Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors.

Abstract

We evaluated the courses of 115 consecutive cases of pediatric acute leukemia treated with induction chemotherapy. Seventy-two patients developed fever associated with neutropenia; 15 developed systemic fungal infections. We reviewed multiple demographic and treatment characteristics of these patients in an attempt to identify potential risk factors for the development of invasive fungal disease (IFD). Risk factors identified in a univariate analysis included duration of neutropenia after first fever (P less than .0001), diagnosis of acute nonlymphocytic leukemia (ANLL) (P = .003), onset of fever and neutropenia within 5 days of starting induction chemotherapy (P = .009), and multiple (greater than one) surveillance culture sites positive for fungal organisms (P = .02). In a multiple logistic regression analysis, duration of neutropenia (P less than .001) remained a significant risk factor. The study group of patients had a significantly higher risk of fungal infections than a matched group of leukemia patients developing fever with neutropenia due to postremission consolidation chemotherapy (P = .003). In the first 48 patients, 14 (29%) developed IFD. In the subsequent patients (n = 24), intravenous miconazole (5 mg/kg every 8 hours) was begun at the time of the first fever. One of the 24 patients (4%) given miconazole developed IFD. The use of miconazole was a negative risk factor for the development of IFD in univariate (P = .01) and multivariate (P = .05) analysis. We conclude that pediatric leukemia patients who develop fever associated with neutropenia during induction chemotherapy are at high risk for developing IFD. The role of intravenous miconazole at the time of the first fever in this group deserves further study.

Incidence of Fungal Infections in Pediatric Patients with Hematologic Neoplasms

“…The real-time PCR assay provides a high sensitivity and specificity for the detection of fungal DNA and rapidly identifies most of clinically relevant Aspergillus species (20). Many studies have reported the correlation between the presence of proven, probable, and possible criteria of IFIs according to the EORTC-MSG criteria and PCR results of the respective patients' sera (17,21,22). The results of the present study show 5/8 patients with proven and 5/6 patients with probable criteria.…”

The Ins and Outs of DNA Fingerprinting the Infectious Fungi

“…are carried as commensals into hospital settings by patients, health care workers, and visitors. Particular groups of patients in intensive care units are at risk, especially bone marrow transplant recipients and other groups of immunosuppressed patients (24,47,154,165,302,402,414,421). Surveillance studies indicate that the frequency of BSI and other forms of invasive candidiasis acquired in hospital settings continues to increase (24,264).…”

Combined detection of mannanaemia and anti-mannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species

“…Several Candida species are pervasive pathogens capable of causing systemic infection in critically ill and severely immunocompromised patients [1][2][3][4]. In the 1980s, Candida species were reported to be the seventh most common nosocomial pathogens hospitalwide, ranking fourth in intensive care units (ICUs) where they accounted for c. 10% of all bloodstream infections [5][6][7].…”