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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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3
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Gal Etzioni TR, Fainshtain N, Nitzan-Luques A, Goldstein G, Weinreb S, Temper V, Korem M, Averbuch D. Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome. Microorganisms 2024; 12:145. [PMID: 38257971 PMCID: PMC10820110 DOI: 10.3390/microorganisms12010145] [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: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Invasive fungal infections (IFI) cause morbidity and mortality in children with acute leukemia (AL). We retrospectively collected data on febrile neutropenic episodes (FNE) in AL children (2016-2021) and assessed factors associated with proven/probable IFI. Ninety-three children developed 339 FNE. Seventeen (18.3%) children developed 19 proven/probable IFI (11 yeast; eight molds). The proven/probable yeast IFI rate was 6/52 (11.5%) in children who belong to the high risk for IFI category (HR-IFI-AL: high-risk acute lymphocytic leukemia (ALL), acute myeloid leukemia, relapse); and 5/41 (12.2%) in the non-HR-IFI-AL category (standard/intermediate risk ALL). The proven/probable mold IFI rate was 7/52 (13.5%) in HR-IFI-AL children and 1/41 (2.4%) in the non-HR-IFI-AL category. In the multivariable analysis, underlying genetic syndrome, oral mucositis, and older age were significantly associated with proven/probable IFI, while a longer time since AL diagnosis was protective. Two of 13 (15.4%) HR-IFI-AL children died because of IFI. The elevated risks of proven/probable mold IFI and the associated mortality in HR-IFI-AL children, and high risk of invasive candidiasis in the non-HR-IFI-AL group, emphasize the need for the close monitoring of local epidemiology and the adjustment of practices accordingly.
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Affiliation(s)
- Tamar Ruth Gal Etzioni
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Nurit Fainshtain
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Adi Nitzan-Luques
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Gal Goldstein
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Sigal Weinreb
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Violeta Temper
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- Pediatric Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
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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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Butters C, Thursky K, Hanna DT, Cole T, Davidson A, Buttery J, Haeusler G. Adverse effects of antibiotics in children with cancer: are short-course antibiotics for febrile neutropenia part of the solution? Expert Rev Anti Infect Ther 2023; 21:267-279. [PMID: 36694289 DOI: 10.1080/14787210.2023.2171987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Febrile neutropenia is a common complication experienced by children with cancer or those undergoing hematopoietic stem cell transplantation. Repeated episodes of febrile neutropenia result in cumulative exposure to broad-spectrum antibiotics with potential for a range of serious adverse effects. Short-course antibiotics, even in patients with high-risk febrile neutropenia, may offer a solution. AREAS COVERED This review addresses the known broad effects of antibiotics, highlights developments in understanding the relationship between cancer, antibiotics, and the gut microbiome, and discusses emerging evidence regarding long-term adverse antibiotic effects. The authors consider available evidence to guide the duration of empiric antibiotics in pediatric febrile neutropenia and directions for future research. EXPERT OPINION Broad-spectrum antibiotics are associated with antimicrobial resistance, Clostridioides difficile infection, invasive candidiasis, significant disturbance of the gut microbiome and may seriously impact outcomes in children with cancer or undergoing allogenic hematopoietic stem cell transplant. Short-course empiric antibiotics are likely safe in most children with febrile neutropenia and present a valuable opportunity to reduce the risks of antibiotic exposure.
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Affiliation(s)
- Coen Butters
- Department of General Paediatrics and Adolescent Medicine, John Hunter Children's Hospital, Newcastle, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Diane T Hanna
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Theresa Cole
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Andrew Davidson
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Anaesthesia, Royal Children's Hospital, Parkville, Australia.,Department of Critical Care, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Australia
| | - Jim Buttery
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia.,Centre for Health Analytics, Melbourne Children's Campus, Parkville, Australia.,Health Informatics Group and SAEFVIC, Murdoch Children's Research Institute, Parkville, Australia
| | - Gabrielle Haeusler
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Parkville, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Parkville, Australia
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Dutra JAP, Maximino SC, Gonçalves RDCR, Morais PAB, de Lima Silva WC, Rodrigues RP, Neto ÁC, Júnior VL, de Souza Borges W, Kitagawa RR. Anti-Candida, docking studies, and in vitro metabolism-mediated cytotoxicity evaluation of Eugenol derivatives. Chem Biol Drug Des 2023; 101:350-363. [PMID: 36053023 DOI: 10.1111/cbdd.14131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 01/14/2023]
Abstract
The high morbidity and mortality rates of Candida infections, especially among immunocompromised patients, are related to the increased resistance rate of these species and the limited therapeutic arsenal. In this context, we evaluated the anti-Candida potential and the cytotoxic profile of eugenol derivatives. Anti-Candida activity was evaluated on C. albicans and C. parapsilosis strains by minimum inhibitory concentration (MIC), scanning electron microscopy (SEM), and molecular docking calculations at the site of the enzyme lanosterol-14-α-demethylase active site, responsible for ergosterol formation. The cytotoxic profile was evaluated in HepG2 cells, in the presence and absence of the metabolizing system (S9 system). The results indicated compounds 1b and 1d as the most active ones. The compounds have anti-Candida activity against both strains with MIC ranging from 50 to 100 μg ml-1 . SEM analyses of 1b and 1d indicated changes in the envelope architecture of both C. albicans and C. parapsilosis like the ones of eugenol and fluconazole, respectively. Docking results of the evaluated compounds indicated a similar binding pattern of fluconazole and posaconazole at the lanosterol-14-α-demethylase binding site. In the presence of the S9 system, compound 1b showed the same cytotoxicity profile as fluconazole (1.08 times) and compound 1d had 1.23 times increase in cytotoxicity. Eugenol and other evaluated compounds showed a significant increase in cytotoxicity. Our results suggest compound 1b as a promising starting point candidate to be used in the design of new anti-Candida agent prototypes.
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Affiliation(s)
- Jessyca Aparecida Paes Dutra
- Graduate Program of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Bonfim, Brazil
| | - Sarah Canal Maximino
- Graduate Program of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Bonfim, Brazil
| | | | - Pedro Alves Bezerra Morais
- Department of Chemistry and Physics, Exact, Natural and Health Sciences Center, Federal University of Espírito Santo, Guararema, Brazil
| | | | - Ricardo Pereira Rodrigues
- Graduate Program of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Bonfim, Brazil
| | - Álvaro Cunha Neto
- Department of Chemistry, Exact Sciences Center, Federal University of Espírito Santo, Goiabeiras, Brazil
| | - Valdemar Lacerda Júnior
- Department of Chemistry, Exact Sciences Center, Federal University of Espírito Santo, Goiabeiras, Brazil
| | - Warley de Souza Borges
- Department of Chemistry, Exact Sciences Center, Federal University of Espírito Santo, Goiabeiras, Brazil
| | - Rodrigo Rezende Kitagawa
- Graduate Program of Pharmaceutical Sciences, Health Sciences Center, Federal University of Espírito Santo, Bonfim, Brazil
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Increased incidence rates of positive blood cultures shortly after chemotherapy compared to radiotherapy among individuals treated for solid malignant tumours. Infection 2023; 51:147-157. [PMID: 35764910 PMCID: PMC9879832 DOI: 10.1007/s15010-022-01863-2] [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: 10/12/2021] [Accepted: 05/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cancer treatments suppress immune function and are associated with increased risk of infections, but the overall burden of serious infectious diseases in treated patients has not been clearly elucidated. METHODS All patients treated for solid malignant tumours with radiotherapy (RT) and/or standard first-line chemotherapy (C) at the Department of Oncology at Rigshospitalet between 01/1/2010 and 31/12/2016 were included. Patients were followed from treatment initiation until the first of new cancer treatment, 1 year after treatment initiation, end of follow-up or death. Incidence rates (IR) of positive blood culture (PBC) per 1000 person-years follow-up (PYFU) were calculated. FINDINGS 12,433 individuals were included, 3582 (29%), 6349 (51%), and 2502 (20%) treated with RT, C, or both RT & C, respectively, contributing 8182 PYFU. 429 (3%) individuals experienced 502 unique episodes of PBC, incidence rate (95% CI) 52.43 (47.7, 57.6) per 1000 PYFU. The 30-day mortality rate after PBC was 24% independent of treatment modality. Adjusted incidence rate ratios in the first 3 months (95% CI) after PBC significantly varied by treatment: 2.89 (1.83, 4.55) and 2.52 (1.53, 4.14) for C and RT & C compared to RT. Escherichia coli (n = 127, 25%) was the top microorganism identified. INTERPRETATION PBCs are not common, but when they occur, mortality is high.
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8
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ÖZEN S, ÖZDEMİR H, TAŞKIN EÇAKMAK, ARGA G, KONCA HK, ÇAKMAKLI HF, HASKOLOĞLU Ş, OKULU E, DİNÇASLAN H, İNCE E, İLERİ T, TAÇYILDIZ N, DOĞU F, EVREN E, US E, KARAHAN ZC, FİTÖZ S, KENDİRLİ T, KULOĞLU Z, TUTAR E, İKİNCİOĞULLARI A, ÜNAL E, ERTEM M, İNCE E, ÇİFTÇİ E. Pediatric Invasive Aspergillosis: A Retrospective Review of 59 Cases. Jpn J Infect Dis 2022; 76:113-119. [PMID: 36450573 DOI: 10.7883/yoken.jjid.2022.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Invasive aspergillosis (IA) is a major cause of morbidity and mortality. This study aimed to present our 10-year IA experience at a single center. Fifty-nine pediatric patients with IA were included in this study. The male-to-female ratio was 42/17. The median age was 8.75 years. Hematologic malignancy was present in the majority of the patients (40/59, 68%). The mean neutropenia duration was 18.5 days. Cytosine arabinoside was the most common immunosuppressive therapy directed at T cells during IA diagnosis. IA cases were categorized as proven (27%), probable (51%), or possible (22%) according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. The lungs (78%) were the most common site of IA, and nodules were the most frequent radiological findings (75.5%). In 38 patients (64.4%) receiving antifungal prophylaxis, prophylactic agents included fluconazole (30.5%), liposomal amphotericin B (23.7%), posaconazole (8.5%), and voriconazole (1.7%). Initial treatment was most commonly administered as monotherapy (69.5%). The median antifungal treatment duration was 67 days. Eleven deaths (18.6%) were due to aspergillosis. With the increased use of corticosteroids, biological agents, and intensive immunosuppressive chemotherapy, IA will most likely continue to occur frequently in pediatric patients.
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Affiliation(s)
- Seval ÖZEN
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | - Halil ÖZDEMİR
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | - Esra ÇAKMAK TAŞKIN
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | - Gül ARGA
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | - Hatice Kübra KONCA
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | | | - Şule HASKOLOĞLU
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Turkey
| | - Emel OKULU
- Division of Neonatology, Ankara University Faculty of Medicine, Turkey
| | - Handan DİNÇASLAN
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Turkey
| | - Elif İNCE
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Turkey
| | - Talia İLERİ
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Turkey
| | - Nurdan TAÇYILDIZ
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Turkey
| | - Figen DOĞU
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Turkey
| | - Ebru EVREN
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Turkey
| | - Ebru US
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Turkey
| | - Zeynep Ceren KARAHAN
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Turkey
| | - Suat FİTÖZ
- Department of Radiology, Ankara University Faculty of Medicine, Turkey
| | - Tanıl KENDİRLİ
- Division of Pediatric Intensive Care, Ankara University Faculty of Medicine, Turkey
| | - Zarife KULOĞLU
- Division of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Turkey
| | - Ercan TUTAR
- Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Turkey
| | - Aydan İKİNCİOĞULLARI
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Turkey
| | - Emel ÜNAL
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Turkey
| | - Mehmet ERTEM
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Turkey
| | - Erdal İNCE
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
| | - Ergin ÇİFTÇİ
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Turkey
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9
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Maertens J, Pagano L, Azoulay E, Warris A. Liposomal amphotericin B-the present. J Antimicrob Chemother 2022; 77:ii11-ii20. [PMID: 36426672 PMCID: PMC9693760 DOI: 10.1093/jac/dkac352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Most invasive fungal infections are opportunistic in nature but the epidemiology is constantly changing, with new risk groups being identified. Neutropenia is a classical risk factor for fungal infections, while critically ill patients in the ICU are now increasingly at risk of yeast and mould infections. Factors to be considered when choosing antifungal treatment include the emergence of rarer fungal pathogens, the risk of resistance to azoles and echinocandins and the possibility of drug-drug interactions. Liposomal amphotericin B has retained its place in the therapeutic armamentarium based on its clinical profile: a broad spectrum of antifungal activity with a low risk of resistance, predictable pharmacokinetics with a rapid accumulation at the infection site (including biofilms), a low potential for drug-drug interactions and a low risk of acute and chronic treatment-limiting toxicities versus other formulations of amphotericin B. It is a suitable choice for the first-line empirical or pre-emptive treatment of suspected fungal infections in neutropenic haematology patients and is an excellent alternative for patients with documented fungal disease who can no longer tolerate or continue their first-line azole or echinocandin therapy, both in the haematology setting and in the ICU. Moreover, it is the first-line drug of choice for the treatment of invasive mucormycosis. Finally, liposomal amphotericin B is one of the few antifungal agents approved for use in children of all ages over 1 month and is included in paediatric-specific guidelines for the management of fungal disease.
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Affiliation(s)
- J Maertens
- Department of Hematology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.,Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - L Pagano
- Sezione di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, APHP, University of Paris, Paris, France
| | - A Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK.,Great Ormond Street Hospital, Paediatric Infectious Diseases Unit, London, UK
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10
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Infections fongiques invasives chez l’enfant immunodéprimé en hématologie pédiatrique : recommandations de prise en charge au sein des centres de la SFCE. Bull Cancer 2022; 109:1109-1124. [DOI: 10.1016/j.bulcan.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
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11
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Paecilomyces/Purpureocillium Infection in Children, Case Report, and Review of the Literature. J Fungi (Basel) 2022; 8:jof8090930. [PMID: 36135655 PMCID: PMC9501290 DOI: 10.3390/jof8090930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Paecilomyces/Purpureocillium has recently been recognized as an emerging human pathogen, causing serious infection in immunocompromised and immunocompetent patients. Several predisposing factors have been reported, including foreign body implants, previous surgery, or trauma. Treatment with antifungal drugs often fails as species-specific differences in antifungal susceptibilities are one of the management challenges. Surgical debridement with or without antifungal therapy was sufficient to cure the infection in a few reported cases. Nonetheless, the surgical approach has been found to decrease the chance of dissemination and recurrence. Here, we report the first pediatric patient with chronic osteomyelitis of the femur secondary to Paecilomyces species, with no predisposing risk factors. Our case was successfully treated with a combination of antifungal therapy and surgical debridement. Additionally, we describe the first extensive literature review of previously reported Paecilomyces/Purpureocillium species infections in pediatric age groups.
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12
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Liu Y, Zhang X, Yue T, Tang Y, Ke Z, Li Y, Luo X, Huang L. Combination of C-Reactive Protein and Procalcitonin in Distinguishing Fungal from Bacterial Infections Early in Immunocompromised Children. Antibiotics (Basel) 2022; 11:antibiotics11060730. [PMID: 35740137 PMCID: PMC9219757 DOI: 10.3390/antibiotics11060730] [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: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Invasive fungal infection (IFI) is life-threatening in children with cancer and hematology disorders, especially when diagnosis and treatment are delayed. Conventional β-D-glucan and galactomannan tests have poor positive predictive values in the diagnosis of IFI in children with cancer. This study aims to access the diagnostic performance of C-reactive protein (CRP) and procalcitonin (PCT) in differentiating IFI from bacterial bloodstream infections in children with malignant and hematology disorders. CRP and PCT levels were measured in samples taken from patients between 12 and 24 h after fever onset, of which 24 and 102 were in the IFI and bacterial groups, respectively. We found that the CRP levels were much higher in the IFI group than the bacterial group (100.57 versus 40.04 mg/L, median, p < 0.001), while the PCT levels remained significantly lower (0.45 versus 1.29 μg/L, median, p = 0.007). Both CRP and PCT showed significant diagnostic utilities with an area under the curve (AUC) of 0.780 (95% CI, 0.664−0.896, p < 0.001) and 0.731 (95% CI, 0.634−0.828, p < 0.001) when using the cut-off values of 94.93 mg/L and 2.00 μg/L, respectively. However, the combined biomarker of CRP and PCT yielded a better diagnostic performance with an AUC of 0.934 (95% confidential interval (CI), 0.881−0.987, p < 0.001), which was significantly higher than that of CRP or PCT (both p < 0.001), with a sensitivity of 87.5% and a specificity of 87.3%. Our study demonstrates high levels of CRP combined with low PCT could differentiate IFI from bacterial bloodstream infections in immunocompromised children.
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Affiliation(s)
| | | | | | | | | | | | - Xuequn Luo
- Correspondence: (X.L.); (L.H.); Tel.: +86-20-87338822 (L.H.); Fax: +86-20-87755766 (L.H.)
| | - Libin Huang
- Correspondence: (X.L.); (L.H.); Tel.: +86-20-87338822 (L.H.); Fax: +86-20-87755766 (L.H.)
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13
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Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
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14
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Antifungal Combination Therapy for Invasive Fungal Infections in a Paediatric Oncology and Haematology Department: A Retrospective Analysis of Practice. J Mycol Med 2022; 32:101276. [DOI: 10.1016/j.mycmed.2022.101276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
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15
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Epidemiology of Fungal Colonization in Children Treated at the Department of Oncology and Hematology: Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042485. [PMID: 35206670 PMCID: PMC8872470 DOI: 10.3390/ijerph19042485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/07/2022]
Abstract
Oncological patients are especially predisposed to fungal infections due to multiple risk factors and immunocompromising treatment. Epidemiological research regarding pediatric oncologic patients is still insufficient, and existing data are difficult to generalize on different populations. Therefore, we aimed to analyze fungal infections and fungal epidemiology in the Department of Oncology and Hematology of the University Children’s Hospital in Krakow with help from the Clinical Microbiology Department. During the chosen period of 2005 and 2015–2020, 2342 tests were performed in our ward on 847 patients. Analyzed samples were divided into five source groups. The amount of patients with positive test results was 62.5%. The year with the highest detection level was 2005. The most frequent pathogen was Candida albicans, with a significant decrease in tendency. An increase in non-albicans species was observed. Candida parapsilosis was not frequently observed compared to similar studies. We noticed an increase in positive results from the urinary tract material. Our results confirmed that fungal infections are still an issue, and they may indicate the efficacy of prophylaxis. The majority of our results are consistent with the literature, yet we managed to emphasize data unique to our patients’ population. Our findings are helpful in clinical work and for further studies in our center.
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16
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Invasive Trichosporonosis in Neonates and Pediatric Patients with Malignancies or Hematologic Disorders. Pathogens 2022; 11:pathogens11020242. [PMID: 35215184 PMCID: PMC8875650 DOI: 10.3390/pathogens11020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Trichosporon species have emerged as important opportunistic fungal pathogens, with Trichosporon asahii being the leading and most frequent cause of invasive disease. (2) Methods: We performed a global review focused on invasive trichosporonosis in neonates and pediatric patients with malignancies or hematologic disorders. We reviewed case reports and case series of trichosporonosis due to T. asahii published since 1994, the year of the revised taxonomic classification. (3) Results: Twenty-four cases of invasive trichosporonosis were identified in neonates with the presence of central venous catheter and use of broad-spectrum antibiotics recognized as the main predisposing factors. Thirty-two cases were identified in children with malignancies or hematologic disorders, predominantly with severe neutropenia. Trichosporon asahii was isolated from blood in 24/32 (75%) pediatric cases. Cutaneous involvement was frequently observed in invasive trichosporonosis. Micafungin was the most commonly used prophylactic agent (9/22; 41%). Ten patients receiving prophylactic echinocandins were identified with breakthrough infections. A favorable outcome was reported in 12/16 (75%) pediatric patients receiving targeted monotherapy with voriconazole or combined with liposomal amphotericin B. Overall mortality in neonates and children with malignancy was 67% and 60%, respectively. (4) Conclusions: Voriconazole is advocated for the treatment of invasive trichosporonosis given the intrinsic resistance to echinocandins and poor susceptibility to polyenes.
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17
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Central Nervous System Fungal Infections in Paediatric Patients. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-021-00427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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19
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Hall MW, Carcillo JA, Cornell T. Immune System Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics 2022; 149:S91-S98. [PMID: 34970674 PMCID: PMC9166150 DOI: 10.1542/peds.2021-052888n] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Immune system dysfunction is poorly represented in pediatric organ dysfunction definitions. OBJECTIVE To evaluate evidence for criteria that define immune system dysfunction in critically ill children and associations with adverse outcomes and develop consensus criteria for the diagnosis of immune system dysfunction in critically ill children. DATA SOURCES We conducted electronic searches of PubMed and Embase from January 1992 to January 2020, using medical subject heading terms and text words to define immune system dysfunction and outcomes of interest. STUDY SELECTION Studies of critically ill children with an abnormality in leukocyte numbers or function that is currently measurable in the clinical laboratory in which researchers assessed patient-centered outcomes were included. Studies of adults or premature infants, animal studies, reviews and commentaries, case series (≤10 subjects), and studies not published in English with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from eligible studies into a standard data extraction form along with risk of bias assessment by a task force member. RESULTS We identified the following criteria for immune system dysfunction: (1) peripheral absolute neutrophil count <500 cells/μL, (2) peripheral absolute lymphocyte count <1000 cells/μL, (3) reduction in CD4+ lymphocyte count or percentage of total lymphocytes below age-specific thresholds, (4) monocyte HLA-DR expression <30%, or (5) reduction in ex vivo whole blood lipopolysaccharide-induced TNFα production capacity below manufacturer-provided thresholds. LIMITATIONS Many measures of immune system function are currently limited to the research environment. CONCLUSIONS We present consensus criteria for the diagnosis of immune system dysfunction in critically ill children.
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Affiliation(s)
- Mark W. Hall
- Division of Critical Care Medicine, Department of Pediatrics, College of Medicine, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio
| | - Joseph A. Carcillo
- Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh and Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Timothy Cornell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children’s Hospital Stanford, Palo Alto, California
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20
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Hannemann M, Wilmes D, Dombrowski F, Löffler J, Kaminski A, Hummel A, Ulm L, Bohnert J, Rickerts V, Springer J, Lode HN, Ehlert K. Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report. Front Pediatr 2022; 10:1060663. [PMID: 36533236 PMCID: PMC9755516 DOI: 10.3389/fped.2022.1060663] [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] [Received: 10/03/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribution and the expected poor outcome of invasive fusariosis. Particularly, splenic rupture as a complication of disseminated disease has not been reported yet. CASE PRESENTATION Two weeks after allogeneic HSCT for severe aplastic anemia, a 16-year-old boy presented with painful, erythematous skin nodules affecting the entire integument. As disseminated mycosis was considered, treatment with liposomal amphotericin B and voriconazole (VCZ) was initiated. Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies. Microbiological tests revealed Fusarium solani species. Despite stable neutrophil engraftment and uninterrupted treatment with VCZ, he developed mold disease-associated splenic rupture with hypovolemic shock and fungal endocarditis. The latter induced a cardiac thrombus and subsequent embolic cerebral infarctions with unilateral hemiparesis. Following cardiac surgery, the patient did not regain consciousness because of diffuse cerebral ischemia, and he died on day +92 after HSCT. CONCLUSION Invasive fusariosis in immunocompromised patients is a life-threatening condition. Despite antimycotic treatment adapted to antifungal susceptibility testing, the patient reported here developed uncommon manifestations such as splenic rupture and fungal endocarditis.
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Affiliation(s)
- Maurice Hannemann
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Dunja Wilmes
- Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Frank Dombrowski
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Kaminski
- Department for Heart and Vascular Surgery, Klinikum Karlsburg, Karlsburg, Germany
| | - Astrid Hummel
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Lena Ulm
- Institute of Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen Bohnert
- Institute of Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Volker Rickerts
- Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Jan Springer
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Karoline Ehlert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
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21
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Dutta A, Ikwuezunma A, Castellanos MI, Brackett J, Reddy K, Mahajan P, Marshburn AM, Kamdar K, Paek H, Palazzi DL, Rabin KR, Scheurer ME, Gramatges MM. An evidence-based, risk-adapted algorithm for antifungal prophylaxis reduces risk for invasive mold infections in children with hematologic malignancies. Pediatr Blood Cancer 2021; 68:e29228. [PMID: 34268879 DOI: 10.1002/pbc.29228] [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] [Received: 05/04/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with hematologic malignancies, especially those who receive intensive chemotherapy, are at high risk for invasive mold infections (IMI) that confer substantial mortality. Randomized controlled trials support the use of antifungal prophylaxis with antimold activity as an optimal strategy for risk reduction in this population, but studies outlining the practical application of evidence-based recommendations are lacking. PROCEDURE We conducted a 15-year, single-institution retrospective review in a diverse cohort of children with hematologic malignancies treated with chemotherapy to determine the incidence of proven or probable IMI diagnosed between 2006 and 2020. Multivariable logistic regression was used to identify host and disease factors associated with IMI risk. We then compared the incidence and type of IMI and related factors before and after 2016 implementation of an evidence-based, risk-adapted antifungal prophylaxis algorithm that broadened coverage to include molds in patients at highest risk for IMI. RESULTS We identified 61 cases of proven or probable IMI in 1456 patients diagnosed with hematologic malignancies during the study period (4.2%). Implementation of an antifungal prophylaxis algorithm reduced the IMI incidence in this population from 4.8% to 2.9%. Both Hispanic ethnicity and cancer diagnosis prior to 2016 were associated with risk for IMI. CONCLUSION An evidence-based, risk-adapted approach to antifungal prophylaxis for children with hematologic malignancies is an effective strategy to reduce incidence of IMI.
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Affiliation(s)
- Ankhi Dutta
- Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ashley Ikwuezunma
- University of Texas Medical School, Rio Grande Valley, Edinburg, Texas, USA
| | - Maria I Castellanos
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Julienne Brackett
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kiranmye Reddy
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Priya Mahajan
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Ann M Marshburn
- Department of Pediatrics, Division of Pediatric Hospital Medicine, UTHealth Science Center, Houston, Texas, USA
| | - Kala Kamdar
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Hana Paek
- Department of Pharmacy, Texas Children's Hospital, Houston, Texas, USA
| | - Debra L Palazzi
- Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Karen R Rabin
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Department of Pediatrics, Section of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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22
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Yeoh DK, Moore AS, Kotecha RS, Bartlett AW, Ryan AL, Cann MP, McMullan BJ, Thursky K, Slavin M, Blyth CC, Haeusler GM, Clark JE. Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10-year review. Pediatr Blood Cancer 2021; 68:e29275. [PMID: 34357688 DOI: 10.1002/pbc.29275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive fungal disease (IFD) is a common and important complication in children with acute myeloid leukaemia (AML). We describe the epidemiology of IFD in a large multicentre cohort of children with AML. METHODS As part of the retrospective multicentre cohort TERIFIC (The Epidemiology and Risk factors for Invasive Fungal Infections in immunocompromised Children) study, proven/probable/possible IFD episodes occurring in children with primary or relapsed/refractory AML from 2003 to 2014 were analysed. Crude IFD prevalence, clinical characteristics, microbiology and treatment were assessed. Kaplan-Meier survival analysis was used to estimate 6-month survival. RESULTS There were 66 IFD episodes diagnosed in 63 children with AML. The majority (75.8%) of episodes occurred in the context of primary AML therapy. During primary AML therapy, the overall prevalence was 20.7% (95% CI 15.7%-26.5%) for proven/probable/possible IFD and 10.3% (95% CI 6.7%-15.0%) for proven/probable IFD. Of primary AML patients, 8.2% had IFD diagnosed during the first cycle of chemotherapy. Amongst pathogens implicated in proven/probable IFD episodes, 74.4% were moulds, over a third (37.9%) of which were non-Aspergillus spp. Antifungal prophylaxis preceded 89.4% of IFD episodes, most commonly using fluconazole (50% of IFD episodes). All-cause mortality at 6 months from IFD diagnosis was 16.7% with IFD-related mortality of 7.6% (all in cases of proven IFD). CONCLUSIONS IFD is a common and serious complication during paediatric AML therapy. Mould infections, including non-Aspergillus spp. predominated in this cohort. A systematic approach to the identification of patients at risk, and a targeted prevention strategy for IFD is needed.
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Affiliation(s)
- Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,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
| | - Andrew S Moore
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western, Perth, Western Australia, Australia
| | - Adam W Bartlett
- 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.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Anne L Ryan
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Megan P Cann
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Brendan J McMullan
- 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.,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
| | - Karin Thursky
- 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.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Health and Medical Research Council National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Monica Slavin
- 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.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, 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
| | - 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.,The Paediatric Integrated Cancer Service, Melbourne, Victoria, 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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23
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Postan M, Rottenberg ME. Editorial: Neurotropism of Parasites and the Immune Responses. Front Immunol 2021; 12:775666. [PMID: 34659274 PMCID: PMC8517510 DOI: 10.3389/fimmu.2021.775666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Miriam Postan
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.,Instituto Nacional de Parasitología "Dr. Mario Fatala Chabén", Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbran" (ANLIS)/Malbran, Buenos Aires, Argentina
| | - Martin E Rottenberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Olivier-Gougenheim L, Rama N, Dupont D, Saultier P, Leverger G, AbouChahla W, Paillard C, Gandemer V, Theron A, Freycon C, Pluchart C, Blouin P, Pellier I, Thouvenin-Doulet S, Desplantes C, Ducassou S, Oudot C, Rouger-Gaudichon J, Cheikh N, Poiree M, Schneider P, Plat G, Contet A, Rialland F, Gouache E, Brethon B, Bertrand Y, Domenech C. Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study. J Pediatr 2021; 236:204-210. [PMID: 33991540 DOI: 10.1016/j.jpeds.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severely immunocompromised children who were treated for acute leukemia or had undergone allogeneic hematopoietic stem cell transplantation (a-HSCT). STUDY DESIGN We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFIs in children with acute leukemia under first- line or relapse treatment or who had undergone a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatric hematology units. RESULTS From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) in 2721 patients, including 61 cases of candidiasis, 60 cases of aspergillosis, and 23 cases of infection with "emergent" fungi, including 10 cases of mucormycosis and 6 cases of fusariosis. The IFI rate was higher in patients with acute myelogenous leukemia (12.9%) (OR, 3.24; 95% CI, 2.15-4.81; P < .0001) compared with the rest of the cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. In these patients, the use of primary antifungal prophylaxis (principally fluconazole) was associated with a lower IFI rate (OR, 0.28; 95% CI, 0.14-0.60; P = 4.90 ×10-4) compared with a-HSCT recipients who did not receive antifungal prophylaxis. The main cause of IFI in children receiving prophylaxis was emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to the prophylactic agents. CONCLUSIONS The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.
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Affiliation(s)
- Laura Olivier-Gougenheim
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France.
| | - Nicolas Rama
- Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
| | - Damien Dupont
- Institut des Agents Infectieux, Parasitology-Mycology Unit, Lyon, France
| | - Paul Saultier
- Pediatric Hematology-OncologyUnit, CHU Marseille, Marseille, France
| | - Guy Leverger
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | | | | | | | - Alexandre Theron
- Pediatric Hematology-Oncology Unit, CHU Montpellier, Montpellier, France
| | - Claire Freycon
- Pediatric Hematology-Oncology Unit, CHU Grenoble, Grenoble, France
| | - Claire Pluchart
- Pediatric Hematology-Oncology Unit, Institut Jean Godinot, CHU Reims, Reims, France
| | - Pascale Blouin
- Pediatric Hematology-Oncology Unit, CHU Tours, Tours, France
| | | | | | | | | | - Caroline Oudot
- Pediatric Hematology-Oncology Unit, CHU Limoges, Limoges, France
| | | | - Nathalie Cheikh
- Pediatric Hematology-Oncology Unit, CHU Besançon, Besançon, France
| | - Maryline Poiree
- Pediatric Hematology-Oncology Unit, CHU Lenval Nice, Nice, France
| | | | - Genevieve Plat
- Pediatric Hematology-Oncology Unit, CHU Toulouse, Toulouse, France
| | - Audrey Contet
- Pediatric Hematology-Oncology Unit, CHU Nancy, Nancy, France
| | - Fanny Rialland
- Pediatric Hematology-Oncology Unit, CHU Nantes, Nantes, France
| | - Elodie Gouache
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | - Benoit Brethon
- Pediatric Hematology Unit, AP-HP Robert Debré, Paris, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Carine Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
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Togano T, Suzuki Y, Nakamura F, Tse W, Kume H. Epidemiology of visceral mycoses in patients with acute leukemia and myelodysplastic syndrome: Analyzing the national autopsy database in Japan. Med Mycol 2021; 59:50-57. [PMID: 32400871 DOI: 10.1093/mmy/myaa029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022] Open
Abstract
Visceral mycoses (VM) are a deadly common infection in patients with acute leukemia and myelodysplastic syndrome (MDS). We retrospectively analyzed the data from the centralized "Annual Report of Autopsy Cases in Japan" that archives the national autopsy cases since 1989. Among the total of 175,615 archived autopsy cases, 7183 cases (4.1%) were acute leukemia and MDS patients. While VM was only found in 7756 cases (4.4% in total cases), we found VM had a disproportionally high prevalence among acute leukemia and MDS patients: 1562 VM cases (21.7%) and nearly sixfold higher in prevalence. Aspergillus spp. was the most predominant causative agent (45.0%), and Candida spp. was the second (22.7%) among confirmed single pathogen involved cases. The prevalence of Candida spp. infection decreased about 50% due to the widely use of fluconazole prophylaxis, which may skew toward doubling of the Mucormycetes incidence compared to 30 years ago. Complicated fungal infection (> one pathogen) was 11.0% in acute leukemia and MDS in 2015. It was 14.7 times higher than in other populations. Among 937 patients who received allogeneic hematopoietic cell transplantation (HCT), the prevalence of VM was 28.3% and 23.3% with GVHD. Aspergillus spp. was less prevalent, but Candida spp. was more associated with GVHD. Its prevalence remains stable. Although Aspergillus spp. was the primary causative agent, non-albicans Candida spp. was increasing as a breakthrough infection especially in GVHD cases. Complicated pathogen cases were more common in acute leukemia and MDS.
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Affiliation(s)
- Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan.,Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Yuhko Suzuki
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Fumihiko Nakamura
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - William Tse
- Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hikaru Kume
- Department of Pathology, Kitasato University, School of Medicine, Sagamihara, Japan
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Rotte LGY, Loeffen YGT, Bierings MB, Wolfs TFW, Lindemans CA. Allogenic Hematopoietic Stem Cell Transplantation Is Feasible in Pediatric Patients with an Active or Recently Diagnosed Invasive Fungal Infection. Transplant Cell Ther 2021; 27:781.e1-781.e5. [PMID: 34153502 DOI: 10.1016/j.jtct.2021.06.015] [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: 03/10/2021] [Revised: 05/19/2021] [Accepted: 06/12/2021] [Indexed: 01/28/2023]
Abstract
Data on the outcome of allogenic hematopoietic stem cell transplantation (HSCT) in pediatric patients with a history of invasive fungal infection (IFI) are limited. The aim of this study was to report on the feasibility and outcome of allogenic HSCT in pediatric patients with an active or recently diagnosed IFI. In this retrospective, single-center study, 317 children underwent an allogenic HSCT (January 2012 to June 2020), of whom 23 had an active or recent (<6 months before transplantation) diagnosis of a probable or proven IFI before HSCT. Medical records were reviewed for data collection. Descriptive statistics were performed. One-year survival was described with Kaplan-Meier analysis. Four proven and 19 probable IFIs were diagnosed. The lungs were the main site of infection (22 out of 23 patients); brain involvement was diagnosed in six patients (26.1%). Aspergillus spp. were the most frequently identified organisms. Of the four patients diagnosed with mucormycosis, three had mixed infections with Aspergillus spp. One patient was diagnosed with Alternaria sinusitis and one patient with an infection with Curvularia spp. with both pulmonary and cutaneous involvement. One year after HSCT, 18 of the 23 patients (78.3%) were alive. Four of the five patients who did not survive died of non-IFI-related causes. One patient died due to a newly developed IFI post-transplant. Three patients showed non-fatal progression of their original IFIs that required prolonged antifungal treatment. Survival of this cohort of high-risk pediatric patients who underwent allogenic HSCT with an active or recently diagnosed IFI was favorable. An active IFI or recent history of IFI should not be a contraindication for proceeding to allogenic HSCT.
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Affiliation(s)
- Laura G Y Rotte
- Pediatrics, Wilhelmina Children's Hospital, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Yvette G T Loeffen
- Pediatrics, Wilhelmina Children's Hospital, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marc B Bierings
- Hematopoietic Stem Cell Transplantation Unit, Princess Máxima Center for Pediatric Oncology, Wilhelmina Children's Hospital, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Tom F W Wolfs
- Pediatrics, Wilhelmina Children's Hospital, UMC Utrecht, University Utrecht, Utrecht, The Netherlands.
| | - Caroline A Lindemans
- Hematopoietic Stem Cell Transplantation Unit, Princess Máxima Center for Pediatric Oncology, Wilhelmina Children's Hospital, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
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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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28
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Luckowitsch M, Rudolph H, Bochennek K, Porto L, Lehrnbecher T. Central Nervous System Mold Infections in Children with Hematological Malignancies: Advances in Diagnosis and Treatment. J Fungi (Basel) 2021; 7:168. [PMID: 33652605 PMCID: PMC7996787 DOI: 10.3390/jof7030168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence of invasive mold disease (IMD) has significantly increased over the last decades, and IMD of the central nervous system (CNS) is a particularly severe form of this infection. Solid data on the incidence of CNS IMD in the pediatric setting are lacking, in which Aspergillus spp. is the most prevalent pathogen, followed by mucorales. CNS IMD is difficult to diagnose, and although imaging tools such as magnetic resonance imaging have considerably improved, these techniques are still unspecific. As microscopy and culture have a low sensitivity, non-culture-based assays such as the detection of fungal antigens (e.g., galactomannan or beta-D-glucan) or the detection of fungal nucleic acids by molecular assays need to be validated in children with suspected CNS IMD. New and potent antifungal compounds helped to improve outcome of CNS IMD, but not all agents are approved for children and a pediatric dosage has not been established. Therefore, studies have to rapidly evaluate dosage, safety and efficacy of antifungal compounds in the pediatric setting. This review will summarize the current knowledge on diagnostic tools and on the management of CNS IMD with a focus on pediatric patients.
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Affiliation(s)
- Marie Luckowitsch
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Henriette Rudolph
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
| | - Luciana Porto
- Institute for Neuroradiology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (M.L.); (H.R.); (K.B.)
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Xie L, Long Q, Zhou G, Liu S, Wen FQ. Successful outcome of disseminated Candida tropicalis osteomyelitis on remission induction for childhood Philadelphia chromosome-positive acute lymphoblastic leukaemia-case report. Ital J Pediatr 2021; 47:27. [PMID: 33573668 PMCID: PMC7879669 DOI: 10.1186/s13052-020-00953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background Invasive fungal infection (IFI) is one of the most challenging complications in children undergoing acute lymphoblastic leukaemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. Case presentation Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)-positive ALL. He was on remission induction therapy at the time of neutropenia, and an abscess developed in his right arm. The blood and bone cultures were positive for C. tropicalis. Antibiotics and antifungals were administered. Magnetic resonance imaging of the arm revealed an intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. He has fully recovered into complete clinical remission but with visible sequelae on magnetic resonance imaging (MRI). He took oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and received subsequent cycles of chemotherapy in parallel. Conclusions In the successful management of Ph-positive ALL, dasatinib, a second-generation Abl-tyrosine kinase inhibitor, is crucial. The recommended treatment for Candida osteomyelitis in Ph-positive ALL patients is a fungicidal agent combined with surgery and modification chemotherapy with dasatinib. The use of combined modalities of treatment seems to be crucial in the successful management of Ph-positive ALL.
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Affiliation(s)
- Lichun Xie
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.,Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China
| | - Qingling Long
- Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China
| | - Guichi Zhou
- Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China
| | - Sixi Liu
- Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China
| | - Fei-Qiu Wen
- The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China. .,Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China.
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30
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Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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31
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Cesaro S, Tridello G, Knelange NS, Blijlevens N, Martin M, Snowden JA, Malladi R, Ljungman P, Deconinck E, Gedde-Dahl T, Byrne J, Xhaard A, Chevallier P, Maertens J, Zuckerman T, Lioure B, Petersen E, Cornelissen JJ, Arcese W, Blaise D, Milpied N, Cahn JY, Aljurf M, de Wreede L, Mauro M, de la Camara R, Averbuch D, Mikulska M, Styczynski J. Impact of early candidemia on the long-term outcome of allogeneic hematopoietic stem cell transplant in non-leukemic patients: an outcome analysis on behalf of IDWP-EBMT. Bone Marrow Transplant 2021; 56:1563-1572. [PMID: 33514919 DOI: 10.1038/s41409-021-01212-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022]
Abstract
We assessed the incidence and outcome of early candidemia after hematopoietic stem cell transplant (HSCT). The analysis included all first HSCTs performed from 2000 to 2015 in adult and pediatric patients with a non-leukemic disease and recorded in the EBMT registry. Overall survival (OS), non-relapse mortality (NRM), and relapse mortality (RM) were evaluated. Candidemia was diagnosed in 420 of 49,852 patients at a median time of 17 days post HSCT (range 0-100), the cumulative incidence being 0.85%. In 65.5% of episodes, candidemia occurred by day 30 after HSCT. The mortality rate by day 7 was 6.2%, whereas 100-day NRM was higher (HR 3.47, p < 0.0001), and 100-day OS was lower (HR 3.22, p < 0.0001) than that of patients without candidemia. After a median follow-up of 4.3 years, 5-year OS, NRM, and RM for patients with and without candidemia were 50.5% vs. 60.8%, p < 0.0001, 28.2% vs.18.8%, p < 0.0001, and 25.3% vs. 27.2%, p = 0.4, respectively. In conclusion, in non-leukemic transplant patients, the occurrence of an early episode of candidemia is rare but it is still associated with a negative effect on the outcome.
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Affiliation(s)
- Simone Cesaro
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Gloria Tridello
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ram Malladi
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Jennifer Byrne
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | | | | | | | | | - Bruno Lioure
- Techniciens d'Etude Clinique suivi de patients greffes, Strasbourg, France
| | - Eefke Petersen
- University Medical Centre Regensburg, Utrecht, Netherlands
| | | | - William Arcese
- Hematopoietic Stem cell Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, Marseille, France
| | | | - Jean Yves Cahn
- CHU Grenoble Alpes-Université Grenoble Alpes, Grenoble, France
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Margherita Mauro
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Diana Averbuch
- 5Pediatric Infectious Diseases, Hadassah University Hospital, Jerusalem, Israel
| | | | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum UMK Torun, Bydgoszcz, Poland
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Tahir M, Peseski AM, Jordan SJ. Case Report: Candida dubliniensis as a Cause of Chronic Meningitis. Front Neurol 2020; 11:601242. [PMID: 33363510 PMCID: PMC7752766 DOI: 10.3389/fneur.2020.601242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Candida dubliniensis is closely related to Candida albicans and rarely isolated in clinical specimens. C. dubliniensis is increasingly recognized as a pathogen in immunocompromised hosts. We present the third known case of Candida dubliniensis meningitis in a young immunocompetent host. Case Presentation: A 27-year-old female with a history of intravenous heroin use and chronic hepatitis C presented with a 10-month history of headaches and progressive bilateral vision loss. On physical examination, visual acuity was 20/20 in her right eye and grade II papilledema was noted. Examination of her left eye revealed complete loss of vision and grade IV papilledema. An MRI with and without contrast revealed increased leptomeningeal enhancement involving the posterior fossa and spinal cord. After multiple lumbar punctures, cerebrospinal fluid fungal cultures grew Candida dubliniensis. The patient was successfully treated with a combination of liposomal amphotericin and fluconazole for 6 weeks with complete resolution of her CNS symptoms, with the exception of irreversible vision loss. Conclusion: We report a case of chronic meningitis due to Candida dubliniensis in an immunocompetent woman with hepatitis C and a history of intravenous heroin use. Additional studies are needed to confirm risk factors for Candida dubliniensis colonization, which likely predisposes individuals to invasive candidiasis.
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Affiliation(s)
- Madiha Tahir
- The University of Vermont Health Network-Champlain Valley Physicians Hospital, Plattsburgh, NY, United States
| | - Andrew M Peseski
- Division of Internal Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Stephen J Jordan
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Pinto TDA, Jardim BA, Breda GL, Morales HMP, Bonfim C, Raboni SM. Infectious complications in pediatric allogeneic hematopoietic stem cell transplantation recipients-A retrospective clinical and epidemiological cohort study. Transpl Infect Dis 2020; 22:e13369. [PMID: 32538520 DOI: 10.1111/tid.13369] [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: 11/17/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an important therapeutic strategy for several hematologic diseases. In the absence of a matched related donor, allogeneic HSCT has been associated with increased risk of infectious complications. Here, we present the clinical and epidemiological characteristics of early infectious complications in children undergoing HSCT from Southern Brazil. METHODS This is a retrospective unicentric cohort study of infections in all children receiving their first HSCT during the period between 2010 and 2017. RESULTS Data from 292 patients were analyzed; bone marrow failures (52.7%) comprised most of the baseline diagnosis. Bone marrow (BM) was the stem cell source in 254 (87%), followed by cord blood (CB) in 34 (11.6%) children. The use of alternative donors (77.8%) and presence of acute graft-vs-host disease (GVHD) (23.6%) were associated with an increased risk of viral and fungal infection. Bacterial infection was observed in 79 patients (27%); 220 patients (75.3%) were diagnosed with viral infection, and 35 patients (12%) developed fungal infection. The presence of fungal disease together with the presence of multiple infections during follow-up was associated with an increased risk of death (P < .001). CONCLUSIONS The clinical profile of HSCT-related infections in this cohort suggests that prognosis in allogeneic HSCT is influenced by the source of stem cells (CB having worse prognosis), presence of acute GVHD and complications arising from fungal infections. The appropriate management of these factors has the potential to improve the overall prognosis rates in pediatric allogeneic HSCT recipients.
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Affiliation(s)
- Tyane de Almeida Pinto
- Postgraduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, Brazil
| | - Bruno Araújo Jardim
- Postgraduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, Brazil
| | - Giovanni Luís Breda
- Infectious Diseases Division, Federal University of Paraná, Curitiba, Brazil
| | | | - Carmem Bonfim
- Bone Marrow Transplant Division, Federal University of Paraná, Curitiba, Brazil
| | - Sonia Mara Raboni
- Postgraduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, Brazil.,Infectious Diseases Division, Federal University of Paraná, Curitiba, Brazil.,Laboratory of Virology, Federal University of Paraná, Curitiba, Brazil
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34
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Otto WR, Green AM. Fungal infections in children with haematologic malignancies and stem cell transplant recipients. Br J Haematol 2020; 189:607-624. [PMID: 32159231 DOI: 10.1111/bjh.16452] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022]
Abstract
Children with haematologic malignancies and haematopoietic stem cell transplant recipients are at high risk for invasive fungal diseases (IFD). There has been an increased number of at-risk children over the past two decades due to improvements in cancer therapies resulting in improved survival of children with high-risk and refractory malignancies. The predominant organisms that cause IFD include Candida spp., Aspergillus spp. and the Mucorales molds. Clinical presentations of IFD vary based on host immune status and the causative organism. Though serum biomarkers such as the galactomannan assay and beta-D-glucan assay have been validated in adults, there are limited data regarding their diagnostic value in children. Thus, the gold standard for IFD diagnosis remains tissue biopsy with histopathological and microbiological evaluation. Treatment of IFD is multimodal and involves antifungal drugs, correction of immune dysfunction and surgical resection when feasible. Paediatric practice regarding IFD is largely extrapolated from data generated in adult patients; in this review, we evaluate both primary paediatric studies and guidelines intended for adult patients that are applied to paediatric patients. There remain significant knowledge gaps with respect to the prevention, diagnosis and treatment of IFD in immunocompromised children, and further research is needed to help guide management decisions.
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Affiliation(s)
- William R Otto
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abby M Green
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Infectious Diseases, Department of Pediatrics, Washington University, St. Louis, MO, USA
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Decembrino N, Perruccio K, Zecca M, Colombini A, Calore E, Muggeo P, Soncini E, Comelli A, Molinaro M, Goffredo BM, De Gregori S, Giardini I, Scudeller L, Cesaro S. A Case Series and Literature Review of Isavuconazole Use in Pediatric Patients with Hemato-oncologic Diseases and Hematopoietic Stem Cell Transplantation. Antimicrob Agents Chemother 2020; 64:e01783-19. [PMID: 31871077 PMCID: PMC7038308 DOI: 10.1128/aac.01783-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/10/2019] [Indexed: 01/12/2023] Open
Abstract
We analyzed the use of isavuconazole (ISA) as treatment or prophylaxis for invasive fungal disease (IFD) in children with hemato-oncologic diseases. A multicentric retrospective analysis was performed among centers belonging to the Italian Association for Pediatric Hematology and Oncology (AIEOP). Pharmacokinetic (PK) monitoring was applied by a high-performance liquid chromatography-tandem mass spectrometry (HLPC-MS/MS) assay. Twenty-nine patients were studied: 10 during chemotherapy and 19 after allogeneic hematopoietic stem cell transplantation (HSCT). The patients consisted of 20 males and 9 females with a median age of 14.5 years (age range, 3 to 18 years) and a median body weight of 47 kg (body weight range, 15 to 80 kg). ISA was used as prophylaxis in 5 patients and as treatment in 24 cases (20 after therapeutic failure, 4 as first-line therapy). According to European Organization for Research and Treatment of Cancer (EORTC) criteria, we registered 5 patients with proven IFD, 9 patients with probable IFD, and 10 patients with possible IFD. Patients with a body weight of <30 kg received half the ISA dose; the others received ISA on the adult schedule (a 200-mg loading dose every 8 h on days 1 and 2 and a 200-mg/day maintenance dose); for all but 10 patients, the route of administration switched from the intravenous route to the oral route during treatment. ISA was administered for a median of 75.5 days (range, 6 to 523 days). The overall response rate was 70.8%; 12 patients with IFD achieved complete remission, 5 achieved partial remission, 5 achieved progression, and 3 achieved stable IFD. No breakthrough infections were registered. PK monitoring of 17 patients revealed a median ISA steady-state trough concentration of 4.91 mg/liter (range, 2.15 to 8.54 mg/liter) and a concentration/dose (in kilograms) ratio of 1.13 (range, 0.47 to 3.42). Determination of the 12-h PK profile was performed in 6 cases. The median area under the concentration-time curve from 0 to 12 h was 153.16 mg·h/liter (range, 86.31 to 169.45 mg·h/liter). Common Terminology Criteria for Adverse Events grade 1 to 3 toxicity (increased transaminase and/or creatinine levels) was observed in 6 patients, with no drug-drug interactions being seen in patients receiving immunosuppressants. Isavuconazole may be useful and safe in children with hemato-oncologic diseases, even in the HSCT setting. Prospective studies are warranted.
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Affiliation(s)
- N Decembrino
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - K Perruccio
- Division of Pediatric Hematology, University Hospital of Perugia, Perugia, Italy
| | - M Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Colombini
- Pediatric Hematology/Oncology, Fondazione Monza e Brianza per il Bambino e la Mamma, Monza, Italy
| | - E Calore
- Clinic of Pediatric Hematology/Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - P Muggeo
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - E Soncini
- Pediatric Hematology/Oncology, Spedali Civili, Brescia, Italy
| | - A Comelli
- Department of Infectious and Tropical Diseases, Spedali Civili, Brescia, Italy
| | - M Molinaro
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - B M Goffredo
- Metabolic Pathology Lab, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - S De Gregori
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - I Giardini
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Scudeller
- Clinical Epidemiology and Biometric Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Cesaro
- Pediatric Hematology/Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Elitzur S, Arad-Cohen N, Barg A, Litichever N, Bielorai B, Elhasid R, Fischer S, Fruchtman Y, Gilad G, Kapelushnik J, Kharit M, Konen O, Laor R, Levy I, Raviv D, Shachor-Meyouhas Y, Shvartser-Beryozkin Y, Toren A, Yaniv I, Nirel R, Izraeli S, Barzilai-Birenboim S. Mucormycosis in children with haematological malignancies is a salvageable disease: a report from the Israeli Study Group of Childhood Leukemia. Br J Haematol 2019; 189:339-350. [PMID: 31885080 DOI: 10.1111/bjh.16329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2·2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004-2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety-two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high-risk acute lymphoblastic leukaemia (OR 3·75; 95% CI 1·51-9·37; P = 0·004) and with increasing age (OR 3·58; 95% CI 1·24-9·77; P = 0·01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12-week survival (OR 9·43; 95% CI 1·47-60·66; P = 0·02) and relapsed underlying malignancy was associated with increased 12-week mortality (OR 6·42; 95% CI, 1·01-40·94; P = 0·05). In patients receiving frontline therapy for their malignancy (n = 24), one-year cumulative mucormycosis-related mortality was 21 ± 8% and five-year overall survival was 70 ± 8%. This largest paediatric population-based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable.
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Affiliation(s)
- Sarah Elitzur
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Assaf Barg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Naomi Litichever
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Bella Bielorai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Elhasid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Hemato-Oncology, Sourasky Medical Center, Tel Aviv, Israel
| | - Salvador Fischer
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Fruchtman
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Gil Gilad
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Kapelushnik
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Mira Kharit
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Osnat Konen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Radiology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ruth Laor
- Pediatric Hematology-Oncology, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Dror Raviv
- Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yael Shachor-Meyouhas
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Disease Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yulia Shvartser-Beryozkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Toren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Isaac Yaniv
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Nirel
- Department of Statistics, Hebrew University, Jerusalem, Israel
| | - Shai Izraeli
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Barzilai-Birenboim
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Linke C, Ehlert K, Ahlmann M, Fröhlich B, Mohring D, Burkhardt B, Rössig C, Groll AH. Epidemiology, utilisation of healthcare resources and outcome of invasive fungal diseases following paediatric allogeneic haematopoietic stem cell transplantation. Mycoses 2019; 63:172-180. [PMID: 31661569 DOI: 10.1111/myc.13029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Epidemiology and management practices of invasive fungal diseases (IFD) after allogeneic haematopoietic stem cell transplantation (HSCT) are a subject of constant change. We investigated the contemporary incidence, diagnostics, antifungal management and outcome at a major paediatric transplant centre in Germany. METHODS The single-centre retrospective observational study included all paediatric allogeneic HSCT patients (pts) transplanted between 2005 and 2015. Patient-related data were assessed up to 365 days post-transplant. The primary endpoint was the incidence of possible, probable and proven IFDs. Secondary endpoints included diagnostics and antifungal treatment; analysis of risk factors; and overall survival with the last follow-up in January 2017. RESULTS A total of 221 first (196), second (21) or third (4) procedures were performed in 200 pts (median age: 9 years, range, 0.5-22) for leukaemia/lymphoma (149) and non-malignant disorders (72). Prophylaxis was administered in 208 HSCT procedures (94%; fluconazole, 116, mould-active agents, 92). At least one computed tomography scan of the chest was performed in 146, and at least one galactomannan antigen assay in 60 procedures. There were 15 cases of proven (candidemia, 4; aspergillosis, 4) or probable (aspergillosis, 7) IFDs, accounting for an incidence rate of 6.8%. Overall mortality at last follow-up was 30%; the occurrence of proven/probable IFDs was associated with a reduced survival probability (P < .001). CONCLUSION Morbidity and mortality from IFDs at our institution were consistent with data reported from other centres. Utilisation of healthcare resources for prevention, diagnosis and management of IFDs was considerable.
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Affiliation(s)
- Christina Linke
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Karoline Ehlert
- Department of Pediatric Hematology and Oncology, Children's Hospital, University Medicine Greifswald, Greifswald, Germany
| | - Martina Ahlmann
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Birgit Fröhlich
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Daniela Mohring
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Claudia Rössig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
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Cesaro S, Tridello G, Blijlevens N, Ljungman P, Craddock C, Michallet M, Martin A, Snowden JA, Mohty M, Maertens J, Passweg J, Petersen E, Nihtinen A, Isaksson C, Milpied N, Rohlich PS, Deconinck E, Crawley C, Ledoux MP, Hoek J, Nagler A, Styczynski J. Incidence, Risk Factors, and Long-term Outcome of Acute Leukemia Patients With Early Candidemia After Allogeneic Stem Cell Transplantation: A Study by the Acute Leukemia and Infectious Diseases Working Parties of European Society for Blood and Marrow Transplantation. Clin Infect Dis 2019; 67:564-572. [PMID: 29481599 DOI: 10.1093/cid/ciy150] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/20/2018] [Indexed: 02/04/2023] Open
Abstract
Background This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. Methods We performed an outcome analysis of 28542 acute leukemia patients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28195 without candidemia or any other type of Candida infection. Results The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 - 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P = .0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001). Conclusions The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short- and-long-term OS.
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Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicole Blijlevens
- Department of Hematology, Radboud University-Nijmegen Medical Centre, The Netherlands
| | - Per Ljungman
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Charles Craddock
- Center for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | | | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Mohamad Mohty
- Hospital Saint Antoine, University Pierre & Marie Curie, and INSERM UMRs, Paris, France
| | | | - Jacob Passweg
- Department of Hematology, University Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | - Arnon Nagler
- ALWP Office, Hospital Saint Antoine, Paris, France
| | - Jan Styczynski
- Department of Pediatric Hematology Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
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Peri AM, Verna M, Biffi S, Alagna L, Longhi B, Migliorino GM, Foresti S, Bandera A, Rovelli A, Rizzari C, Gori A, Colombini A. Combination Antifungal Therapy for Invasive Mold Infections Among Pediatric Patients with Hematological Malignancies: Data from A Real-Life Case-Series. Pathog Immun 2019; 4:180-194. [PMID: 31538132 PMCID: PMC6742350 DOI: 10.20411/pai.v4i2.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/25/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited. Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients' characteristics. Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial response). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects. Conclusions: In our experience, combination antifungal therapy seems to be a safe option in immunocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting.
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Affiliation(s)
- Anna Maria Peri
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Marta Verna
- Hematology-Oncology and Bone Marrow Transplantation Units, Pediatric Department, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Stefano Biffi
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Benedetta Longhi
- Hematology-Oncology and Bone Marrow Transplantation Units, Pediatric Department, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Guglielmo Marco Migliorino
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Sergio Foresti
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital - ASST Monza, Monza, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Attilio Rovelli
- Hematology-Oncology and Bone Marrow Transplantation Units, Pediatric Department, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Carmelo Rizzari
- Hematology-Oncology and Bone Marrow Transplantation Units, Pediatric Department, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Antonella Colombini
- Hematology-Oncology and Bone Marrow Transplantation Units, Pediatric Department, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
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40
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Araújo SG, Lima WG, Amaral Pinto ME, Morais MÍ, Pereira de Sá N, Johann S, Rosa CA, Alves Rodrigues dos Santos Lima L. Pharmacological prospection in-vitro of Lamiaceae species against human pathogenic fungi associated to invasive infections. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2019. [DOI: 10.1016/j.bcab.2019.101345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Linke C, Tragiannidis A, Ahlmann M, Fröhlich B, Wältermann M, Burkhardt B, Rossig C, Groll AH. Epidemiology and management burden of invasive fungal infections after autologous hematopoietic stem cell transplantation: 10-year experience at a European Pediatric Cancer Center. Mycoses 2019; 62:954-960. [PMID: 31332851 DOI: 10.1111/myc.12968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (HSCT) carries risks of infectious morbidity. We analysed epidemiology and management burden associated with invasive fungal diseases (IFDs) in children and adolescents undergoing autologous HSCT. METHODS In a retrospective, single-centre observational study, epidemiology and management burden associated with IFDs were analysed in all paediatric cancer patients who underwent autologous HSCT between 2005 and 2014. Clinical, radiographic and microbiological data were assessed up to 100 days post-transplant. The primary endpoint was the incidence of proven, probable and possible IFDs. Further endpoints included the use of systemic antifungal agents for prevention and management of IFDs; infectious and non-infectious comorbidities; and survival until day + 100. RESULTS Of 95 patients (median age: 8 years; r, 0.75-20) underwent 103 HSCT procedures for solid tumours (92) or lymphoma (11). Primary antifungal prophylaxis was administered in 49 procedures (47.5%). No single case of proven/probable IFD was diagnosed. Nine cases (8.7%) fulfilled criteria of possible pulmonary mould infection and received treatment for a median of 14 days (r, 7-35). In an additional 12 procedures, empiric antifungal therapy with mould active agents was given for a median of 8 days (r, 3-105). Microbiologically documented non-fungal infections were observed in 17 procedures, and five patients were transferred to the ICU. There was one death from biopsy documented toxic endothelial damage at day 83 post-transplant. CONCLUSIONS Autologous HSCT for solid tumours or lymphoma was associated with low morbidity from IFDs. However, utilisation of systemic antifungal agents for prevention and management of suspected IFDs was considerable.
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Affiliation(s)
- Christina Linke
- Infectious Disease Research Program, University Children's Hospital Münster, Münster, Germany.,Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Tragiannidis
- Infectious Disease Research Program, University Children's Hospital Münster, Münster, Germany.,Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martina Ahlmann
- Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Birgit Fröhlich
- Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Wältermann
- Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Birgit Burkhardt
- Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Claudia Rossig
- Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas H Groll
- Infectious Disease Research Program, University Children's Hospital Münster, Münster, Germany.,Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.,Hematology Oncology Unit, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lauten M, Attarbaschi A, Cario G, Döring M, Moser O, Mücke U, Poyer F, Rieken S, Temme C, Voigt S, Lehrnbecher T, Groll AH. Invasive mold disease of the central nervous system in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation: Analysis of 29 contemporary patients. Pediatr Blood Cancer 2019; 66:e27806. [PMID: 31066209 DOI: 10.1002/pbc.27806] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive mold disease (IMD) is a severe infectious complication in immunocompromised patients. The outcome of central nervous system (CNS) IMD is poor, but contemporary data, in particular in the pediatric setting, are lacking. PROCEDURE For this retrospective multicenter analysis, pediatric patients < 18 years with proven or probable CNS IMD receiving chemotherapy or undergoing allogeneic HSCT were reported by the local investigator. CNS IMD had to be diagnosed between 2007 and 2016. Proven CNS IMD was defined as compatible CNS imaging or macroscopic autopsy findings in conjunction with a positive microscopic or microbiological result in the brain tissue or cerebrospinal fluid. Probable CNS IMD was defined as compatible CNS imaging findings in combination with proven or probable IMD at a site outside the CNS. RESULTS AND CONCLUSIONS A total of 29 patients (median age, 14 years; 14 allogeneic HSCT recipients) were diagnosed with proven (n = 12) or probable (n = 17) CNS IMD. Aspergillus spp. was the most common fungal pathogen. All but one patient had IMD sites outside the CNS and eight patients (27.6%) were neurologically asymptomatic at diagnosis of CNS IMD. Forty-nine percent of the patients survived CNS IMD; however, 46.7% of the survivors suffered from severe long-term neurological sequelae. Our data suggest that (1) outcome of CNS IMD has improved in children as compared with previous series, (2) half of surviving patients suffer from severe neurological sequelae, and (3) imaging of the CNS should be performed in all children with IMD irrespective of neurological symptoms.
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Affiliation(s)
- Melchior Lauten
- Department of Pediatrics, University of Lübeck, Pediatric Hematology and Oncology, Lübeck, Germany
| | - Andishe Attarbaschi
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Gunnar Cario
- Department of Pediatrics, Pediatric Hematology and Oncology, Christian Albrechts University Kiel, Kiel, Germany
| | - Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Olga Moser
- Department of Pediatrics, University Hospital Aachen, Aachen, Germany
| | - Urs Mücke
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Fiona Poyer
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Sarah Rieken
- Department of Pediatrics, University of Lübeck, Pediatric Hematology and Oncology, Lübeck, Germany
| | - Christian Temme
- Department of Pediatrics III, University Hospital Essen, Essen, Germany
| | - Sebastian Voigt
- Department of Pediatric Hematology and Oncology, University Hospital Charité Berlin, Berlin, Germany
| | - Thomas Lehrnbecher
- Johann Wolfgang von Goethe University, Pediatric Hematology and Oncology, Children's Hospital III, Frankfurt, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Infectious Disease Research Program, Münster, Germany
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Warris A, Lehrnbecher T, Roilides E, Castagnola E, Brüggemann RJM, Groll AH. ESCMID-ECMM guideline: diagnosis and management of invasive aspergillosis in neonates and children. Clin Microbiol Infect 2019; 25:1096-1113. [PMID: 31158517 DOI: 10.1016/j.cmi.2019.05.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
SCOPE Presenting symptoms, distributions and patterns of diseases and vulnerability to invasive aspergillosis (IA) are similar between children and adults. However, differences exist in the epidemiology and underlying conditions, the usefulness of newer diagnostic tools, the pharmacology of antifungal agents and in the evidence from interventional phase 3 clinical trials. Therefore, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) have developed a paediatric-specific guideline for the diagnosis and management of IA in neonates and children. METHODS Review and discussion of the scientific literature and grading of the available quality of evidence was performed by the paediatric subgroup of the ESCMID-ECMM-European Respiratory Society (ERS) Aspergillus disease guideline working group, which was assigned the mandate for the development of neonatal- and paediatric-specific recommendations. QUESTIONS Questions addressed by the guideline included the epidemiology of IA in neonates and children; which paediatric patients may benefit from antifungal prophylaxis; how to diagnose IA in neonates and children; which antifungal agents are available for use in neonates and children; which antifungal agents are suitable for prophylaxis and treatment of IA in neonates and children; what is the role of therapeutic drug monitoring of azole antifungals; and which management strategies are suitable to be used in paediatric patients. This guideline provides recommendations for the diagnosis, prevention and treatment of IA in the paediatric population, including neonates. The aim of this guideline is to facilitate optimal management of neonates and children at risk for or diagnosed with IA.
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Affiliation(s)
- A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands.
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University 96 School of Health Sciences, Thessaloniki, Greece; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - R J M Brüggemann
- Radboud Center for Infectious Diseases, Radboud University Medical Centre, Center of Expertise in Mycology Radboudumc/CWZ, European Confederation of Medical Mycology (ECMM) Excellence Center of Medical Mycology, Nijmegen, the Netherlands; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - A H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
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Ahangarkani F, Badali H, Rezai MS, Shokohi T, Abtahian Z, Mahmoodi Nesheli H, Karami H, Roilides E, Tamaddoni A. Candidemia due to Candida guilliermondii in an immuno-compromised infant: a case report and review of literature. Curr Med Mycol 2019; 5:32-36. [PMID: 31049456 PMCID: PMC6488283 DOI: 10.18502/cmm.5.1.535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: Candidemia is a life-threatening fungal infection with significant mortality and morbidity in neutropenic individuals, immunosuppressive chemotherapy recipients, and broad-spectrum antibiotics consumers. The epidemiology and antifungal susceptibility testing of non-albicans Candida species have been poorly studied. These species are characterized by low susceptibility to azoles and echinocandins. Herein, we report the first pediatric case of candidemia due to C. guilliermondii in Iran and review the literature on fungemia caused by C. guilliermondii. Case report: We presented the first candidemia case due to C. guilliermondii in a 4-month-old male infant with neuroblastoma in Iran. This study also involves a comprehensive literature review on fungemia caused by C.guilliermondii during a period of 18 years (i.e., 2000-2018) to discuss the epidemiology, clinical features, and treatment of this disease. The literature review resulted in the identification of 501 cases of candidemia caused by C. guilliermondii. Most of the patients were adults and had multiple risk factors. However, the main risk factors were significantly related to cancer chemotherapy, followed by central venous catheter use and Intensive Care Unit admission. Mortality rate due to this disease had a range of 3.4-66.6%, in this regard, the patients with cancer had the highest mortality rate. Conclusion: Given the high mortality of candidemia, the early diagnosis of this infection and timely initiation of antifungal therapy significantly improve the patients’ survival rate and result in better outcomes. Consequently, it is highly recommended to monitor the local epidemiology of this life-threatening infection and raise awareness in this regard.
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Affiliation(s)
- Fatemeh Ahangarkani
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center/Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Invasive Fungi Research Center/Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center/Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Abtahian
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Karami
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Emmanuel Roilides
- 3rd Department of Pediatrics, Infectious Diseases Section, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ahmad Tamaddoni
- Amirkola Children Hospital, Babol University of Medical Sciences, Babol, Iran
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Lehrnbecher T, Schöning S, Poyer F, Georg J, Becker A, Gordon K, Attarbaschi A, Groll AH. Incidence and Outcome of Invasive Fungal Diseases in Children With Hematological Malignancies and/or Allogeneic Hematopoietic Stem Cell Transplantation: Results of a Prospective Multicenter Study. Front Microbiol 2019; 10:681. [PMID: 31040830 PMCID: PMC6476895 DOI: 10.3389/fmicb.2019.00681] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/19/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Available data on the incidence and outcome of invasive fungal diseases (IFD) in children with hematological malignancies or after allogeneic hematopoietic stem cell transplantation (HSCT) are mostly based on monocenter, retrospective studies or on studies performed prior to the availability of newer triazoles or echinocandins. Procedure: We prospectively collected clinical data on incidence, diagnostic procedures, management and outcome of IFD in children treated for hematological malignancies or undergoing HSCT in three major European pediatric cancer centers. Results: A total of 304 children (median age 6.0 years) who underwent 360 therapies (211 chemotherapy treatments, 138 allogeneic HSCTs and/or 11 investigational chemotherapeutic treatments) were included in the analysis. Nineteen children developed proven/probable IFD, mostly due to Aspergillus (n = 10) and Candida spp. (n = 5), respectively. In patients receiving chemotherapy, 11 IFDs occurred, all during induction or re-induction therapy. None of these patients died due to IFD, whereas IFD was lethal in 3 of the 8 HSCT recipients with IFD. Significant differences among centers were observed with regard to the use of imaging diagnostics and the choice, initiation and duration of antifungal prophylaxis. Conclusion: This prospective multicenter study provides information on the current incidence and outcome of IFD in the real life setting. Practice variation between the centers may help to ultimately improve antifungal management in children at highest risk for IFDs.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Stefan Schöning
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Fiona Poyer
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Jamina Georg
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Andreas Becker
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Kathrin Gordon
- Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Andishe Attarbaschi
- Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
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46
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Bartlett AW, Cann MP, Yeoh DK, Bernard A, Ryan AL, Blyth CC, Kotecha RS, McMullan BJ, Moore AS, Haeusler GM, Clark JE. Epidemiology of invasive fungal infections in immunocompromised children; an Australian national 10-year review. Pediatr Blood Cancer 2019; 66:e27564. [PMID: 30511385 DOI: 10.1002/pbc.27564] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/09/2018] [Indexed: 11/07/2022]
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.
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Affiliation(s)
- Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, Australia.,Biostatistics and Databases Program, Kirby Institute, UNSW, Sydney, Australia
| | - Megan P Cann
- Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Australia
| | - Daniel K Yeoh
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Western Australia, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Anne L Ryan
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, Australia
| | - Andrew S Moore
- Department of Oncology, Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Australia.,Infection Management Service, Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Queensland
| | - Gabrielle M Haeusler
- The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia.,Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.,Monash University, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julia E Clark
- Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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Muggeo P, Calore E, Decembrino N, Frenos S, De Leonardis F, Colombini A, Petruzziello F, Perruccio K, Berger M, Burnelli R, Zanazzo GA, Santoro N, Cesaro S. Invasive mucormycosis in children with cancer: A retrospective study from the Infection Working Group of Italian Pediatric Hematology Oncology Association. Mycoses 2018; 62:165-170. [PMID: 30338581 DOI: 10.1111/myc.12862] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Invasive mucormycosis is a rare but frequently fatal fungal disease. The acute and rapidly progressive evolution causes unfavourable outcome in 22%-59% of patients and its treatment represents a clinical challenge, especially in immunocompromised patients. Current data in paediatric oncological patients are limited. OBJECTIVES The infection Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) analysed the episodes of invasive mucormycosis occurred between 2009 and 2016. PATIENTS Fifteen cases of proven mucormycosis (male/female 8/7; median age 14.1 years, range 7.7-18.6) were reported after chemotherapy for acute leukaemia and lymphoma (12) and allogeneic stem cell transplantation (3). The aetiology was Rhizopus oryzae 4, Lichtheimia corymbifera 3 and Mucor spp. 8. RESULTS Paranasal sinus was the primary site of infection in 14/15 patients combined with orbital involvement (9), central nervous system (8), lung (4), thyroid gland and kidney (1). All patients received liposomal Amphotericin B (L-AmB) (3-10 mg/kg), with surgical debridement in 14/15 cases. Eleven patients received maintenance treatment with posaconazole (9) or isavuconazole (2). Eight out of fifteen patients (53.3%) died, after 3-6 months. CONCLUSIONS Mucormycosis involved mainly the sinu-orbital site and affected children >10 years. Despite aggressive treatment with high-dose L-AmB and timely surgical debridement, the mortality rate remains still high.
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Affiliation(s)
- Paola Muggeo
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefano Frenos
- Oncoematologia Pediatrica, Ospedale Meyer, Firenze, Italy
| | - Francesco De Leonardis
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | | | | | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Massimo Berger
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza, Regina Margherita Children Hospital, Turin, Italy
| | - Roberta Burnelli
- Pediatric Onco-Hematology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - Giulio A Zanazzo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste, Trieste, Italy
| | - Nicola Santoro
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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48
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Dobinson HC, Down G, Clark JE. Exserohilum
infections in Australian Queensland children. Mycoses 2018; 62:181-185. [DOI: 10.1111/myc.12864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/04/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hazel C. Dobinson
- Infection Management and Prevention Service; Queensland Children's Hospital; Brisbane Queensland Australia
| | - Gregory Down
- Infection Management and Prevention Service; Queensland Children's Hospital; Brisbane Queensland Australia
| | - Julia E. Clark
- Infection Management and Prevention Service; Queensland Children's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
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49
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Çağlar İ, Devrim İ, Özdemir H, Şahbudak Z, Sönmez G, Buyukcam A, Gulhan B, Kara A, Aygun DF, Bayram N, Celebi S, Çetin B, Nepesov MI, Yilmaz AT, Kepenekli E, Çiftdogan DY, Acar MK, Yayla BC, Okumuş C, Ecevit Z, Hatipoglu N, Kuyucu N, Kosker M, Sen S, Karbuz A, Sutcu M, Duramaz BB, Özen M, Çiftçi E, Alabaz D, Kurugol Z, Kara A, Kanik S, Kilic O, Oncel S, Somer A, Tapisiz A, Belet N, Akcan ÖM, Türel Ö, Ozkaya A, Tezer H, Cengiz AB, İnce E, Camcioglu Y, Kocabas E, Arisoy ES, Salman N. Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey. J Glob Antimicrob Resist 2018; 15:232-238. [PMID: 30121343 DOI: 10.1016/j.jgar.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. METHODS A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. RESULTS A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. CONCLUSION The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital.
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Affiliation(s)
- İlknur Çağlar
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - İlker Devrim
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey.
| | - Halil Özdemir
- Ankara University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Zümrüt Şahbudak
- Ege University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Gülsüm Sönmez
- Çukurova University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Adana, Turkey
| | - Ayse Buyukcam
- Hacettepe University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Belgin Gulhan
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ahu Kara
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Deniz F Aygun
- Cerrahpaşa Medical Faculty, Department of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Nuri Bayram
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Solmaz Celebi
- Uludağ University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Bursa, Turkey
| | - Benhur Çetin
- Gaziantep Cengiz Gokcek Children's Hospital, Department of Pediatric Infectious Diseases, Gaziantep, Turkey
| | - Merve I Nepesov
- Eskişehir Osmangazi University, Faculty of Medicine, Clinic of Pediatric Infectious Diseases, Eskişehir, Turkey
| | - Ayşe T Yilmaz
- Kocaeli University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey
| | - Eda Kepenekli
- Marmara University Pendik Training and Research Hospital, Department of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Dilek Yilmaz Çiftdogan
- İzmir Katip Çelebi University, Faculty of Medicine & İzmir Tepecik Training and Research Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Manolya K Acar
- Istanbul University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Burcu Cura Yayla
- Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Canan Okumuş
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Zafer Ecevit
- Başkent University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Nevin Hatipoglu
- Bakırköy Dr. Sadi Konuk Research and Training Hospital, Pediatric Infectious Diseases Clinic, İstanbul, Turkey
| | - Necdet Kuyucu
- Mersin University, Faculty of Medicine, Department of Pediatrics, Mersin, Turkey
| | - Muhammed Kosker
- Diyarbakır Children's Hospital, Pediatric Infectious Diseases Clinic, Diyarbakır, Turkey
| | - Semra Sen
- Manisa Celal Bayar University, Faculty of Medicine, Pediatric Infectious Diseases Unit, Manisa, Turkey
| | - Adem Karbuz
- Okmeydanı Training and Research Hospital, Pediatric Infectious Diseases Unit, İstanbul, Turkey
| | | | - Burcu Bursal Duramaz
- Bezmialem Vakıf University, Faculty of Medicine, Department of Pediatric İnfectious Diseases, İstanbul, Turkey
| | - Metehan Özen
- Acıbadem University, Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Ergin Çiftçi
- Ankara University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Derya Alabaz
- Çukurova University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Adana, Turkey
| | - Zafer Kurugol
- Ege University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Ateş Kara
- Hacettepe University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Saliha Kanik
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Omer Kilic
- Eskişehir Osmangazi University, Faculty of Medicine, Clinic of Pediatric Infectious Diseases, Eskişehir, Turkey
| | - Selim Oncel
- Kocaeli University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey
| | - Ayper Somer
- Istanbul University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İstanbul, Turkey
| | - Anil Tapisiz
- Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Nursen Belet
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | | | - Özden Türel
- Bezmialem Vakıf University, Faculty of Medicine, Department of Pediatric İnfectious Diseases, İstanbul, Turkey
| | - Aslinur Ozkaya
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Hasan Tezer
- Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Erdal İnce
- Ankara University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Yıldız Camcioglu
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Pediatric Infectious Diseases and Clinical Immunology and Allergy, İstanbul, Turkey
| | - Emine Kocabas
- Çukurova University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Adana, Turkey
| | - Emin S Arisoy
- Kocaeli University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey
| | - Nuran Salman
- Istanbul University, Faculty of Medicine, Department of Pediatric Infectious Diseases, İstanbul, Turkey
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Abstract
BACKGROUND Fungal infections of the central nervous system (FIs-CNS) have become significantly more common over the past 2 decades. Invasion of the CNS largely depends on the immune status of the host and the virulence of the fungal strain. Infections with fungi cause a significant morbidity in immunocompromised hosts, and the involvement of the CNS may lead to fatal consequences. METHODS One hundred and thirty-five articles on fungal neuroinfection in PubMed, Google Scholar, and Cochrane databases were selected for review using the following search words: "fungi and CNS mycoses", CNS fungal infections", "fungal brain infections", " fungal cerebritis", fungal meningitis", "diagnostics of fungal infections", and "treatment of CNS fungal infections". All were published in English with the majority in the period 2000-2018. This review focuses on the current knowledge of the epidemiology, clinical presentations, diagnosis, and treatment of selected FIs-CNS. RESULTS The FIs-CNS can have various clinical presentations, mainly meningitis, encephalitis, hydrocephalus, cerebral abscesses, and stroke syndromes. The etiologic factors of neuroinfections are yeasts (Cryptococcus neoformans, Candida spp., Trichosporon spp.), moniliaceous moulds (Aspergillus spp., Fusarium spp.), Mucoromycetes (Mucor spp., Rhizopus spp.), dimorphic fungi (Blastomyces dermatitidis, Coccidioides spp., Histoplasma capsulatum), and dematiaceous fungi (Cladophialophora bantiana, Exophiala dermatitidis). Their common route of transmission is inhalation or inoculation from trauma or surgery, with subsequent hematogenous or contiguous spread. As the manifestations of FIs-CNS are often non-specific, their diagnosis is very difficult. A fast identification of the etiological factor of neuroinfection and the application of appropriate therapy are crucial in preventing an often fatal outcome. The choice of effective drug depends on its extent of CNS penetration and spectrum of activity. Pharmaceutical formulations of amphotericin B (AmB) (among others, deoxycholate-AmBd and liposomal L-AmB) have relatively limited distribution in the cerebrospinal fluid (CSF); however, their detectable therapeutic concentrations in the CNS makes them recommended drugs for the treatment of cryptococcal meningoencephalitis (AmBd with flucytosine) and CNS candidiasis (L-AmB) and mucormycosis (L-AmB). Voriconazole, a moderately lipophilic molecule with good CNS penetration, is recommended in the first-line therapy of CNS aspergillosis. Other triazoles, such as posaconazole and itraconazole, with negligible concentrations in the CSF are not considered effective drugs for therapy of CNS fungal neuroinfections. In contrast, clinical data have shown that a novel triazole, isavuconazole, achieved considerable efficacy for the treatment of some fungal neuroinfections. Echinocandins with relatively low or undetectable concentrations in the CSF do not play meaningful role in the treatment of FIs-CNS. CONCLUSION Although the number of fungal species causing CNS mycosis is increasing, only some possess well-defined treatment standards (e.g., cryptococcal meningitis and CNS aspergillosis). The early diagnosis of fungal infection, accompanied by identification of the etiological factor, is needed to allow the selection of effective therapy in patients with FIs-CNS and limit their high mortality.
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Affiliation(s)
- Katarzyna Góralska
- Department of Biomedicine and Genetics, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland.
| | - Joanna Blaszkowska
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
| | - Magdalena Dzikowiec
- Department of Diagnostics and Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz, Pomorska 251, 92-213, Lodz, Poland
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