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Alternaria Invasive Infection in Children With Hemato-Oncological Disease: A National Multicenter Report.

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Journal of Pediatric Hematology/Oncology
|March 6, 2025
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Pediatric invasive Alternaria infections are uncommon but occur in leukemia patients with neutropenic fever. Treatment with voriconazole shows a high recovery rate, indicating a favorable prognosis for these fungal infections.

Keywords:
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Area of Science:

  • Mycology
  • Pediatric Hematology-Oncology
  • Infectious Diseases

Background:

  • Invasive fungal diseases pose a significant threat to pediatric hemato-oncology patients.
  • Aspergillus and Candida species are common fungal pathogens, but Alternaria infections are less understood in this population.
  • There is a need to characterize pediatric Alternaria infections due to their understudied nature.

Purpose of the Study:

  • To characterize the clinical features and outcomes of invasive Alternaria infections in pediatric hemato-oncology patients nationwide.
  • To identify common presentations and risk factors associated with Alternaria infections in this vulnerable group.
  • To evaluate the effectiveness of treatment strategies for pediatric Alternaria infections.

Main Methods:

  • A retrospective, multicenter observational study was conducted.
  • Medical records of pediatric patients diagnosed with invasive Alternaria infection between 2011 and 2023 were reviewed.
  • Data from Israel's five largest tertiary pediatric centers were analyzed.

Main Results:

  • Twenty-two pediatric patients (aged 4-18 years) with invasive Alternaria infection were identified.
  • The most frequent underlying diagnoses were acute lymphoid leukemia (55%) and acute myeloid leukemia (23%).
  • Common manifestations included invasive rhinosinusitis (77%), ecthyma-like skin lesions (14%), and pulmonary infections (9%).
  • Eighty-six percent of patients presented with neutropenic fever, and 76% of sinusitis cases had suggestive symptoms.
  • Treatment with voriconazole resulted in a 90% recovery rate, regardless of surgical intervention.
  • Two fatalities occurred, but they were not attributed to the Alternaria infections.

Conclusions:

  • Invasive Alternaria infections predominantly affect pediatric leukemia patients experiencing neutropenic fever.
  • Rhinosinusitis is the most common clinical presentation of Alternaria infection in this cohort.
  • Voriconazole demonstrates high efficacy, leading to a favorable prognosis for pediatric Alternaria infections despite the patients' severe underlying conditions.