|
1
|
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.
Collapse
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
| |
Collapse
|