1063. Invasive Fusarium Infections in Immunocompromised Children: Ten-year, Single-Center Review of Contemporary Cases
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Fusarium has emerged as an important cause of invasive mould infection (IMI) with excessively high mortality rates in immunocompromised (IC) adults; data in children are lacking.

Methods: Retrospective review of culture-proven invasive Fusarium infections in pediatric patients at Children’s Medical Center Dallas (January 1, 2000-December 31, 2010). Demographic, risk factors, clinical, diagnostics, management, and outcome data were collected.

Results: Fusarium species were isolated from cultures in 32 patients.  9 IC children had invasive disease: 5 males, median age of 12y [range 2-17] with underlying leukemia (5 ALL, 2 AML; 4 receiving induction, 1 consolidation, 1 intensification phase of chemotherapy), 1 allo-MUD HSCT patient (day +8), 1 heart transplant recipient (35 days post-transplant).   8 of 9 pts (89%) had an absolute neutrophil count <500/mm3 for a median of 15 d [6-96] before IMI diagnosis.  3 were receiving antifungal prophylaxis (2  fluconazole, 1 lipo-ampho) or empiric therapy (2 lipo-ampho, 2 caspofungin, 1 fluconazole) for fever & neutropenia (F/N). Initial symptoms prompting evaluation included persistent F/N and skin lesions (5) and facial swelling (3). Clinical disease included only sinopulmonary (2), invasive fungal sinusitis (1), or skin lesions (1) and 5 with disseminated disease involving the sinuses (2), lung (4), skin (5, painful subcutaneous nodules or echthyma-like lesions), osteoarticular (2), myositis (2), 2 had + blood cultures.  Initial management included combination lipo-ampho and voriconazole in 8 patients (median length of antifungal therapy 91 d [25-367], 172 d [19-367] respectively),  GMCSF and IFN in 7 pts (median length 65 d [30-193], 53 d [29-175]), and surgery (8 pts; median of 1 [1-6] surgery /pt). Chemotherapy was interrupted in 6 patients.  Median length of hospitalization was 47 d [23-78]. Overall mortality at 6 months was 11%; 1 patient had breakthrough IMI 10 months after initial diagnosis; 4 patients had relapse of their underlying malignancy.

Conclusion: Fusarium infections in IC children have clinical patterns similar to that seen in IC adults. Despite an expanding antifungal armamentarium, optimal therapy is not well established and morbidity continues to be significant. 


Subject Category: P. Pediatric and perinatal infections

Monica I. Ardura, DO1,2, Sean Nguyen, PharmD, BCPS3 and Jane D. Siegel, MD1,2, (1)Pediatric Infectious Diseases, UT Southwestern Medical Center, Dallas, TX, (2)Children's Medical Center Dallas, Dallas, TX, (3)Pharmacy, Children's Medical Center Dallas, Dallas, TX

Disclosures:

M. I. Ardura, None

S. Nguyen, None

J. D. Siegel, None

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