Invasive Candidiasis in Pediatric Hematologic Malignancy: Increased Risk of Dissemination With Candida tropicalis

Area of Science:

• Pediatric Hematology Oncology
• Infectious Diseases
• Mycology

Background:

• Invasive fungal disease (IFD) is a significant concern in pediatric patients with hematologic malignancies.
• Non-albicans Candida (NAC) species are increasingly implicated in invasive candidiasis (IC), often associated with poorer prognoses.
• Understanding species-specific epidemiology and outcomes is vital for effective management.

Purpose of the Study:

• To compare the epidemiology, risk factors, organ dissemination, biomarkers, and outcomes of invasive candidiasis (IC) in children with hematologic malignancy.
• To evaluate trends in antifungal resistance over time.
• To identify species-specific differences in IC presentation and prognosis.

Main Methods:

• Retrospective chart review of 53 pediatric patients (0-18 years) with hematologic malignancy and IC at two centers (2011-2022).
• Data collected included demographics, host factors, Candida species, antifungal susceptibilities, treatment, and outcomes.
• Analysis performed at the species level to identify differences.

Main Results:

• The incidence rate of IC was 29 per 1000 patients with leukemia and lymphoma.
• Candida tropicalis (30%) was the most common species, followed by Candida albicans (25%).
• C. tropicalis infections were associated with higher rates of dissemination to the eyes, spleen, and skin. Intraocular candidiasis was observed in 24% of patients with dilated retinal exams, often linked to prolonged candidemia. The 12-week crude mortality rate was 16.9%.

Conclusions:

• Non-albicans Candida (NAC), especially C. tropicalis, dominates IC cases in pediatric hematologic malignancy patients.
• Screening for intraocular candidiasis is critical in managing IC in this population.
• Further research is needed to refine screening criteria for intraocular candidiasis.