Epidemiology, Clinical Features, and Outcomes of Proven Invasive Fungal Infections in Pediatric Patients

Invasive fungal infections (IFIs) cause significant morbidity and mortality in immunocompromised pediatric patients; systematic data comparing mold- and yeast-related infections remain limited.

To evaluate epidemiology, clinical features, antifungal treatment, and outcomes of proven infectious fungal infections (IFIs) in immunocompromised children, comparing mold and yeast infections.

This single-center retrospective study included 65 immunocompromised patients aged ≤ 18 years with proven IFIs diagnosed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) criteria.

Of 65 patients (75.4% male; median age 62 months), mold infections occurred in 21 (32.3%) and yeast infections in 44 (67.7%). Aspergillus spp. (n = 6) and Mucor spp. (n = 3) were common molds; Candida parapsilosis (n = 15) predominated among yeasts. ALL was more prevalent in the mold group (38.1% vs. 11.4%; p = 0.019), while other oncological malignancies predominated in the yeast group (50.0% vs. 19.0%; p = 0.017). Combination therapy (66.7% vs. 9.1%; p < 0.001), salvage therapy (52.4% vs. 27.3%; p = 0.048), and treatment duration (median 56 vs. 21 days; p < 0.001) were higher in the mold group. Mold infections showed higher rates of nodules, cavitation, and air-crescent sign on thoracic CT (p < 0.05) and greater pulmonary progression (23.8% vs. 2.3%; p = 0.011). The overall pediatric intensive care unit (PICU) admission rate was 40.0%; mechanical ventilation was more frequent in the mold group (47.6% vs. 15.9%; p = 0.007) and was identified as the sole independent predictor of IFI-attributable mortality (OR 14.5; 95% CI 3.47-60.41; p < 0.001).Overall mortality was 36.9% with no between-group difference (p = 0.892); IFI-attributable mortality was higher in the mold group (28.6% vs. 18.2%; p = 0.081).

Mold and yeast infections show distinct clinical, radiological, and therapeutic profiles in immunocompromised children, with mold infections showing greater treatment burden and higher IFI-attributable mortality.