A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers

Carlesse, Fabianne; Daudt, Liane Esteves; Seber, Adriana; Dutra, Álvaro Pimenta; Melo, Analy Salles de Azevedo; Simões, Belinda Pinto; Macedo, Carla Renata Donato Pacheco; Bonfim, Carmem; Benites, Eliana Carla Armelin; Gregianin, Lauro José; Batista, Marjorie Vieira; Abramczyk, Marcelo Luiz; Tostes, Vivian Siqueira; Lederman, Henrique Manoel; Lee, Maria Lúcia de Martino; Loggetto, Sandra Regina; Castro, Cláudio Galvão de; Colombo, Arnaldo Lopes

doi:10.1016/j.bjid.2019.09.005

Cited by 8 publications

(9 citation statements)

References 99 publications

(214 reference statements)

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“…There are no treatment guidelines for patients with invasive fusariosis and because of the lack of clinical trials, the optimal strategy remains unclear. Retrospective studies describe the use of voriconazole as first-line therapy, followed by amphotericin B [21]. Data on combination therapy are limited to sporadic reports and little evidence is available to define standard guidelines.…”

Section: Discussionmentioning

confidence: 99%

Systemic Fusariosis: A Rare Complication in Children with Acute Lymphoblastic Leukemia

Biddeci

Donà

Geranio

et al. 2020

JoF

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Fusarium species are ubiquitous pathogens causing opportunistic infections in immunocompromised patients. Clinical presentation depends on a host’s immunity and can be localized or disseminated. Since there are few reports of disseminated fusariosis in children, we described an unusual case of Fusarium solani infection in a 9-year-old child with acute lymphoblastic leukemia (ALL). This patient presented a deep wound in the elbow at diagnosis. During the induction phase of chemotherapy, he developed multiple skin lesions and severe pneumonia; Fusarium solani was cultured from the skin lesions. He was treated with a high dose of liposomal amphotericin B, followed by voriconazole. Starting from this peculiar case, we collected all patients with acute leukemia affected by Fusarium infection, treated in the pediatric Onco-Hematology Division of Padua University Hospital during the last 20 years. We identified another six cases: all these patients were affected by acute myeloid leukemia (AML) and five of them presented a relapsed/refractory disease. Two out of seven patients died because of infection; five patients recovered from infection, but three out of seven died because of leukemia. Skin lesions in immunocompromised patients should rise the suspicion of disseminated fusariosis. Furthermore, considering the emergence of filamentous fungi in immunocompromised patients, we all should be aware of Fusarium infection, reminding us that the diagnosis is important to cure the infection.

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Section: Discussionmentioning

confidence: 99%

Systemic Fusariosis: A Rare Complication in Children with Acute Lymphoblastic Leukemia

Biddeci

Donà

Geranio

et al. 2020

JoF

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“…The standard diagnostic tools used in the clinical setting to diagnose IFIs are summarised in Table 3. To date, more comprehensive reviews are available that provide details on the most relevant and applicable diagnostic techniques currently used in the clinical settings [199][200][201][202][203][204]. [195,197,199,205,[213][214][215]…”

Section: Diagnostic Methods Based On Properties Of the Fungal Cellmentioning

confidence: 99%

“…Additionally, immediate correction of metabolic disorders or abnormalities in patients with uncontrolled diabetes is mandatory in suspected mucormycosis cases. Surgical intervention for the complete removal of infected tissue in urgent cases significantly improves patient outcome [199,202,204,223]. Only four classes of antifungal medications are currently available for the treatment of IFIs, these are: polyenes, pyrimidine analogue, echinocandins and triazoles [207,210,224].…”

Section: Antifungal Treatment and Iron Chelation Therapymentioning

confidence: 99%

“…For Cryptococcal infections, the gold standard antifungal drugs include the polyenes, flucytosine (5-FC), triazoles and their combinations [226,227]. Treatment options for invasive aspergillosis include voriconazole, liposomal amphotericin B (LAMB) and most recently isavuconazole [199,228,229]. In mucormycosis, the lipid formulations of AMB, i.e., LAMB and AMB lipid complex, (AMLC) is the optimal treatment option [199,202,204,222,228,230].…”

Section: Antifungal Treatment and Iron Chelation Therapymentioning

confidence: 99%

“…Treatment options for invasive aspergillosis include voriconazole, liposomal amphotericin B (LAMB) and most recently isavuconazole [199,228,229]. In mucormycosis, the lipid formulations of AMB, i.e., LAMB and AMB lipid complex, (AMLC) is the optimal treatment option [199,202,204,222,228,230]. It is important to note that Mucoralean fungi are innately resistant to most antifungals in vitro, including voriconazole [231].…”

Section: Antifungal Treatment and Iron Chelation Therapymentioning

confidence: 99%

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Iron Assimilation during Emerging Infections Caused by Opportunistic Fungi with emphasis on Mucorales and the Development of Antifungal Resistance

Stanford

Voigt

2020

Genes

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Iron is a key transition metal required by most microorganisms and is prominently utilised in the transfer of electrons during metabolic reactions. The acquisition of iron is essential and becomes a crucial pathogenic event for opportunistic fungi. Iron is not readily available in the natural environment as it exists in its insoluble ferric form, i.e., in oxides and hydroxides. During infection, the host iron is bound to proteins such as transferrin, ferritin, and haemoglobin. As such, access to iron is one of the major hurdles that fungal pathogens must overcome in an immunocompromised host. Thus, these opportunistic fungi utilise three major iron acquisition systems to overcome this limiting factor for growth and proliferation. To date, numerous iron acquisition pathways have been fully characterised, with key components of these systems having major roles in virulence. Most recently, proteins involved in these pathways have been linked to the development of antifungal resistance. Here, we provide a detailed review of our current knowledge of iron acquisition in opportunistic fungi, and the role iron may have on the development of resistance to antifungals with emphasis on species of the fungal basal lineage order Mucorales, the causative agents of mucormycosis.

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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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A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers

Cited by 8 publications

References 99 publications

Systemic Fusariosis: A Rare Complication in Children with Acute Lymphoblastic Leukemia

Systemic Fusariosis: A Rare Complication in Children with Acute Lymphoblastic Leukemia

Iron Assimilation during Emerging Infections Caused by Opportunistic Fungi with emphasis on Mucorales and the Development of Antifungal Resistance

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

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