INVASIVE FUNGAL DISEASE IN A PEDIATRIC HEMATOLOGY AND ONCOLOGY UNIT: A
14-YEAR PERIOD REVIEW
Abstract
BACKGROUND. Invasive fungal disease (IFD) is a significant cause of
morbidity and mortality in immunosuppressed children. We aim to describe
the epidemiology and clinical parameters of IFD in a Pediatric
Hematology-Oncology Unit (PHOU) with an increasing activity during the
last 14 years. METHODS. We retrospectively reviewed the medical records
of children (up to 18 years old) admitted for IFD to the PHOU of a
tertiary hospital in Madrid (Spain), between 2006-2019. Epidemiological,
diagnostic and therapeutic parameters were compared according to the
type of infection, study period (considering 3 equivalent time
fractions) and outcome. RESULTS. Twenty-eight episodes of IFD occurred
in 27 out of 471 children at risk (13 males, median 10 years old). Five
episodes of candidemia (all in the first period) and 23 bronchopulmonary
mold diseases were registered. Six (21.4%), eight (28.6%) and 14
(50%) episodes met criteria for proven, probable and possible IFD,
respectively. Most episodes (71.4%) occurred in high-risk children
receiving antifungal prophylaxis. Eight children required intensive care
and six died during treatment. Mold infections occurred in older
children (126 vs. 21 months; p=0,045), increased over time (p=0.002) and
were more common in high-risk compared to low-risk children (87% vs.
0%; p=0.001). There were no differences in mortality rates between
periods, types of infection or underlying conditions. CONCLUSIONS. Yeast
infections decreased within the study time and mold infections were more
frequent in high-risk patients. A rising activity in our PHOU and an
increase in the complexity of pathologies were not followed by an
increase in mortality rates.