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[Fluconazole therapy for pediatric patients with severe candidal infections]
H Wakiguchi1, H Hisakawa, M Sinohara
1Department of Pediatrics, Kochi Medical School.
Abstract:
Three children with severe candidal infections were treated with fluconazole (FLCZ). An excellent effect or a partial effect was obtained in each case. Case 1 was a boy with candida esophagitis. He had been treated for relapsed ALL and became febrile with severe swallowing pain. FLCZ was administered intravenously and he became afebrile after 10 days of the therapy. Case 2 was a boy with candida pneumonitis. He had been treated for relapsed ALL and became febrile with diffuse infiltration in chest X-ray. FLCZ was administered intravenously and he became afebrile transiently, though fever and abnormal X-ray shadows reappeared soon and died of pneumonia and leukemic infiltrations. Case 3 was a girl with candida pneumonitis. She had been treated for relapsed neuroblastoma and became febrile and dyspneic. She was treated with intravenous FLCZ with no effects and died of pneumonia. All three patients showed positive results in 2 of 3 markers for candida infection, including, Cand-Tec, D-arabinitol and fungal index. FLCZ was well tolerated and no adverse effects or abnormal laboratory test results were observed. FLCZ was considered as an effective and safe antifungal agent in the treatment for fungal infections in children.
Insights
Fluconazole (FLCZ) effectively treated severe fungal infections in three children with underlying conditions. This antifungal agent demonstrated safety and efficacy, offering a valuable treatment option for pediatric candidiasis.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Clinical Pharmacology
Background:
- Severe fungal infections, particularly candidiasis, pose a significant threat to immunocompromised pediatric patients.
- Children with relapsed acute lymphoblastic leukemia (ALL) or neuroblastoma are at increased risk for invasive fungal infections.
- Early and effective antifungal therapy is crucial for improving outcomes in these vulnerable populations.
Observation:
- Three pediatric cases of severe candidal infections (esophagitis and pneumonitis) were treated with intravenous fluconazole (FLCZ).
- Patients presented with fever, pain, dyspnea, and radiographic evidence of infection.
- Diagnostic markers for candidiasis, including Cand-Tec, D-arabinitol, and fungal index, were positive in all cases.
Findings:
- Two out of three patients experienced excellent or partial therapeutic effects with FLCZ.
- Case 1 (candida esophagitis) showed complete resolution of fever and symptoms.
- Case 2 and 3 (candida pneumonitis) had transient improvement, but ultimately succumbed to their infections and underlying conditions.
- FLCZ was well-tolerated with no observed adverse effects or abnormal laboratory findings.
Implications:
- Fluconazole (FLCZ) is a potentially effective and safe antifungal agent for treating invasive candidal infections in children.
- The study highlights the challenges in treating severe fungal infections in critically ill pediatric patients, even with appropriate antifungal therapy.
- Further research is warranted to optimize antifungal strategies and improve survival rates for pediatric candidiasis in immunocompromised hosts.