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Clinicopathologic Characterization of Invasive Fungal Intestinal Infections in Pediatric Patients
Muhammad Shaheen1, Guang-Sheng Lei1, Ryan F Relich1
1Department of Pathology and Laboratory Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
Background:
Invasive fungal intestinal infections are rare in pediatric patients with limited studies reported to date.
Methods:
Retrospective study of invasive intestinal fungal infections in pediatric patients. For fungal specification, 18S rRNA gene PCR was performed using formalin-fixed paraffin-embedded tissues.
Results:
A total of 19 cases from 18 patients were included (13 males, 72%) with a median age of 20 days (8 days-14 years). About 13 patients (72%) presented within 67 days of birth and 11 patients (61%) were premature and 14 patients (78%) had a significant medical history. The most common location was the jejunum/ileum (56%) followed by the right colon and terminal ileum (22%). In 10 patients, the fungal elements were seen in the mucosa with 3 extending into the submucosa, and only 3 patients showed full-thickness involvement. Tissue necrosis and angioinvasion were seen in 13 (72%) and 8 (44%) patients, respectively. Morphologically, organisms consistent with Candida spp. were seen in 17 patients and with a mucoraceous mold in 1 patient. A 18S rRNA gene sequencing performed in 18 cases identified Candida dubliniensis in 16 cases and Candida spp. in 2 cases. During the study follow-up period, 56% of the patients died.
Conclusion:
In our experience, most cases were due to Candida spp. and predominantly in premature infants and associated with poor outcomes.
Insights
Invasive fungal intestinal infections, primarily Candida dubliniensis, are rare but deadly in premature infants. These infections are linked to high mortality rates in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Mycology
Background:
- Invasive fungal intestinal infections are uncommon in pediatric populations.
- Limited research exists on these infections in children.
Purpose of the Study:
- To investigate the characteristics and outcomes of invasive fungal intestinal infections in pediatric patients.
- To identify the fungal species involved and their clinical significance.
Main Methods:
- Retrospective study of pediatric patients with invasive intestinal fungal infections.
- Fungal identification using 18S rRNA gene PCR on formalin-fixed paraffin-embedded tissues.
Main Results:
- 19 cases from 18 pediatric patients were analyzed, with a median age of 20 days.
- Most infections occurred in premature infants with significant medical histories, predominantly affecting the jejunum/ileum.
- Candida dubliniensis was identified in 16 cases, and tissue necrosis/angioinvasion were common. Mortality was 56%.
Conclusions:
- Invasive fungal infections in pediatric patients are often caused by Candida spp., particularly in premature infants.
- These infections are associated with high morbidity and mortality.
- Early diagnosis and intervention are crucial for improving outcomes.
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