Related Experiment Videos
Histoplasmosis in a pediatric oncology center
1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. Elisabeth.Adderson@stjude.org
Insights
Diagnosing histoplasmosis in pediatric cancer patients is challenging due to non-specific symptoms and insensitive tests. However, prompt treatment with antifungals leads to good outcomes, though cancer therapy may be altered.
Area of Science:
- Mycology
- Pediatric Oncology
- Infectious Diseases
Background:
- Histoplasmosis is a fungal infection that can pose diagnostic challenges in immunocompromised patients.
- Pediatric cancer patients in endemic areas are at risk for invasive fungal infections like histoplasmosis.
Purpose of the Study:
- To describe the clinical presentation and management of histoplasmosis in children undergoing cancer treatment.
- To evaluate diagnostic methods and treatment outcomes for histoplasmosis in this vulnerable population.
Main Methods:
- Retrospective review of clinical data from pediatric patients diagnosed with histoplasmosis.
- Analysis of diagnostic test utilization, treatment regimens, and patient outcomes.
Main Results:
- Sixty-one episodes of histoplasmosis occurred in 57 pediatric cancer patients (76% male, 64% with acute lymphocytic leukemia).
- Diagnosis was often delayed, with mean times of 20.6 days (pulmonary) and 18.6 days (disseminated).
- Histopathologic examination and urine antigen tests were most effective; most patients received amphotericin B followed by azoles, with no deaths attributed to histoplasmosis.
Conclusions:
- Available diagnostic tests for histoplasmosis often lack sensitivity in pediatric cancer patients.
- Delayed diagnosis complicates patient care, but outcomes after appropriate antifungal treatment are generally favorable.
- Cancer therapy modifications were common, and many patients received unnecessary antibacterial drugs.
Objective:
To understand the presentation and current management of histoplasmosis in a pediatric oncology center. Study design Retrospective review of clinical features of patients with histoplasmosis at a tertiary-care cancer center in an endemic area.
Results:
Between 1988 and 2001, 57 patients with cancer had 61 episodes of acute histoplasmosis. Of these, 76% were male, and 64% had acute lymphocytic leukemia (ALL). Most were not neutropenic and had nonspecific febrile illnesses. The most rapid and specific tests for histoplasmosis in patients with cancer were histopathologic examination of lung biopsy specimens in patients with localized pulmonary infection and Histoplasma sp. antigen detection in the urine of patients with disseminated histoplasmosis (DH). The mean times to diagnosis were 20.6+/-15.2 days (pulmonary) and 18.6+/-8.2 days (disseminated) after the onset of symptoms. Most patients were treated with amphotericin B (AmB) followed by azole drugs for a mean of 8.5+/-3.1 weeks (pulmonary) and 10.4+/-7.9 weeks (disseminated). No patient died of histoplasmosis, but cancer therapy often was modified because of the infection. Most received unnecessary antibacterial drugs.
Conclusions:
Most readily available diagnostic tests for histoplasmosis lack sensitivity in these patients. Delay in diagnosis of histoplasmosis complicates care. No deaths were attributed to histoplasmosis; outcomes after treatment are good.
