Invasive Mold Infections (IMI) are a leading cause of morbidity and mortality among patients with hematologic malignancies (HM). Knowledge about pediatric IMI is limited and local epidemiological investigation is merited.
We conducted a retrospective review of HM patients, who were admitted to Texas Children’s Hospital (TCH) from 2006-2015 with IMI. Children (<18 years) with proven and probable IMI were included in the study. Demographics, risk factors, underlying disease, clinical course, and treatment were recorded. Outcomes were assessed at 12 weeks after diagnosis using standard guidelines.
Thirty three out of 211 patients met criteria. More than half (28/34) had a diagnosis of leukemia, 7 of which were relapsed or refractory (25%). Twenty-three out of 33 patients (68.8%) were of Hispanic ethnicity, compared with 40% of the TCH Oncology Clinic population. The median time to IMI from the diagnosis was 116.5 days (range 10-988 days). Aspergillus spp. (12/33; 36.3%) followed by Exserohilum spp (6/33; 18%) were the predominant organisms. Five patients had multiple mold species while seven patients had a concurrent Candida species identified. Risk factors were similar among patients with invasive aspergillosis and other IMI. Ten patients (31.3%) had been on antifungal prophylaxis prior to onset of IMI, predominantly with fluconazole. More than half of the patients had concurrent infections (17/33, 53.1%), mostly bacterial. Combination antifungals with triazole and polyenes were most commonly used (21/33; 63.6%). Complete remission of IMI was achieved in 20/33 (60.6%) patients with 8/33 (24.2%) deaths at the end of 12 weeks. Three of the eight reported deaths (37.5%) were attributed to IMI. The most commonly affected organs were lungs (21/33; 63.6%) and sinuses (20/33, 60.6%). Seven (21.2%) had disseminated disease. No difference in risk factors or outcome was detected among patients with relapsed or refractory disease.
Conclusion: This study represents one of the largest single center study for IMI among children with HM. Risk factors and outcome were similar between different mold species and in patients with relapsed/refractory disease. Patients with Hispanics ethnicity were disproportionately diagnosed with IMI. Prospective studies are warranted to investigate the association of ethnicity with IMI.
K. Reddy, None
A. Marshburn, None
J. Brackett, None
M. Scheurer, None
M. Gramatges, None
D. Palazzi, None
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