Invasive mold infections in iatrogenically immunocompromised children: An eight‐yr review

Abstract

IMI are emerging as an important cause of mortality and morbidity among the growing number of immunocompromised children. A retrospective chart review was performed in all patients with a proven diagnosis of IMI over an eight-yr period (1997-2004) at The Hospital for Sick Children, Toronto, Canada to document the incidence, clinical spectrum, microbiology, treatment, and outcome of pediatric IMI. Twenty-eight patients developed IMI over the study period (10 cancer, 12 HCT, and six SOT patients). IMI occurred in 0.51%, 2.2% and 3.2% after a median time of 118, 60 and 71 days, among cancer, HCT and SOT recipients, respectively. Aspergillus spp. infection was diagnosed most commonly (23 patients) and the most common site of infection was the lung (21 patients). Patients at increased risk included those with acute myelogenous leukemia, allogeneic unrelated HCT recipients, graft-versus-host disease, and lung transplant recipients. The mortality after one yr was 60% among cancer patients, 58% among HCT patients, and 16% among SOT patients.

A Prospective, International Cohort Study of Invasive Mold Infections in Children

“…Although data for combination antifungal therapy in children with IMIs are sparse, it is frequently used in practice, as evidenced by our study and by other recent pediatric cohort studies that have reported rates of combination therapy ranging from 32% to 91% [3][4][5]. We found that primary combination therapy was more likely to be used in patients who had received antimold agents before diagnosis.…”

“…Compared with previous cohort studies of IA in children, we found more frequent use of extended spectrum triazoles as well as echinocandins, with voriconazole replacing liposomal amphotericin B as the predominant agent for treatment of IA [3][4][5]. This result likely reflects incorporation of evidence primarily in adults showing superiority of voriconazole to amphotericin B deoxycholate in terms of outcome and tolerability [23].…”

Multiple Modality Treatment Regimen in an Aggressive Resistant Fungal Hand Infection: A Case Report

“…Treatment efforts for this difficult problem must prevent systemic spread as the evolution of disseminated Aspergillosis is associated with mortality rates as high as 80% [2][3][4]8]. Wide local excision of all involved soft tissue has been discussed as the preferred Joseph A. Molnar, MD, Ph.D., receives research funds from KCI, Inc. (the manufacturer of the VAC®) and receives compensation for presentations at educational symposia sponsored by KCI, Inc. surgical intervention.…”

Combination Antifungal Therapy for Invasive Mold Infections Among Pediatric Patients with Hematological Malignancies: Data from A Real-Life Case-Series

“…Invasive mold infections (IMI) represent a major cause of morbidity and mortality among pediatric patients affected by hematological malignancies and are often associated with poor clinical outcomes despite the use of active antifungal drugs [1][2][3][4][5][6].…”