fungal infections (CNSFI) are serious in children with leukemia. Early diagnosis and prompt medical or surgical treatment are crucial for improving outcomes in these rare but deadly infections.
Area of Science:
- Pediatric Hematology Oncology
- Infectious Diseases
- Neuroscience
Background:
- Central nervous system fungal infections (CNSFI) are rare but severe complications in pediatric patients with hematologic malignancies.
- Limited data exists on CNSFI in children, lacking established treatment protocols or guidelines.
- These infections are associated with high morbidity and mortality rates.
Purpose of the Study:
- To evaluate the characteristics, management, and outcomes of CNSFI in pediatric leukemia patients.
- To identify common fungal agents and clinical presentations of CNSFI in this population.
- To emphasize the importance of early diagnosis and prompt intervention.
Main Methods:
- A multicenter retrospective study involving 51 pediatric leukemia patients with proven or probable CNSFI.
- Fungal infections were classified using European Organisation for Research and Treatment of Cancer criteria.
- Data collection included clinical findings, microbiological results, imaging, and treatment modalities.
Main Results:
- Aspergillus was the most common fungal agent identified.
- Headaches and seizures were the most frequent clinical manifestations.
- A significant mortality rate of 43% was observed, with 20% neurological sequelae in survivors.
Conclusions:
- CNSFI must be considered in pediatric leukemia patients presenting with refractory fever and neurological symptoms.
- Prompt radiologic-serological evaluation is essential for timely diagnosis.
- Integrated medical and surgical management strategies are critical for improving patient outcomes.
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