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

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.