8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation

Groll, Andreas H.; Pana, Dorothea; Lanternier, Fanny; Mesini, Alessio; Ammann, Roland A.; Averbuch, Dina; Castagnola, Elio; Cesaro, Simone; Engelhard, Dan; García-Vidal, Carolina; Kanerva, Jukka; Ritz, Nicole; Roilides, Emmanuel; Styczyński, Jan; Warris, Adilia; Lehrnbecher, Thomas

doi:10.1016/s1470-2045(20)30723-3

Cited by 120 publications

(230 citation statements)

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“…Analyses in adults indicate that the performance of galactomannan in BAL is better than that in serum [42]. These data are supported by two pediatric studies [46,47], and the assessment of GM in BAL is recommended as an adjunctive method for diagnosis of invasive pulmonary aspergillosis [23].…”

Section: Galactomannanmentioning

confidence: 70%

“…In one patient each, impaired vision, aphasia, ataxia, hallucination, paresthesia, and seizures were reported. These data indicate that in patients at risk for IFD, further diagnostic work-up including imaging studies with magnetic resonance imaging (MRI) of the brain should be considered in patients with any CNS related symptom or in those with proven or probable IMD outside the CNS [23].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Similarly, subependymal enhancement without ventriculitis was observed in two children, and one of them died, whereas the other survived with severe neurological sequelae. To this end, it is important to mention, that, due to the common dissemination of Aspergillus spp., recent pediatric-specific guidelines recommend to perform a cranial MRI in patients with proven or probable pulmonary aspergillosis [23]. To this end, it is important to mention, that, due to the common dissemination of Aspergillus spp., recent pediatric-specific guidelines recommend to perform a cranial MRI in patients with proven or probable pulmonary aspergillosis [23].…”

Section: Cns Manifestationsmentioning

confidence: 99%

“…Notably, cross-reactivity has been observed with Penicillium, Histoplasma or Fusarium species [45]. Current guidelines recommend prospective monitoring of serum GM twice weekly for early diagnosis of invasive aspergillosis in children at high risk for IFD who do not receive mold-active prophylaxis (A-II), whereas it is discouraged for patients on mold-active prophylaxis (D-IIt) [23]. GM should be assessed in children with prolonged febrile neutropenia and/or abnormalities in chest CT (A-II) [23].…”

Section: Galactomannanmentioning

confidence: 99%

“…Current guidelines recommend prospective monitoring of serum GM twice weekly for early diagnosis of invasive aspergillosis in children at high risk for IFD who do not receive mold-active prophylaxis (A-II), whereas it is discouraged for patients on mold-active prophylaxis (D-IIt) [23]. GM should be assessed in children with prolonged febrile neutropenia and/or abnormalities in chest CT (A-II) [23]. However, careful interpretation of the test results is necessary due to limitations such as poor positive predictive values which mean that actions based on test results are often incorrect and due to the fact that negative test results do not rule out infections due to non-Aspergillus molds.…”

Section: Galactomannanmentioning

confidence: 99%

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Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment

Luckowitsch

Rudolph

Bochennek

et al. 2021

JoF

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The incidence of invasive mold disease (IMD) has significantly increased over the last decades, and IMD of the central nervous system (CNS) is a particularly severe form of this infection. Solid data on the incidence of CNS IMD in the pediatric setting are lacking, in which Aspergillus spp. is the most prevalent pathogen, followed by mucorales. CNS IMD is difficult to diagnose, and although imaging tools such as magnetic resonance imaging have considerably improved, these techniques are still unspecific. As microscopy and culture have a low sensitivity, non-culture-based assays such as the detection of fungal antigens (e.g., galactomannan or beta-D-glucan) or the detection of fungal nucleic acids by molecular assays need to be validated in children with suspected CNS IMD. New and potent antifungal compounds helped to improve outcome of CNS IMD, but not all agents are approved for children and a pediatric dosage has not been established. Therefore, studies have to rapidly evaluate dosage, safety and efficacy of antifungal compounds in the pediatric setting. This review will summarize the current knowledge on diagnostic tools and on the management of CNS IMD with a focus on pediatric patients.

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Section: Galactomannanmentioning

confidence: 70%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Cns Manifestationsmentioning

confidence: 99%

Section: Galactomannanmentioning

confidence: 99%

Section: Galactomannanmentioning

confidence: 99%

See 3 more Smart Citations

Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment

Luckowitsch

Rudolph

Bochennek

et al. 2021

JoF

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Ultrasonography is an effective method for evaluating hepatosplenic fungal infections in pediatric onco‐hematological patients

Zhang,

Nie,

et al. 2024

J of Clinical Ultrasound

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PurposeThis prospective study assessed the value of ultrasonography (US) in the evaluation of hepatosplenic fungal infections (HSFI).MethodsThirty‐two pediatric participants with confirmed onco‐hematological diseases and HSFI were included. Lesions in the liver and/or spleen were detected by US, magnetic resonance imaging (MRI), or computed tomography (CT).ResultsOf the participants, 11 (34%) had confirmed HSFI, while 21 (66%) had highly suspected HSFI. The US, CT, MRI, and fungal blood cultures demonstrated positive results in 31, 19, 25, and 7 patients, respectively. US had a significantly higher detection rate than CT, MRI, and fungal blood cultures (p < 0.05). The “bull's eye” phenomenon was a distinctive US feature of HSFI. Follow‐up examinations indicated that after a mean of 7.7 (1–15) months, liver and/or spleen lesions disappeared in five patients. The lesion was significantly smaller in 10 patients. Residual calcifications were detected in 15 patients. Two patients died.ConclusionConclusively, the US may substitute for tissue biopsy, other imaging modalities, or fungal blood culture for the confirmation of HSFI, and may guide better antifungal treatment, thus achieving better outcomes.

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Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10‐year review

Yeoh

Moore

Kotecha

et al. 2021

Pediatric Blood & Cancer

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Background Invasive fungal disease (IFD) is a common and important complication in children with acute myeloid leukaemia (AML). We describe the epidemiology of IFD in a large multicentre cohort of children with AML. Methods As part of the retrospective multicentre cohort TERIFIC (The Epidemiology and Risk factors for Invasive Fungal Infections in immunocompromised Children) study, proven/probable/possible IFD episodes occurring in children with primary or relapsed/refractory AML from 2003 to 2014 were analysed. Crude IFD prevalence, clinical characteristics, microbiology and treatment were assessed. Kaplan–Meier survival analysis was used to estimate 6‐month survival. Results There were 66 IFD episodes diagnosed in 63 children with AML. The majority (75.8%) of episodes occurred in the context of primary AML therapy. During primary AML therapy, the overall prevalence was 20.7% (95% CI 15.7%–26.5%) for proven/probable/possible IFD and 10.3% (95% CI 6.7%–15.0%) for proven/probable IFD. Of primary AML patients, 8.2% had IFD diagnosed during the first cycle of chemotherapy. Amongst pathogens implicated in proven/probable IFD episodes, 74.4% were moulds, over a third (37.9%) of which were non‐Aspergillus spp. Antifungal prophylaxis preceded 89.4% of IFD episodes, most commonly using fluconazole (50% of IFD episodes). All‐cause mortality at 6 months from IFD diagnosis was 16.7% with IFD‐related mortality of 7.6% (all in cases of proven IFD). Conclusions IFD is a common and serious complication during paediatric AML therapy. Mould infections, including non‐Aspergillus spp. predominated in this cohort. A systematic approach to the identification of patients at risk, and a targeted prevention strategy for IFD is needed.

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8th European Conference on Infections in Leukaemia: 2020 guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation

Cited by 120 publications

References 123 publications

Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment

Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment

Ultrasonography is an effective method for evaluating hepatosplenic fungal infections in pediatric onco‐hematological patients

Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10‐year review

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