Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

Abstract

Fungal diseases are an important cause of mortality in immunocompromised hosts, and their incidence in pediatric cancer patients in low- to middle-income countries is underestimated. In this review, we present relevant, up-to-date information about the most common opportunistic and endemic fungal diseases among children with cancer, their geographic distribution, and recommended diagnostics and treatment. Efforts to improve the care of children with cancer and fungal disease must address the urgent need for sustainable and cost-effective solutions that improve training, fungal disease testing capability, and the use of available resources. We hope that the collective information presented here will be used to advise healthcare providers, regional and country health leaders, and policymakers of the current challenges in diagnosing and treating fungal infections in children with cancer in low- to middle-income countries.

Fungal infections in hematopoietic stem cell transplantation in children at a pediatric children’s hospital in Argentina

“…Platelet >×10 9 /L 21 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 17 (15)(16)(17)(18)(19)(20)(21)(22)(23) We found that blood was the most common site of infection, which is consistent with the predominance of yeasts observed in our study. However, this finding is in contrast to reports in which lung is the most common primary site, which is expected for populations with a high risk of Aspergillus.…”

“…Although survival was worse among those who experienced IFI, only 1 patient died directly due to a fungal infection. It is harder to compare our IFI rates to those of low-or middleincome country centers because little data have been published Median days to engraftment (IQR) ANC > 0.5×10 9 /L 16 (13)(14)(15)(16)(17)(18)(19)(20) 17 (13)(14)(15)(16)(17)(18)(19)(20)(21) .27…”

“…Platelet > 20×10 9 /L 29 (19-48) 25 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) .27…”

“…2,[14][15][16][17] Epidemiological description of IFIs in low-and middle-income countries is often particularly challenging because of the limited availability of diagnostic tools such as imaging equipment, fungal biomarkers, and biopsy capabilities; therefore, there is a paucity of data regarding IFI incidence in Latin America. [18][19][20][21] However, these tools have been available in our center for almost 20 years; thus, our center is well-positioned to address this gap in the literature.…”

Rare modification in the ergosterol biosynthesis pathway leads to amphotericin B resistance inCandida aurisclinical isolates

“…Antifungal treatment of C. auris infections is further complicated by several factors, including the scale of azole resistance (e.g. 90% of C. auris isolates in the U.S. are fluconazole-resistant) (9), emergence of multidrug resistance involving two or more drug classes (19,20), and scarce availability of first-line therapy drugs, echinocandins, in resource-limited countries (21). Thus, a better understanding of the scale and molecular mechanism of AmB resistance in C. auris is urgently needed.…”