Prospective study on fungemia in children with cancer: analysis of 35 cases and comparison with 130 fungemias in adults

Abstract

The aim of this prospective study on fungemia in children with cancer compared with adults with cancer appearing during the last 10 years in a pediatric hospital and in national cancer institutions was to investigate risk factors, etiology, therapy, complications and outcome. Univariate analysis showed significant differences in 35 children with cancer and fungemia in comparison with 130 cases of fungemias in adults with cancer. It was found that (1) therapy with corticosteroids (40 vs 18.5%, P<0.03), (2) breakthrough fungemia during ketoconazole prophylaxis (20 vs 7.7%, P<0.025), and (3) meningitis as a complication of fungemia (11.4 vs 0.8%, P< 0.001) occurred more frequently in the pediatric subgroup with fungemia. Candida albicans was more common as the causative agent of fungemia among adults (58.5 vs 37.1, P<0.02) than in children. However, mortality was similar in children with cancer and in adults with cancer and fungemia (31.4 vs 23.1%, NS). Comparison of risk factors revealed no differences between adults and children with cancer and fungemia except in etiology, breakthrough fungemia during prophylaxis with ketoconazole, prior therapy with corticosteroids and meningitis as a complication. The outcome was also similar in pediatric and adult cancer patients with fungal bloodstream infection.

Outcome of severe sepsis in pediatric oncology patients*

“…As previously reported, fungal sepsis was strongly associated with ICU mortality (41)(42)(43). On the other hand, the relatively low mortality rate (9%) associated with Gram-negative sepsis was somewhat unanticipated.…”

Epidemiology, Outcomes, and Costs of Invasive Aspergillosis in Immunocompromised Children in the United States, 2000

“…[6][7][8][9][10][11] Similar to many other disease processes, studies of adult patients with invasive fungal infections may not be relevant in pediatric patients. 12 For example, with invasive candidiasis, there are differences in isolated Candida species and antifungal susceptibilities, 13 risk factors, 14,15 treatment, 16 and outcomes 14,17 between pediatric and adult patients. Little is known about the epidemiology, risk factors, outcome, and costs of IA in a large cohort of pediatric patients.…”

Deep cutaneous fungal infections in immunocompromised children

“…C albicans fungemia was more frequent in immunocompromised adults than in children identified with other Candida species. 6,7 A review of cutaneous mold infections in pediatric patients in Houston, TX (1991TX ( -2000 showed that neonates were involved in 50% of the cases and that extremely low birth weight (ELBW) premature infants, immunocompromised hosts, and cutaneous trauma were major risk factors. 5 This study reports DCFI in 26 pediatric patients ( # 18 years old) given a diagnosis in a pediatric tertiary care center in Montreal, Quebec, Canada, and describes their clinical characteristics, the diagnostic methods used, and patient outcomes.…”