Epidemiology of invasive fungal infections in immunocompromised children; an Australian national 10‐year review

Abstract

Background A thorough understanding of local and contemporary invasive fungal infection (IFI) epidemiology in immunocompromised children is required to provide a rationale for targeted prevention and treatment strategies. Methods Retrospective data over 10 years from four tertiary pediatric oncology and hematopoietic stem cell transplant (HSCT) units across Australia were analyzed to report demographic, clinical, and mycological characteristics of IFI episodes, and crude IFI prevalence in select oncology/HSCT groups. Kaplan–Meier survival analyses were used to calculate 180‐day overall survival. Results A total of 337 IFI episodes occurred in 320 children, of which 149 (44.2%), 51 (15.1%), and 110 (32.6%) met a modified European Organization for Research and Treatment of Cancer (mEORTC) criteria for proven, probable, and possible IFI, respectively. There were a further 27 (8.0%) that met a “modified possible IFI” criteria. Median age at IFI diagnosis was 8.4 years. Crude mEORTC IFI prevalence in acute lymphoblastic leukemia, acute myeloid leukemia, solid tumor, and allogeneic HSCT cohorts was 10.6%, 28.2%, 4.4%, and 11.7%, respectively. Non‐Aspergillus species represented 48/102 (47.1%) molds identified, and non‐albicans Candida represented 66/93 (71.0%) yeasts identified. There were 56 deaths among 297 children who met mEORTC criteria, with 180‐day overall survival for proven, probable, and possible IFIs of 79.7%, 76.2%, and 84.4%, respectively. Conclusion Non‐Aspergillus molds and non‐albicans Candida contributed substantially to pediatric IFI in our study, with high IFI prevalence in leukemia and allogeneic HSCT cohorts. Inclusion of IFIs outside of European Organization for Research and Treatment of Cancer criteria revealed an IFI burden that would go otherwise unrecognized in published reports.

Epidemiology and outcome of invasive fungal disease in children after hematopoietic cell transplantation or treated for malignancy: Impact of national programme of antifungal prophylaxis

“…On the other hand, the necessity of prolonged therapy reflects the intensity of the disease resulting in adverse outcome of IFD. The dissemination of the disease or clinical resistance of fungi might lead to prolonged therapy and to higher mortality …”

Invasive Pulmonary Aspergillosis

“…Cases of IA have also been reported in pediatric patients with solid tumor with a very low incidence or prevalence. 73,74 Rare cases of IA have been reported in patients with solid tumor treated with targeted anticancer therapies: gefitinib (epidermal growth factor receptor tyrosine kinase inhibitor), 75 bevacizumab (antivascular endothelial growth factor monoclonal antibody), 76,77 pembrolizumab and nivolumab (anti-PD-1 receptor monoclonal antibody), 78,79 temsirolimus (inhibitor of m-TOR). 80 An acute progression of a chronic pulmonary aspergillosis has been observed in a patient receiving nivolumab.…”

Breakthrough invasive candidiasis in pediatric patient with Ewing’s sarcoma: dinical case report and literature review

“…ИМ фоновыми заболеваниями были солидные опухоли, наиболее частыми -нейробластома (5,3 %), саркомы (2,5 %) и опухоли центральной нервной системы (1,5 %) [18].…”

“…Следует отметить, что у пациентов с солидными опухолями, в том числе с СЮ, превалирующими патогенами ИК являются C. albicans, Candida parapsilosis, C. krusei, Candida tropicalis, Candida lusitaniae [15,18,[20][21][22] и в ряде исследований подчеркивается доминирование видов не-albicans [18,23]. В исследовании J. J. Hawkshead и соавт.…”