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[Fungal infections in pediatric oncology]
L Manfredini1, A Garaventa, E Castagnola
1IV Divisione di Pediatria, Istituto Scientifico Giannina Gaslini di Genova, Italia.
Abstract:
The clinical charts of cancer patients with documented fungal infections hospitalized at G. Gaslini Children's Hospital, Italy, from 1980 to 1990 were reviewed. Thirty-seven episodes developing in 37 patients were identified, based on microbiological and/or histological documentation. Patients' age ranged from 3 months to 18 years (median 7 years). Twenty patients were treated for hematological malignancy and 17 had solid tumor. Seven patients (3 with leukemia and 4 with solid tumours), developed mycosis after bone marrow transplantation procedure. A history of neutropenia in the month preceding the documentation of fungal infection was present in 76% of cases (28 of 37). However, only 16 of 28 (55%) of these patients were still neutropenic at time of diagnosis. In 40% of the cases the fungal infection developed as primary infection not preceded by any febrile and/or infectious episode. Fungemias without evident organ localization accounted for the 40% of episodes with a mortality rate of 20%. The other 22 cases (60%) were classified as invasive mycoses; 9 of these patients died (41%). Mortality was higher among patients with mold infection (5 of 7, 72%), than in those with yeast infection (7 of 29.24%). Molds infections and invasive mycoses were virtually absent in the first part of our period of observation (1980-84), but emerged in the second period (1985-90) when also the incidence rate of fungal disease increased (from 2.67/10,000 person/day to 5.93), probably in relation with extensive construction works and with the implementation of a bone marrow transplantation program.
Insights
Fungal infections in pediatric cancer patients increased significantly from 1980-1990, particularly invasive mold infections and fungemias, highlighting a rise in hospital-acquired mycoses. This trend correlated with bone marrow transplantation programs and hospital construction.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Mycology
Background:
- Fungal infections pose a significant threat to immunocompromised pediatric cancer patients.
- Understanding trends and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To review and analyze fungal infections in pediatric cancer patients over a 10-year period.
- To identify changes in the incidence and types of fungal infections.
- To explore potential contributing factors to these changes.
Main Methods:
- Retrospective review of clinical charts of cancer patients with documented fungal infections.
- Data collection on patient demographics, underlying malignancy, treatments, and infection characteristics.
- Analysis of infection types (fungemia, invasive mycoses), causative agents (yeast, mold), and outcomes.
Main Results:
- Thirty-seven episodes of fungal infection were identified in pediatric cancer patients (3 months to 18 years).
- Neutropenia was common (76%), but not always present at diagnosis (55%).
- Invasive mycoses (60%) had a 41% mortality rate, higher with mold infections (72%) than yeast (24%).
- Fungal infections, especially molds and invasive mycoses, increased in the latter half of the study period (1985-1990).
- Incidence rose from 2.67 to 5.93 per 10,000 person/day, linked to bone marrow transplantation and construction.
Conclusions:
- Fungal infections, particularly invasive molds, represent a growing concern in pediatric cancer care.
- Increased incidence may be associated with intensive treatments like bone marrow transplantation and environmental factors.
- Proactive surveillance and infection control measures are essential.