Invasive Fungal Infections in Pediatric Oncology Patients

Abstract

The purpose of this study was to determine the incidence of fungal infections in pediatric hematology and oncology (PHO) patients and to describe variations regarding site of infection, organisms, and mortality. The records of 1,052 patients presenting to the UCLA PHO service with various malignancies from 1991 to 2001 were retrospectively reviewed. No patient received invasive antifungal prophylaxis. Transplant patients were excluded. The 11-year incidence of fungal infections in this pediatric oncology cohort was 4.9%. There was a linear increase in the incidence of fungal infections from 2.9% to 7.8% between 1996 and 2001 (P = 0.001). Patients with acute leukemia represented 36% of the population but had a disproportionate incidence (67%) of fungal infections. Adolescents had twice the expected incidence of infection (P < 0.0001). Overall, Candida sp. was the major pathogen. Over time, a trend of fewer infections caused by Candida and more due to Aspergillus was noted. Blood-borne infections decreased over time, while those in the urinary and respiratory tracts increased (P = 0.04). Sixty-two percent of infections occurred in neutropenic patients. PHO patients had an overall mortality of 21%, but those with fungal infections experienced a 2.6-fold higher mortality that was not attributable to infections alone. Empiric antifungal therapy had no effect on mortality rates. Concurrent nonfungal infections did not increase mortality rates. The incidence of fungal infections increased over time, possibly as a result of advances in antibacterial and chemotherapeutic regimens. Adolescents and patients with leukemia were especially at risk. Fungal infections are a poor prognostic factor, independent of fungal-related mortality. New diagnostic methods allowing for early detection and treatment as well as more effective therapies are needed.

Risk factors for candida infection of the genital tract in the tropics

“…Candida spp. belongs to the pathogenic fungi, its infectivity is the result of interaction by host, fungi, environment and nosocomial factors [17][18][19] . To understand the mechanism of candidal vulvovaginitis and exploit it for treatment, further studies using new advances in Candida biology as well as high-quality, large-scale data are needed.…”

Murine Models of Candida Gastrointestinal Colonization and Dissemination

“…In animal models, the three primary mechanisms that promote microbial GI translocation are as follows: (i) disruption of the normal GI microbiome equilibrium, allowing intestinal dominance of pathogens; (ii) increased permeability of the intestinal mucosal barrier, and (iii) deficiencies in host immune defenses (notably cellular immune defenses) (7,8). Not surprisingly, common risk factors for developing candidemia in human patients include neutropenia, mucositis, use of broad-spectrum antibiotics, and invasive medical procedures (9,10). Therefore, since colonization is a precursor to invasive disease, understanding how host and microbial factors govern fungal GI colonization is essential for our understanding of the pathogenesis of fungal disease.…”

Single-Dose Pharmacokinetics of Intravenous Itraconazole and Hydroxypropyl-β-Cyclodextrin in Infants, Children, and Adolescents

“…Itraconazole infusion appeared to be well tolerated in this population with a single adverse event (stinging at the site of infusion) deemed to be related to study drug administration. Based on the findings of this investigation, it appears that intravenous itraconazole can be administered to infants beyond 6 months, children, and adolescents using a weight-normalized approach to dosing.With both traditional and emerging fungal pathogens contributing to an increasing rate of morbidity, invasive mycoses remain a serious and potentially fatal complication for immunocompromised children (1,16,23,26,27,31). In recent years, a growing number of new therapeutic agents have found their way to market (28).…”

“…With both traditional and emerging fungal pathogens contributing to an increasing rate of morbidity, invasive mycoses remain a serious and potentially fatal complication for immunocompromised children (1,16,23,26,27,31). In recent years, a growing number of new therapeutic agents have found their way to market (28).…”