Invasive Mold Infections in Pediatric Cancer Patients Reflect Heterogeneity in Etiology, Presentation, and Outcome: A 10-Year, Single-Institution, Retrospective Study

Abstract

Although Aspergillus spp. was the most common mold in our pediatric cancer population, the epidemiology of the IMIs was diverse. Adults and children share similar risk factors for and epidemiology of IMIs.

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

“…Pediatric Invasive Mold Infections differences in global treatment success, progression-free survival, or mortality when comparing patients with different IMI types, but small numbers of patients with mucormycosis or other IMIs limit conclusions regarding outcome by subtype. The 12-week mortality rate of 30% in our cohort is similar to the 31% 12-week mortality rates from recent single-center cohort studies of IMIs in children with cancer or receiving HSCT [5,24]. The long-term mortality rate reported for one of these studies was much higher at 73%, and prior pediatric cohort studies, primarily focusing on IA, have reported similarly poor long-term mortality rates, ranging from 50% to 88% [3-5, 7, 25, 26].…”

“…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].…”

“…Our findings are similar in that children with mucormycosis and other non-Aspergillus IMIs differed from those with IA primarily in exposure to prior mold-active agents, but not in immunologic risk factors. Other studies have shown prior exposure to voriconazole to be a risk factor for mucormycosis and other non-Aspergillus IMIs [5,[17][18][19][20]. Breakthrough infection with non-Aspergillus molds has also been reported in patients receiving other agents such as caspofungin and posaconazole [21,22].…”

Epidemiology of invasive fungal infections in immunocompromised children; an Australian national 10‐year review

“…Lomentospora prolificans was the most commonly encountered non‐ Aspergillus mold in our study, and although reported in previous predominantly adult Australian studies, it rarely features in pediatric series . There is also a striking paucity of mucormycosis, which is in contrast to other international paediatric and local adult studies. Variations in the prevalence and epidemiology of non‐ Aspergillus mold infections may reflect selective antifungal pressure through antifungal prophylaxis strategies and local environmental influences, such as agricultural antifungal use and construction works and highlights the importance of ongoing evaluations of local IFI epidemiology and outcomes in specific diagnostic and HSCT cohorts to optimize prevention and treatment strategies to minimize IFI morbidity and mortality.…”