1532. Invasive Fungal Infections in a Pediatric Hematology Oncology and Stem cell Transplant Unit. A Retrospective Study in a Tertiary Care Center in Jeddah  
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • idsa final poster.jpg (2.3 MB)
  • Background:  To identify the epidemiology, clinical presentation, risk factors, and role of biomarkers in diagnosing invasive fungal infections (IFI) in pediatric patients with hematological malignancies and hematopoietic stem cell transplant recipients.

    Methods: A retrospective study was conducted in our pediatric oncology and stem cell transplant unit at King Faisal Specialist Hospital and Research Center- Jeddah branch. Patients diagnosed with invasive fungal infections were included between January 2009 and December 2012. Invasive fungal infection was diagnosed according to the latest EORTC/MSG criteria. 

    Results: There were 3cases that presented with invasive fungal infection (IFI) during the study periodThe most common underlying diseases were acute lymphoblastic leukemia (n= 12, 40%), acute myeloid leukemia (n=6, 20%), and aplastic anemia (n= 4, 13.3%). Hematopoietic stem cell transplantation (HSCT) was done for 53.3% of these patients (n=16)Of all patients, 10% were diagnosed with a proven (n=3), 20% probable (n=6), and 70% possible invasive fungal infections (n= 21)There was 37.5% of HSCT recipients who developed IFI before conditioning regimen (n= 6). Severe and prolonged neutropenia was present in 70% of patients prior to the onset of IFI. Lungs were the commonest site of involvement in these cases. Galactomannan assays in serum were measured in all suspected cases and were positive (cutoff value of 0.5) in 10% only (n=3)Aspergillus fumigatus was isolated mostly from sinus aspirates and tissue cultures in cases of proven and probable IFI. Full recovery was documented in 83.3% of cases.

    Conclusion: Diagnosing IFI in pediatric patients undergoing chemotherapy and hematopoietic stem cell transplantation is more complicated than adults. Biologic markers and imaging studies in our pediatric population are not specific tools and might not beadequate to confirm the diagnosis of IFI. More invasive procedures such as bronchoalveolar lavage and tissue biopsy are still underperformed and should be implemented. Antimold prophylaxis in patients with prolonged profound neutropenia who are at high risk for IFI should be considered. Improved prevention, early detection and better diagnostic approaches are needed to improve the outcomes of our patients.


    Ban AL-Sayyed, MD, Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, Raif Othman, MD, Pediatric Oncology and BMT, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, Abdullatef Ahmed, MD, Pediatric Oncology and BMT, King Faisal Speciality Hospital and Research Center, Jeddah, Saudi Arabia, Mohamed Bayoumy, MD, Pediatric Hematology Oncology and BMT, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia and Mohannad Mannaa, MD, Pediatric Pulmonary and Sleep Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

    Disclosures:

    B. AL-Sayyed, None

    R. Othman, None

    A. Ahmed, None

    M. Bayoumy, None

    M. Mannaa, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.