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Martín V, de la Haba RR, López-Cornejo P, López-López M, Antonio Lebrón J, Bernal E, Baeza N, Ruiz S, José Ostos F, Merino-Bohorquez V, Chevalier S, Lesouhaitier O, Tahrioui A, José Montes F, Sánchez-Carrasco T, Luisa Moyá M. Synergistic antifungal activity against Candida albicans between voriconazole and cyclosporine a loaded in polymeric nanoparticles. Int J Pharm 2024; 664:124593. [PMID: 39168289 DOI: 10.1016/j.ijpharm.2024.124593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
The goal of this work is to investigate if the synergistic antifungal activity between cyclosporine A, CsA, and voriconazole, VRZ, increases when both drugs are encapsulated in a nanocarrier as compared when they are free. The preparation and characterization of blank and VRZ and CsA loaded polymeric based PLGA nanoparticles (PLGA, PLGA-PEG, and PLGA+PEG) was a necessary previous step. Using the more suitable NPs, those of PLGA, the antifungal susceptibility tests performed with VRZ-loaded PLGA NPs, show no significant increase of the antifungal activity in comparison to that of free VRZ. However, the synergistic behavior found for the (VRZ+CsA)-loaded PLGA NPs was fourfold stronger than that observed for the two free drugs together. On the other hand, the investigation into the suppression of C. albicans biofilm formation showed that blank PLGA NPs inhibit the biofilm formation at high NPs concentrations. However, a minor effect or even a slight biofilm increase formation was observed at low and moderate NPs concentrations. Therefore, the enhancement of the biofilm inhibition found for the three tested treatments (CsA alone, VRZ alone, and VRZ+CsA) when comparing free and encapsulated drugs, within the therapeutic window, can be attributed to the drug encapsulation approach. Indeed, polymeric PLGA NPs loaded with CsA, VRZ, or VRZ+CsA are more effective at inhibiting the C. albicans biofilm growth than their free counterparts.
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Affiliation(s)
- Victoria Martín
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Rafael R de la Haba
- Departament of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, C/Profesor García González 2, Seville 41012, Spain
| | - Pilar López-Cornejo
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Manuel López-López
- Department of Chemical Engineering, Physical Chemistry and Materials Science, Faculty of Experimental Sciences, University of Huelva, Campus de El Carmen, Avda. de las Fuerzas Armadas s/n, Huelva 21071, Spain
| | - José Antonio Lebrón
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Eva Bernal
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Natalia Baeza
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Sara Ruiz
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Francisco José Ostos
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Vicente Merino-Bohorquez
- Department of Pharmacology, University of Seville, C/Profesor García González 2, Seville 41012, Spain
| | - Sylvie Chevalier
- Univ Rouen Normandie, Université Caen Normandie, Normandie Univ, CBSA UR4312, Rouen F-76000, France
| | - Olivier Lesouhaitier
- Univ Rouen Normandie, Université Caen Normandie, Normandie Univ, CBSA UR4312, Rouen F-76000, France
| | - Ali Tahrioui
- Univ Rouen Normandie, Université Caen Normandie, Normandie Univ, CBSA UR4312, Rouen F-76000, France
| | - Francisco José Montes
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - Teresa Sánchez-Carrasco
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain
| | - María Luisa Moyá
- Department of Physical Chemistry, University of Seville, C/Profesor García González 1, Seville 41012, Spain.
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Yeoh DK, Haeusler GM, Slavin MA, Kotecha RS. Challenges and considerations for antifungal prophylaxis in children with acute myeloid leukemia. Expert Rev Hematol 2024; 17:679-686. [PMID: 39110722 DOI: 10.1080/17474086.2024.2390639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/06/2024] [Indexed: 09/21/2024]
Abstract
INTRODUCTION Children receiving treatment for acute myeloid leukemia (AML) are at high risk of invasive fungal disease (IFD). Evidence from pediatric studies support the efficacy of antifungal prophylaxis in reducing the burden of IFD in children receiving therapy for AML, yet existing antifungal agents have specific limitations and comparative data to inform the optimal prophylactic approach are lacking. AREAS COVERED This review summarizes the epidemiology of invasive fungal disease (IFD) and current antifungal prophylaxis recommendations for children with acute myeloid leukemia (AML). Challenges with currently available antifungal agents and considerations related to the changing landscape of AML therapy are reviewed. A keyword search was conducted to identify pediatric studies regarding IFD and antifungal prophylaxis in children with AML up to December 2023. EXPERT OPINION Children undergoing treatment for AML are recommended to receive antifungal prophylaxis to reduce risk of IFD, with tolerability, pharmacokinetics, feasibility of administration, and drug interactions all factors that require consideration in this context. With increased use of novel targeted agents for AML therapy, together with the development of new antifungal agents, data from well-designed clinical studies to optimize prophylactic approaches will be essential to limit the burden of IFD in this vulnerable cohort.
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Affiliation(s)
- Daniel K Yeoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Australia
| | - Monica A Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
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Kushner LE, Schwenk HT, Qin F, Boothroyd D, Aftandilian C. Application of cell-free DNA fungal polymerase chain reaction for invasive fungal disease evaluation in pediatric oncology and stem cell transplant patients. Pediatr Blood Cancer 2024; 71:e31133. [PMID: 38943234 DOI: 10.1002/pbc.31133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/19/2024] [Accepted: 05/21/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Molecular diagnostics may enable early, noninvasive detection of invasive fungal disease (IFD) in immunocompromised patients. Cell-free deoxyribonucleic acid (cfDNA) fungal polymerase chain reaction (PCR) assays were recently incorporated into institutional prolonged febrile neutropenia pathways. We aimed to evaluate the performance of plasma cfDNA PCR panels (mold and Candida panels) in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients with clinical concern for IFD. METHODS This single-center, observational study assessed plasma cfDNA fungal PCR performance for noninvasive IFD detection in hospitalized pediatric oncology and HSCT patients. The primary outcome was IFD diagnosis per published consensus definitions within 1 month. Positive and negative agreement between plasma cfDNA fungal PCR and consensus definitions were calculated. We also described test turnaround time and patient survival. RESULTS From October 2021 to 2022, 54 patients underwent 60 evaluations with 11 proven/probable IFD cases. Comparing plasma cfDNA fungal PCRs to consensus definitions for proven/probable IFD, there was 73% positive agreement and 96% negative agreement. Two proven/probable cases with negative PCRs were caused by organisms not included on either panel. Median time to cfDNA fungal PCR result was 35 hours (interquartile range: 19-69) in eight proven/probable cases detected by cfDNA fungal PCR. There were 17 deaths among 54 patients, and IFD contributed to 45% of deaths in patients with proven/probable IFD. CONCLUSIONS Plasma cfDNA fungal PCRs detected relevant molds or yeast in most cases classified as proven/probable IFD. However, this targeted approach missed some cases. More studies are required to determine optimal utilization of molecular diagnostics in pediatric patients.
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Affiliation(s)
- Lauren E Kushner
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hayden T Schwenk
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, USA
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University, Palo Alto, California, USA
| | - Derek Boothroyd
- Quantitative Sciences Unit, Stanford University, Palo Alto, California, USA
| | - Catherine Aftandilian
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Shaheen M, Lei GS, Relich RF, González IA. Clinicopathologic Characterization of Invasive Fungal Intestinal Infections in Pediatric Patients. Pediatr Dev Pathol 2024:10935266241272564. [PMID: 39215520 DOI: 10.1177/10935266241272564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Invasive fungal intestinal infections are rare in pediatric patients with limited studies reported to date. METHODS Retrospective study of invasive intestinal fungal infections in pediatric patients. For fungal specification, 18S rRNA gene PCR was performed using formalin-fixed paraffin-embedded tissues. RESULTS A total of 19 cases from 18 patients were included (13 males, 72%) with a median age of 20 days (8 days-14 years). About 13 patients (72%) presented within 67 days of birth and 11 patients (61%) were premature and 14 patients (78%) had a significant medical history. The most common location was the jejunum/ileum (56%) followed by the right colon and terminal ileum (22%). In 10 patients, the fungal elements were seen in the mucosa with 3 extending into the submucosa, and only 3 patients showed full-thickness involvement. Tissue necrosis and angioinvasion were seen in 13 (72%) and 8 (44%) patients, respectively. Morphologically, organisms consistent with Candida spp. were seen in 17 patients and with a mucoraceous mold in 1 patient. A 18S rRNA gene sequencing performed in 18 cases identified Candida dubliniensis in 16 cases and Candida spp. in 2 cases. During the study follow-up period, 56% of the patients died. CONCLUSION In our experience, most cases were due to Candida spp. and predominantly in premature infants and associated with poor outcomes.
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Affiliation(s)
- Muhammad Shaheen
- Department of Pathology and Laboratory Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Guang-Sheng Lei
- Department of Pathology and Laboratory Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ryan F Relich
- Department of Pathology and Laboratory Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Iván A González
- Department of Pathology and Laboratory Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Panagopoulou P, Roilides E. An update on pharmacotherapy for fungal infections in allogeneic stem cell transplant recipients. Expert Opin Pharmacother 2024; 25:1453-1482. [PMID: 39096057 DOI: 10.1080/14656566.2024.2387686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Invasive fungal diseases (IFD) constitute a major cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. AREAS COVERED We describe epidemiology, causes and risk factors of IFD in allogeneic HSCT discussing prophylaxis and treatment in various HSCT phases. We present the most recent studies on this thematic area, including novel data on currently available antifungals, i.e. formulations, dosing, safety, efficacy and therapeutic drug monitoring. Finally, we present the most recent relevant recommendations published. Literature search included PubMed, Scopus, and clinicaltrials.gov between January 2014 and April 2024. EXPERT OPINION The antifungal agents employed for prophylaxis and therapy should be predicated on local epidemiology of IFD. Fluconazole prophylaxis remains a first-line choice before engraftment when the main pathogen is Candida spp. After engraftment, prophylaxis should be with mold-active agents (i.e. triazoles). For candidiasis, echinocandins are suggested as first-line treatment, whereas aspergillosis responds well to mold-active azoles and liposomal amphotericin B (L-AmB). For mucormycosis, treatment of choice includes L-AmB and isavuconazole. Choice between fever-driven and diagnostics-driven strategies remains equivocal. Open research topics remain: 1) optimization of tools to ensure prompt and accurate IFD diagnosis to avoid unnecessary exposure to antifungals, drug interactions and cost; 2) refinement of treatment for resistant/refractory strains.
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Affiliation(s)
- Paraskevi Panagopoulou
- Pediatric Hematology & Oncology, 4th Department of Pediatrics, Aristotle University School of Medicine and Papageorgiou General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine and Hippokration General Hospital, Thessaloniki, Greece
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Federica F, Elisa Z, Maria Grazia P, Calogero V, Patrizia DI, Maria Caterina P, Marica DP, Piergiorgio G, DeCorti F. Surgical treatment of invasive fungal infection in pediatric oncology. Eur J Haematol 2024; 113:90-98. [PMID: 38558136 DOI: 10.1111/ejh.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Invasive fungal disease (IFD) is typically aggressive and related with high mortality in children with a hematological malignancy. The association of medical and surgical treatment may ameliorate the outcome. The aim of this study was to analyze the surgical treatment of fungal infections in pediatric oncological populations. METHODS Retrospective study (2000-2022) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies and IFD, analyzing the outcome. RESULTS From the 70 pediatric cases of hematologic malignancies with the diagnosis IFD over 22 years, we included in the present study 44 cases who required surgical approaches for either diagnosis or treatment. Twenty-one patients were males and the mean age was 11 (range 1-23) years. The main indications for surgery were lack of improvement following medical treatment and/or progression of fungal infection (80%) and diagnosis confirmation (20%). Only five patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%) and the most frequently identified pathogen was Aspergillus (75%). The most common surgical procedures were lobectomy (performed in 17 patients) and atypical lung resection (10). Complications of surgery were mostly treated by medical approach. The mean time of resumption of oncological treatment was 40 (range 0-150) days. CONCLUSIONS Surgery is an important step in the multimodal treatment of invasive fungal infection with excellent resolution rate. Overall mortality depends on the underlying malignancy.
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Affiliation(s)
- Fati Federica
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Zambaiti Elisa
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatric Surgery, Pediatric Hospital Regina Margherita, Turin, Italy
| | - Petris Maria Grazia
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - Virgone Calogero
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Dall' Igna Patrizia
- Division of Pediatric Surgery, Department of Emergencies and Organ Transplantation, Bari University, Bari, Italy
| | - Putti Maria Caterina
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - De Pieri Marica
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gamba Piergiorgio
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Federica DeCorti
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
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Jain N, Ryan AL, Haeusler GM, McMullan BJ, Moore AS, Bartlett AW, Blyth CC, Kotecha RS, Yeoh DK, Clark JE. Invasive fungal disease in children with solid tumors: An Australian multicenter 10-year review. Pediatr Blood Cancer 2024; 71:e31031. [PMID: 38679843 DOI: 10.1002/pbc.31031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Invasive fungal disease (IFD) occurs less frequently during treatment for solid compared to hematological malignancies in children, and risk groups are poorly defined. Retrospective national multicenter cohort data (2004-2013) were analyzed to document prevalence, clinical characteristics, and microbiology of IFD. Amongst 2067 children treated for solid malignancy, IFD prevalence was 1.9% overall and 1.4% for proven/probable IFD. Of all IFD episodes, 42.5% occurred in patients with neuroblastoma (prevalence 7.0%). Candida species comprised 54.8% of implicated pathogens in proven/probable IFD. In children with solid tumors, IFD is rare, and predominantly caused by yeasts.Routine prophylaxis may not be warranted.
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Affiliation(s)
- Neha Jain
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anne L Ryan
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
- The Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Brendan J McMullan
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Andrew S Moore
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Julia E Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
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Zhang W, Nie W, Li B, Wang H. Ultrasonography is an effective method for evaluating hepatosplenic fungal infections in pediatric onco-hematological patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38761012 DOI: 10.1002/jcu.23730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This prospective study assessed the value of ultrasonography (US) in the evaluation of hepatosplenic fungal infections (HSFI). METHODS Thirty-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). RESULTS Of 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. CONCLUSION Conclusively, 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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Affiliation(s)
- Wenhua Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Wei Nie
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Bin Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Hui Wang
- Department of Special Examination, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Fonseca SNS. Overview of invasive fungal infections in children in South America - the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis. Curr Opin Pediatr 2024; 36:136-143. [PMID: 38299979 DOI: 10.1097/mop.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Invasive fungal infection (IFI) in children is a growing problem with crescent morbidity and mortality, well recognized in developed countries, affecting mainly immunocompromised children, including neonates and children in intensive care units. The burden of IFI in South American children is less well comprehended. In addition, the current epidemiology of endemic systemic mycoses in children may have changed over time. RECENT FINDINGS Candida spp. infections are very prevalent in South America hospitalized children, especially in neonates, in a rate far superior compared to developed countries. C. auris, has already been responsible for outbreaks in neonates and children in Venezuela and Colombia. Sporotrichosis is well established as an urban zoonosis in impoverish families. Paracoccidioidomycosis and histoplasmosis are affecting new areas of Brazil, probably due to climate change, deforestation, and human migration. SUMMARY This review aims to unveil the real dimension of these infections in South American children. Hopefully, the awareness brought by this review will help healthcare professionals to recognize IFI more easily and it will provide support for getting more resources for IFI treatment and prevention.
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Affiliation(s)
- Silvia Nunes Szente Fonseca
- Department of Pediatrics and Pediatric Infectious Diseases, Escola de Medicina Estácio-Idomed, Ribeirão Preto, São Paulo State, Brazil
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Whitehurst DA, Friedman DL, Zhao Z, Sarma A, Snyder E, Dulek DE, Banerjee R, Kitko CL, Esbenshade AJ. A comprehensive assessment of the prolonged febrile neutropenia evaluation in pediatric oncology patients. Pediatr Blood Cancer 2024; 71:e30818. [PMID: 38110594 DOI: 10.1002/pbc.30818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Pediatric oncology patients with prolonged (≥96 hours) febrile neutropenia (absolute neutrophil count < 500/μL) often undergo an evaluation for invasive fungal disease (IFD) and other infections. Current literature suggests that beta-D-glucan (BDG), galactomannan, bronchoalveolar lavage (BAL), and computed tomography (CT) scans (sinus, chest, and abdomen/pelvis) may help determine a diagnosis in this population. METHODS In a retrospective cohort study of all cancer/stem cell transplant patients (diagnosed 2005-2019) from one pediatric hospital, all episodes with prolonged febrile neutropenia or IFD evaluations (defined as sending a fungal biomarker or performing a CT scan to assess for infection) were identified. RESULTS In total, 503 episodes met inclusion criteria and 64% underwent IFD evaluations. In total, 36.4% of episodes documented an infection after initiation of prolonged febrile evaluation, most commonly Clostridioides difficile colitis (6.4%) followed by a true bacterial bloodstream infection (BSI) (5.2%), proven/probable IFD (4.8%), and positive respiratory pathogen panel (3.6%). There was no difference in sinus CTs showing sinusitis (74% vs 63%, p = 0.46), whereas 32% of abdomen/pelvis CTs led to a non-IFD diagnosis, and 25% of chest CTs showed possible pneumonia. On chest CT, the positive predictive value (PPV) for IFD was 19% for nodules and 14% for tree and bud lesions. BDG had a PPV of 25% for IFD and GM 50%. BAL diagnosed IFD once and pneumocystis jirovecii pneumonia twice. CONCLUSIONS Chest CTs and abdomen/pelvis CTs provide clinically relevant information during the prolonged febrile neutropenia evaluation, whereas BDG, galactomannan, BAL, and sinus CTs have less certain utility.
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Affiliation(s)
| | - Debra L Friedman
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Snyder
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Ritu Banerjee
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Carrie L Kitko
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Adam J Esbenshade
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Pediatric Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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11
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Das S, Capoor MR, Singh A, Agarwal Y. Diagnostic Utility of Galactomannan Enzyme Immunoassay in Invasive Aspergillosis in Pediatric patients with Hematological Malignancy. Mycopathologia 2023; 188:1055-1063. [PMID: 37806994 DOI: 10.1007/s11046-023-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study aims to determine the diagnostic utility of galactomannan enzyme immunoassay (GM EIA) in invasive aspergillosis (IA) in children with hematological malignancy (high risk population) in terms of sensitivity, specificity, negative predictive value (NPV) and positive predictive values (PPV) at various cut offs while validating the revised EORTC/MSG 2019 criteria in order to obtain the best cut-off. MATERIAL AND METHODS For 100 pediatric patients, serum and respiratory samples were collected. Clinical, mycological workup (potassium-hydroxide mount, fungal culture) and GM EIA was done to classify proven, probable, and possible IA as per EORTC-MSG guidelines,2019. Sensitivity, specificity, PPV and NPV were calculated of GM indices at cut-off 0.5, 0.7 and 1, and validated with revised EORTC -MSG, 2019. RESULTS Of 100 patients enrolled, 75 were diagnosed with ALL, 14 with AML, two with Hodgkin's, three had non-Hodgkin lymphoma, and six had undifferentiated leukemia. With routine mycological findings, 51 were classified as probable IA, 11 as possible IA, and 38 as no IA. Aspergillus flavus was the most prevalent on culture (56.9%, 29/51) followed by A. fumigatus (29%, 15/51) A. niger (7.8%, 4/51), A. terreus (3.9%, 2/51) and A. nidulans (2%, 1/51). GM EIA demonstrated sensitivity 82.3%, specificity 97.4%, PPV 98.1%, and NPV 77.1% at cut-off 0.67 when comparing probable/possible IA v/s no IA groups. The GM EIA had the best sensitivity (82.4%), specificity (81.8%), PPV (95.5%), and NPV (50%) at cut off 0.78 when the probable IA group was compared to the possible IA. Seven patients succumbed of whom 5 had GMI ≥ 2. CONCLUSION This study deduces the optimal cut-off for serum GM EIA to be 0.67 obtained by ROC analysis when comparing possible and probable IA versus no IA and reinforces the definition of probable category of EORTC-MSG criteria, 2019. At 0.5 ODI the sensitivity (87.1%) and NPV (80.5%) are high, thus making it the most suitable cut-off for detecting true positive and ruling out IA respectively, in pediatric patients with hematological malignancy. GM EIA when performed adjunctive to clinico-radiological findings can prove to be screening, diagnostic and prognostic test for IA in pediatric hematological malignancy patients.
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Affiliation(s)
- Sutapa Das
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Malini R Capoor
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India.
| | - Amitabh Singh
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Yatish Agarwal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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12
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Schladerer SP, Otth M, Scheinemann K. Quality criteria for pediatric oncology centers: A systematic literature review. Cancer Med 2023; 12:18999-19012. [PMID: 37584279 PMCID: PMC10557895 DOI: 10.1002/cam4.6452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Survival of children and adolescents diagnosed with cancer improved over the last decades due to better diagnostics, treatment, and supportive care. Quality criteria that measure, compare, and make the quality of care of individual pediatric oncology centers more transparent are heterogeneous and inconsistent. AIM With this systematic review, we aimed to summarize existing quality criteria for pediatric oncology centers in countries with highly developed health-care systems. METHODS We searched three databases for publications, and websites for guidelines about quality criteria for pediatric oncology centers in February 2022. We considered all types of publications except expert opinions. We excluded publications not focusing on highly developed health-care systems, addressing the certification of professionals, or focusing on subspecialties (e.g., pediatric neuro-oncology). We discarded quality criteria if they were too specific (e.g., for a specific treatment center), too broad (e.g., national 5-year overall survival), or if the aspect was covered by standardized clinical procedures or at the national level. We grouped the identified criteria thematically. RESULTS We identified 18 publications and guideline documents with 530 criteria, of which 201 fulfilled the inclusion criteria. The combination of similar criteria resulted in 90 overarching criteria, which we assigned to the following categories: facilities and networks, multidisciplinary team and other experts, supportive care, treatment, long-term care, and volume and numbers. CONCLUSION Our results provide a comprehensive overview of existing quality criteria for pediatric oncology in countries with highly developed health-care systems. These criteria can serve as a basis to develop national quality criteria in pediatric oncology.
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Affiliation(s)
- Sarah P. Schladerer
- Faculty of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | - Maria Otth
- Faculty of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
- Pediatric Hematology‐Oncology CenterChildren's Hospital of Eastern SwitzerlandSt GallenSwitzerland
- Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene TherapyUniversity Children's Hospital Zurich‐Eleonore FoundationZurichSwitzerland
| | - Katrin Scheinemann
- Faculty of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
- Pediatric Hematology‐Oncology CenterChildren's Hospital of Eastern SwitzerlandSt GallenSwitzerland
- Department of PediatricsMcMaster Children's Hospital and McMaster UniversityHamiltonCanada
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13
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Otto WR, Arendrup MC, Fisher BT. A Practical Guide to Antifungal Susceptibility Testing. J Pediatric Infect Dis Soc 2023; 12:214-221. [PMID: 36882026 PMCID: PMC10305799 DOI: 10.1093/jpids/piad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
We review antifungal susceptibility testing and the development of clinical breakpoints, and detail an approach to using antifungal susceptibility results when breakpoints have not been defined. This information may prove helpful when selecting therapy for invasive fungal infections in children.
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Affiliation(s)
- William R Otto
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Brian T Fisher
- Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Ricard N, Zebali L, Renard C, Goutagny MP, Benezech S, Bertrand Y, Philippe M, Domenech C. New Perspectives on Primary Prophylaxis of Invasive Fungal Infection in Children Undergoing Hematopoietic Stem Cell Transplantation: A 10-Year Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15072107. [PMID: 37046769 PMCID: PMC10093632 DOI: 10.3390/cancers15072107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Allogenic hematopoietic stem cell transplantation (a-HCT) remains a therapeutic treatment for many pediatric hematological diseases. The occurrence of invasive fungal infections (IFIs) is a complication for which ECIL-8 recommends primary antifungal prophylaxis. In this study, we evaluated the impact of our local strategy of not systematically administering primary antifungal prophylaxis in children undergoing a-HCT on the occurrence and mortality of IFIs. Methods: We performed a retrospective monocentric study from 2010 to 2020. We retained all proven and probable IFIs diagnosed during the first year post a-HCT. Results: 308 patients were included. Eighteen patients developed twenty IFIs (thirteen proven, seven probable) (6.5%) among which aspergillosis (n = 10, 50%) and candidosis (n = 7, 35%) were the most frequently diagnosed infections. Only 2% of children died because of an IFI, which represents 14% of all deaths. Multivariate analysis found that age > 10 years (OR: 0.29), the use of a therapeutic antiviral treatment (OR: 2.71) and a low neutrophil count reconstitution (OR: 0.93) were significantly associated with the risk of IFI occurrence. There was also a trend of malignant underlying disease and status ≥ CR2 but it was not retained in multivariate analysis. Conclusions: IFI occurrence was not higher in our cohort than what is reported in the literature with the use of systematic antifungal prophylaxis, with a good survival rate nonetheless. Thus, a prophylaxis could be considered for children with a high risk of IFI such as those aged over 10 years.
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Affiliation(s)
- Noémi Ricard
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
| | - Lelia Zebali
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Cécile Renard
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Marie-Pierre Goutagny
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Sarah Benezech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Yves Bertrand
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Michael Philippe
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Carine Domenech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine and Maieutics Charles Mérieux Lyon Sud, Université Claude Bernard Lyon 1, 69921 Lyon, France
- International Center of Research in Infectiology, Université Lyon 1, INSERM U 1111, CNRS UMR 5308, 69007 Lyon, France
- Correspondence: ; Tel.: +33-469-166-567; Fax: +33-478-782-703
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15
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Otto WR, Dvorak CC, Boge CLK, Ostrosky-Zeichner L, Esbenshade AJ, Nieder ML, Alexander S, Steinbach WJ, Dang H, Villaluna D, Chen L, Skeens M, Zaoutis TE, Sung L, Fisher BT. Prospective Evaluation of the Fungitell® (1→3) Beta-D-Glucan Assay as a Diagnostic Tool for Invasive Fungal Disease in Pediatric Allogeneic Hematopoietic Cell Transplantation: A Report from the Children's Oncology Group. Pediatr Transplant 2023; 27:e14399. [PMID: 36299233 PMCID: PMC9885553 DOI: 10.1111/petr.14399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Invasive fungal disease (IFD) is a major source of morbidity and mortality for hematopoietic cell transplant (HCT) recipients. Non-invasive biomarkers, such as the beta-D-glucan assay, may improve the diagnosis of IFD. The objective was to define the utility of surveillance testing using Fungitell® beta-D-glucan (BDG) assay in children receiving antifungal prophylaxis in the immediate post-HCT period. METHODS Weekly surveillance blood testing with the Fungitell® BDG assay was performed during the early post-HCT period in the context of a randomized trial of children, adolescents, and young adults undergoing allogeneic HCT allocated to triazole or caspofungin prophylaxis. Positivity was defined at the manufacturer cutoff of 80 pg/ml. IFD was adjudicated using blinded central reviewers. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Fungitell® BDG assay for the outcome of proven or probable IFD. RESULTS A total of 51 patients (out of 290 patients in the parent trial) contributed blood specimens. In total, 278 specimens were evaluated. Specificity was 80.8% (95% confidence interval [CI]: 75.6%-85.3%), and NPV was over 99% (95% CI: 86.8%-99.9%). However, there were no true positive results, resulting in sensitivity of 0% (95% CI: 0.0%-84.2%) and PPV of 0% (95% CI: 0.0%-6.7%). CONCLUSIONS Fungitell® BDG screening is of limited utility in diagnosing IFD in the post-HCT period, mainly due to high false-positive rates. Fungitell® BDG surveillance testing should not be performed in children during the early post-HCT period while receiving antifungal prophylaxis as the pretest probability for IFD is low.
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Affiliation(s)
- William R. Otto
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA
| | - Craig L. K. Boge
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, University of Texas-Houston McGovern Medical School, Houston, TX
| | - Adam J. Esbenshade
- Division of Pediatric Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael L. Nieder
- Division of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Sarah Alexander
- Division of Haematology Oncology, The Hospital for Sick Children, Toronto, Ontario
| | - William J. Steinbach
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ha Dang
- Biostatistics and Data Management, Johnson and Johnson Medical Devices Companies, Irvine, CA
| | | | - Lu Chen
- Division of Biostatistics, City of Hope, Duarte, CA
| | - Micah Skeens
- Department of Hematology/Oncology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | | | - Lillian Sung
- Division of Haematology Oncology, The Hospital for Sick Children, Toronto, Ontario
| | - Brian T. Fisher
- Division of Pediatrics Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
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16
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de Almeida Campos L, Fin MT, Santos KS, de Lima Gualque MW, Freire Cabral AKL, Khalil NM, Fusco-Almeida AM, Mainardes RM, Mendes-Giannini MJS. Nanotechnology-Based Approaches for Voriconazole Delivery Applied to Invasive Fungal Infections. Pharmaceutics 2023; 15:pharmaceutics15010266. [PMID: 36678893 PMCID: PMC9863752 DOI: 10.3390/pharmaceutics15010266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Invasive fungal infections increase mortality and morbidity rates worldwide. The treatment of these infections is still limited due to the low bioavailability and toxicity, requiring therapeutic monitoring, especially in the most severe cases. Voriconazole is an azole widely used to treat invasive aspergillosis, other hyaline molds, many dematiaceous molds, Candida spp., including those resistant to fluconazole, and for infections caused by endemic mycoses, in addition to those that occur in the central nervous system. However, despite its broad activity, using voriconazole has limitations related to its non-linear pharmacokinetics, leading to supratherapeutic doses and increased toxicity according to individual polymorphisms during its metabolism. In this sense, nanotechnology-based drug delivery systems have successfully improved the physicochemical and biological aspects of different classes of drugs, including antifungals. In this review, we highlighted recent work that has applied nanotechnology to deliver voriconazole. These systems allowed increased permeation and deposition of voriconazole in target tissues from a controlled and sustained release in different routes of administration such as ocular, pulmonary, oral, topical, and parenteral. Thus, nanotechnology application aiming to delivery voriconazole becomes a more effective and safer therapeutic alternative in the treatment of fungal infections.
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Affiliation(s)
- Laís de Almeida Campos
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Margani Taise Fin
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Kelvin Sousa Santos
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Marcos William de Lima Gualque
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Ana Karla Lima Freire Cabral
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Najeh Maissar Khalil
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
| | - Rubiana Mara Mainardes
- Pharmaceutical Nanotechnology Laboratory, Department of Pharmacy, Midwest State University (UNICENTRO), Alameda Élio Antonio Dalla Vecchia St, 838, Guarapuava 85040-167, PR, Brazil
- Correspondence: (R.M.M.); (M.J.S.M.-G.)
| | - Maria José Soares Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Rodovia Araraquara Jaú, Km 01, Araraquara 14801-902, SP, Brazil
- Correspondence: (R.M.M.); (M.J.S.M.-G.)
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17
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Rahimi F, Amoabediny G, Sabahi H, Zandieh-Doulabi B. Fungal Infected Adipose Stem Cells: The Effects of Novel Lipo-Niosome Nanoparticles Loaded with Amphotericin B and Thymus Essential Oil. CELL JOURNAL 2022; 24:391-402. [PMID: 36043407 PMCID: PMC9428479 DOI: 10.22074/cellj.2022.7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, we aimed to develop new Lipo-niosomes based nanoparticles loaded with Amphotericin B (AmB) and Thymus Essential Oil (TEO) and test their effectiveness in the treatment of fungal-infected human adipose stem cells (hASCs). MATERIALS AND METHODS In this experimental study, optimal formulation of AmB and TEO loaded lipo-niosome (based on lipid-surfactant thin-film hydration method) was chemically, and biologically characterized. Therefore, encapsulation capacity, drug release, size, and the survival rate of cells with different concentrations of free and encapsulated AmB/ TEO were evaluated using the MTT method, and its antifungal activity was compared with conventional AmB. RESULTS Lipo-Niosome containing Tween 60 surfactant: cholesterol: Dipalmitoyl phosphatidylcholine (DPPC): Polyethylene glycol (PEG) with a ratio of 20:40:60:3 were chosen as optimal formulation. Lipo-Niosomes entrapment efficiency was 94.15%. The drug release rate after 24 hours was 52%, 54%, and 48% for Lipo-AmB, Lipo-TEO, and Lipo-AmB/TEO, respectively. Physical and chemical characteristics of the Lipo-Niosomes particles indicated size of 200 nm and a dispersion index of 0.32 with a Zeta potential of -24.56 mv. Furthermore, no chemical interaction between drugs and nano-carriers was observed. The cell viability of adipose mesenchymal stem cells exposed to 50 μg/ml of free AmB, free TEO, and free AmB/TEO was 13.4, 58, and 36.9%, respectively. Whereas the toxicity of the encapsulated formulas of these drugs was 48.9, 70.8, and 58.3% respectively. The toxicity of nanoparticles was very low (8.5%) at this concentration. Fluorescence microscopic images showed that the antifungal activity of Lipo-AmB/ TEO was significantly higher than free formulas of AmB, TEO, and AmB/TEO. CONCLUSION In this study, we investigated the efficacy of the TEO/AmB combination, in both free and encapsulatedniosomal form, on the growth of fungal infected-hASCs. The results showed that the AmB/TEO-loaded Lipo-Niosomes can be suggested as a new efficient anti-fungal nano-system for patients treated with hASCs.
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Affiliation(s)
- Fardin Rahimi
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran,Department of Biomedical Engineering, Research Center for New Technologies in Life Science Engineering, University of Tehran,
Tehran, Iran
| | - Ghasem Amoabediny
- Department of Biomedical Engineering, Research Center for New Technologies in Life Science Engineering, University of Tehran,
Tehran, Iran,School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran,Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers-location Vumc and Academic
Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands,P.O.Box: 14155-6619School of Chemical EngineeringCollege of EngineeringUniversity of TehranTehranIran
| | - Hossein Sabahi
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - Behrouz Zandieh-Doulabi
- Department of Biomedical Engineering, Research Center for New Technologies in Life Science Engineering, University of Tehran,
Tehran, Iran,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), The University of Amsterdam and Vrije Universiteit
Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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18
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Impact of dry hydrogen peroxide on hospital-acquired infection at a pediatric oncology hospital. Am J Infect Control 2021; 50:909-915. [PMID: 34973358 DOI: 10.1016/j.ajic.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aims to describe the effect of Dry Hydrogen Peroxide (DHP), as an adjunct to environmental cleaning and disinfection, on the incidence of hospital-acquired infections (HAIs) at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala City, Guatemala. METHODS A retrospective study of all HAI data from the hospital's surveillance system, which follows Centers for Disease Control and Prevention (CDC) protocols, was conducted from January 2019 to November 2020. DHP was installed in all Pediatric Intensive Care Unit (PICU) rooms in January 2020, but nowhere else in the hospital, including the Intermediate Care Unit (IMCU). RESULTS There were 189 HAI cases during the study period, with 173 occurring in either the PICU or IMCU. A statistically significant decrease in HAI incidence rates occurred in the PICU in 2020 compared to 2019 (P = .028), including Clostridiodes-associated gastroenteritis (P = .048). Logistic multivariate regression yielded a significant association between DHP exposure and reduced odds of developing an HAI during the study (OR = 0.3857, P = .029). CONCLUSION The use of DHP as an adjunct technology for environmental cleaning and disinfection contributed to the reduction in HAIs in the PICU. Our study highlights the value of such an approach as an addition to manual cleaning to decrease the risk of infection from environmental contamination.
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19
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Changing Epidemiology of Invasive Fungal Disease in Allogeneic Hematopoietic Stem Cell Transplantation. J Fungi (Basel) 2021; 7:jof7100848. [PMID: 34682269 PMCID: PMC8539090 DOI: 10.3390/jof7100848] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022] Open
Abstract
Invasive fungal disease (IFD) is a common cause of morbidity and mortality in patients with hematologic malignancies, especially among those undergoing allogeneic hematopoietic stem cell transplantation (HSCT). The epidemiology of IFD in HSCT patients has been evolving over the last decades, mainly in relation to changes in HSCT therapies such as antifungal prophylaxis. A progressive decrease in Candida albicans infection has been documented, alongside a progressive increase in infections caused by non-albicans Candida species, filamentous fungi, and/or multidrug-resistant fungi. Currently, the most frequent IFD is invasive aspergillosis. In some parts of the world, especially in north Central Europe, a high percentage of Aspergillus fumigatus isolates are azole-resistant. New diagnostic techniques have documented the existence of cryptic Aspergillus species with specific characteristics. An increase in mucormycosis and fusariosis diagnoses, as well as diagnoses of other rare fungi, have also been described. IFD epidemiology is likely to continue changing further due to both an increased use of mold-active antifungals and a lengthened survival of patients with HSCT that may result in hosts with weaker immune systems. Improvements in microbiology laboratories and the widespread use of molecular diagnostic tools will facilitate more precise descriptions of current IFD epidemiology. Additionally, rising resistance to antifungal drugs poses a major threat. In this scenario, knowledge of current epidemiology and accurate IFD diagnoses are mandatory in order to establish correct prophylaxis guidelines and appropriate early treatments.
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20
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Ueno R, Nishimura S, Fujimoto G, Ainiwaer D. Healthcare resource utilization and economic burden of antifungal management in patients with hematologic malignancy in Japan: a retrospective database study. Curr Med Res Opin 2021; 37:1121-1134. [PMID: 33989102 DOI: 10.1080/03007995.2021.1927691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine treatment patterns of real-world antifungal management of patients at high risk of invasive fungal infections (IFI) and evaluate healthcare resource utilization and costs associated with antifungal management of IFIs in Japan. METHODS This retrospective, observational study extracted data from a hospital-based claims database for patients in Japan who either (a) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), or (b) were hospitalized with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) and received chemotherapy during the study period of January 2010 to January 2019. RESULTS 863 patients were included in the allo-HSCT cohort and 4498 patients were included in the AML/MDS cohort. In the allo-HSCT cohort, 91% received more than one antifungal drug during the index hospitalization. In the AML/MDS cohort, approximately 50% received more than one antifungal drug during the index hospitalization. For both the allo-HSCT and AML/MDS cohorts, about 90% of the total cost was attributed to inpatient costs. Of note, both the total cost (the total inpatient and outpatient cost) and the index hospitalization costs were higher in patients treated with multiple antifungal drugs than in those treated with a single antifungal drug during the index hospitalization. Despite being at high IFI risk, 12% of the patients in the AML/MDS cohort did not receive antifungal drugs during the index hospitalization. CONCLUSIONS Most patients with hematologic malignancy and high IFI risk underwent complicated antifungal management requiring use of multiple drugs, and accounted for high healthcare resource utilization and costs.
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Tragiannidis A, Kattamis A, Vyzantiadis TA. Invasive Fungal Infections in Children with Haematological Malignancies: Diagnostic and Therapeutic Challenges. J Fungi (Basel) 2021; 7:jof7070516. [PMID: 34203146 PMCID: PMC8305930 DOI: 10.3390/jof7070516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Athanasios Tragiannidis
- Children & Adolescent Haematology-Oncology Unit, Second Department of Paediatrics, Aristotle University of Thessaloniki, AHEPA Hospital, 53646 Thessaloniki, Greece;
| | - Antonios Kattamis
- Paediatric Haematology-Oncology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece;
| | - Timoleon-Achilleas Vyzantiadis
- First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2310-999027
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22
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González-Vicent M, Ramos-Amador JT. [Fungal infection in immunocompromised children]. Rev Iberoam Micol 2021; 38:75-83. [PMID: 34148786 DOI: 10.1016/j.riam.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
In recent years, immunodeficiency condition has experienced a rise among children, who are at risk of invasive fungal infections (IFI) due to their health condition. Cancer, non-malignant hematological diseases, as primary immunodeficiencies, hematopoietic stem cell transplantation (HSCT), extreme prematurity, or critically ill condition in Pediatric Intensive Care Unit (PICU) are some immunosuppressive situations in children. The use of oncologic therapies, including immunotherapy and monoclonal antibodies, for the treatment of the aforementioned health conditions has led to an increase in morbidity and mortality rates of IFI in children. The underlying diseases and their management, comorbidities, the diagnostic tests used (both molecular and imaging), as well as the treatment used can be significantly different between adult patients and children admitted to PICU or with cancer. In pediatrics, the treatment of IFI is based primarily on pharmacokinetic studies performed in adults. In higher risk patients prophylaxis should be considered and, in the case of an IFI diagnosis, an antifungal treatment should be administered as early as possible, supported by the reversion of the immune dysfunction and surgery when appropriate.
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23
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Kim SS, Shin KS. Transcription Factor HSF1 Suppresses the Expression of Surfactant Protein D in Cells Infected with Aspergillus fumigatus. Pathogens 2021; 10:pathogens10060709. [PMID: 34204112 PMCID: PMC8229574 DOI: 10.3390/pathogens10060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Aspergillosis is a life-threatening disease in patients with compromised immune systems. The process of fungal invasion is an important step during host cell infection. We investigated the transcription factor and promoter region of SFTPD, which is activated during the infection process in conidia-treated cells. To investigate the promoter activity of SFTPD in fungal-infected cells, we cloned various lengths of the promoter region (−1000 to +1) of SFTPD and examined its activity in A549 cells treated with Aspergillus fumigatus conidia. We determined the location within the promoter region of SFTPD that exhibits a response to conidia infection. AliBaba 2.1 software was used to predict the transcription factor involved as well as the binding sites in the SFTPD promoter region. The results of a decoy assay show that the HSF1 transcription factor is sufficient to decrease the SFTPD expression. Using chromatin immunoprecipitation, we confirmed that HSF1 directly binds to the selected sequence, which is located in the response region (−142 to −134 bp). These findings suggest that inhibiting the binding of HSF1 to the promoter region of SFTPD is an important step to prevent conidia infection.
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Affiliation(s)
- Sung-Su Kim
- Department of Biomedical Laboratory Science, Daejeon University, Daejeon 34520, Korea
- Correspondence: (S.-S.K.); (K.-S.S.); Tel.: +82-42-280-2903 (S.-S.K.); +82-42-280-2439 (K.-S.S.); Fax: +82-42-280-2904 (S.-S.K.); +82-42-280-2608 (K.-S.S.)
| | - Kwang-Soo Shin
- Department of Microbiology, Graduate School, Daejeon University, Daejeon 34520, Korea
- Correspondence: (S.-S.K.); (K.-S.S.); Tel.: +82-42-280-2903 (S.-S.K.); +82-42-280-2439 (K.-S.S.); Fax: +82-42-280-2904 (S.-S.K.); +82-42-280-2608 (K.-S.S.)
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24
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Kazakou N, Vyzantiadis TA, Gambeta A, Vasileiou E, Tsotridou E, Kotsos D, Giantsidi A, Saranti A, Palabougiouki M, Ioannidou M, Hatzipantelis E, Tragiannidis A. Invasive fungal infections in a pediatric hematology-oncology department: A 16-year retrospective study. Curr Med Mycol 2021; 6:37-42. [PMID: 33628980 PMCID: PMC7888516 DOI: 10.18502/cmm.6.2.2840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised children. The purpose of our study was to evaluate the incidence of IFIs in pediatric patients with underlying hematologic malignancies and determine the patient characteristics, predisposing factors, diagnosis, treatment efficacy, and outcome of IFIs. Materials and Methods For the purpose of the study, a retrospective analysis was performed on cases with proven and probable fungal infections from January 2001 to December 2016 (16 years). Results During this period, 297 children with hematologic malignancies were admitted to the 2nd Pediatric Department of Aristotle University of Thessaloniki, Greece, and 24 cases of IFIs were registered. The most common underlying diseases were acute lymphoblastic leukemia (ALL; n=19,79%), followed by acute myeloid leukemia (AML; n=4, 17%) and non-Hodgkin lymphoma (NHL; n=1,4%). The crude incidence rates of IFIs in ALL, AML, and NHL were 10.5%, 18.2%, and 2.8% respectively. Based on the results, 25% (n=6) and 75% (n=18) of the patients were diagnosed as proven and probable IFI cases, respectively. The lung was the most common site of involvement in 16 (66.7%) cases. Furthermore, Aspergillus and Candida species represented 58.3% and 29.1% of the identified species, respectively. Regarding antifungal treatment, liposomal amphotericin B was the most commonly prescribed therapeutic agent (n=21), followed by voriconazole (n=9), caspofungin (n=3), posaconazole (n=3), micafungin (n=1), and fluconazole (n=1). In addition, 12 children received combined antifungal treatment. The crude mortality rate was obtained as 33.3%. Conclusion As the findings of the present study indicated, despite the progress in the diagnosis and treatment of IFIs with the use of new antifungal agents, the mortality rate of these infections still remains high.
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Affiliation(s)
- Nikoleta Kazakou
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Anastasia Gambeta
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Vasileiou
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Tsotridou
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kotsos
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Giantsidi
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Saranti
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Palabougiouki
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Ioannidou
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuil Hatzipantelis
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Tragiannidis
- nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Porzionato A, Stocco E, Emmi A, Macchi V, De Caro R. Case Report: Sudden Fatal Hemorrhage in Ulcerative Fungal Laryngotracheitis-A Pediatric Case Report. Front Pediatr 2021; 9:764027. [PMID: 35087772 PMCID: PMC8787292 DOI: 10.3389/fped.2021.764027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
In this report, we describe an autopsy case of a child affected by acute lymphoblastic leukemia and opportunistic pulmonary aspergillosis. The patient died because of a full-thickness tracheal wall ulceration with right inferior thyroid artery lesion and sudden hemorrhage, likely ascribable to undiagnosed invasive Aspergillus laryngotracheitis. Aspergillus infection, particularly in immunocompromised patients, should be considered an urgent risk factor to manage as it may lead to sudden fatal events in absence of evident critical symptoms.
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Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Elena Stocco
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Emmi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
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26
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Deshmukh H, Speth C, Sheppard DC, Neurauter M, Würzner R, Lass-Flörl C, Rambach G. Aspergillus-Derived Galactosaminogalactan Triggers Complement Activation on Human Platelets. Front Immunol 2020; 11:550827. [PMID: 33123129 PMCID: PMC7573070 DOI: 10.3389/fimmu.2020.550827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/21/2020] [Indexed: 12/18/2022] Open
Abstract
Invasive fungal infections caused by Aspergillus (A.) and Mucorales species still represent life-threatening diseases in immunocompromised individuals, and deeper knowledge about fungal interactions with elements of innate immunity, such as complement and platelets, appears essential for optimized therapy. Previous studies showed that galactosaminogalactan secreted by A. fumigatus and A. flavus is deposited on platelets, thereby inducing their activation. Since the altered platelet surface is a putative trigger for complement activation, we aimed to study the interplay of platelets with complement in the presence of fungal GAG. Culture supernatants (SN) of A. fumigatus and A. flavus both induced not only GAG deposition but also subsequent deposition of complement C3 fragments on the platelet surface. The SN of a Δuge3 mutant of A. fumigatus, which is unable to synthesize GAG, did not induce complement deposition on platelets, nor did the SN of other Aspergillus species and all tested Mucorales. Detailed analysis revealed that GAG deposition itself triggered the complement cascade rather than the GAG-induced phosphatidylserine exposure. The lectin pathway of complement could be shown to be crucially involved in this process. GAG-induced complement activation on the platelet surface was revealed to trigger processes that might contribute to the pathogenesis of invasive aspergillosis by A. fumigatus or A. flavus. Both pro-inflammatory anaphylatoxins C3a and C5a arose when platelets were incubated with SN of these fungal species; these processes might favor excessive inflammation after fungal infection. Furthermore, platelets were stimulated to shed microparticles, which are also known to harbor pro-inflammatory and pro-coagulant properties. Not only did early processes of the complement cascade proceed on platelets, but also the formation of the terminal complement C5b-9 complex was detected on platelets after incubation with fungal SN. Subsequently, reduced viability of the platelets could be shown, which might contribute to the lowered platelet numbers found in infected patients. In summary, fungal GAG initiates an interplay between complement and platelets that can be supposed to contribute to excessive inflammation, thrombocytopenia, and thrombosis, which are important hallmarks of fatal invasive mycoses.
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Affiliation(s)
- Hemalata Deshmukh
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Speth
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - Donald C Sheppard
- Department of Microbiology and Immunology, McGill University, Montréal, QC, Canada
| | - Magdalena Neurauter
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhard Würzner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - Günter Rambach
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
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