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Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From
Fabianne Carlesse1,2, Adriana Maria Paixão de Sousa da Silva1, Jaques Sztajnbok3,4
1Instituto de Oncologia Pediátrica-IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil.
Insights
Invasive fusariosis (IF) is a severe fungal infection in children with cancer. Disseminated disease and specific treatments impact survival rates, emphasizing the need for early diagnosis and comprehensive management.
Area of Science:
- Mycology
- Infectious Diseases
- Pediatric Oncology
Background:
- Invasive fusariosis (IF) poses a significant threat to immunocompromised individuals, particularly pediatric cancer patients.
- Understanding the clinical course and management strategies for IF is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To characterize the natural history and clinical management of invasive fusariosis in pediatric cancer patients.
- To assess mortality rates and identify factors influencing survival in this cohort.
Main Methods:
- A multicenter, multinational retrospective study was conducted involving pediatric patients (<18 years) diagnosed with IF between 2002 and 2021.
- Data on patient demographics, risk factors, clinical presentation, diagnostic methods, treatment, and outcomes were collected via electronic case report forms.
Main Results:
- Sixty episodes of IF were analyzed, predominantly in patients with hematologic cancer (70%), characterized by lymphopenia, neutropenia, and corticosteroid use.
- Disseminated disease occurred in 55.6% of cases, with skin lesions and pulmonary involvement being most common. *Fusarium solani* complex was the primary agent (66.6%).
- Thirty, 60, and 90-day mortality rates were 35%, 41.6%, and 45%, respectively. Disseminated disease was linked to increased mortality.
Conclusions:
- Invasive fusariosis in pediatric cancer patients has a high mortality rate, significantly influenced by disease dissemination.
- Prompt diagnosis and comprehensive evaluation for multifocal infections are essential for managing IF in severely immunocompromised children.
- Current treatment often involves monotherapy with voriconazole or amphotericin B formulations within 72 hours of diagnosis.
Abstract:
Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.
