Prevalence and Predictors of Invasive Fungal Infections in Children with Persistent Febrile Neutropenia Treated for Acute Leukemia – A Prospective Study

Kumar, Jogender; Singh, Amitabh; Seth, Rachna; Xess, Immaculata; Jana, Manisha; Kabra, Sushil Kumar

doi:10.1007/s12098-018-2722-0

Cited by 34 publications

(36 citation statements)

References 13 publications

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“…Clinical presentations associated with IFD include sinusitis and abdominal discomfort. 5 However, abdominal pain and pneumonia predominated in our study. Nevertheless, respiratory distress, oxygen requirement, and hypotension have been documented as high risk factors of FN in developing serious morbidity.…”

Section: Discussioncontrasting

confidence: 48%

“… 9 , 28 These are usually reported among patients with mostly hematologic malignancies in most studies. 5 , 9 In addition, most previous studies on pediatric oncology populations have included nonfever or nonneutropenic cases. 26 In our study, cancer types were not associated with IFD.…”

Section: Discussionmentioning

confidence: 99%

“…Only 5.8% of patients with FN were ultimately diagnosed with IFD in one high-income country, 4 while higher rates up to 23% were found in a country with limited resources. 5 Related studies have shown increasing risk of developing IFD correlate with prolonged duration of neutropenia after initiation of fever, treatment of acute myeloid leukemia, 6 high-risk (or relapsed) acute lymphoblastic leukemia, 7 high-dose steroid exposure, 8 prolonged use of empirical antibiotics, 9 and pre-existing sites of fungal colonization. 10 , 11 Patients who develop fever during the induction phase of treatment (compared with the maintenance phase) and patients with early fever onset, ie, fever occurring within 5 days of becoming neutropenic appeared to be at higher risk of IFD.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Predictive Factors of Invasive Fungal Disease in Pediatric Oncology Patients with Febrile Neutropenia in a Country with Limited Resources

Monsereenusorn¹,

Sricharoen²,

Rujkijyanont³

et al. 2021

PHMT

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Background:The most common complication among pediatric oncology patients is febrile neutropenia (FN). Invasive fungal disease (IFD) is suspected when fever persists >4-7 days after empirical antibiotics. Its clinical characteristics and predictive factors associated with IFD among pediatric oncology patients with FN were thus explored. Methods: Pediatric oncology patients with FN between January 1, 2012 and December 31, 2016 were enrolled in this study. Clinical characteristics, including laboratory investigations, treatment modalities, and final outcomes of IFD were retrospectively reviewed and analyzed. Results: In all, 73 patients with 180 episodes of confirmed diagnosis of FN were studied. Median age at diagnosis was 6.2 years, with equal sex distribution. The most common diagnosis was acute lymphoblastic leukemia (n=91, 51%), followed by acute myeloid leukemia (n=47, 26%), Burkitt's lymphoma (n=7, 4%) and neuroblastoma (n=7, 4%). Median absolute neutrophil count at FN diagnosis was 0 (0-806) cells/mm 3 . IFD was diagnosed for 25 (14%) episodes. Mortality rates for FN and IFD were 4% and 20%, respectively. Respiratory compromise, oxygen requirement, hypotension, prolonged hospitalization, duration of fever and neutropenia, bacteremia, bacteriuria, funguria, abnormal liver-function results, and prolonged broad-spectrum antibiotic administration were factors associated with IFD (P<0.05). Prolonged duration between initiation of fever and antifungal administration for nearly 10 days was an independent factor in prediction of IFD occurrence (P=0.014). Conclusion:Respiratory compromise, oxygen requirement, hypotension, prolonged hospitalization, duration of fever and neutropenia, bacteremia, bacteriuria, funguria, abnormal liver-function results and prolonged broad-spectrum antibiotic administration were factors associated with IFD. Duration between initiation of fever and antifungal administration of nearly 10 days were considered a risk factors of IFD among patients with FN.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Predictive Factors of Invasive Fungal Disease in Pediatric Oncology Patients with Febrile Neutropenia in a Country with Limited Resources

Monsereenusorn¹,

Sricharoen²,

Rujkijyanont³

et al. 2021

PHMT

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“…A recent study reported that abnormal chest x-ray and clinical sinusitis are important predictors of invasive candidiasis in these patients, and protocols that include early empirical antifungal therapy covering this infection is essential. 93 Thus, as noted, prophylaxis may be effective in reducing the rate of disseminated candidiasis in people with leukemia, but long-term use of antifungal drugs may impose some difficulties, and the results of some studies have shown that despite prophylaxis, IFI has occurred in patients with blood malignancies.…”

Section: Dovepressmentioning

confidence: 98%

<p>An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies</p>

Shariati¹,

Moradabadi²,

Chegini³

et al. 2020

IDR

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In patients with hematologic malignancies due to immune system disorders, especially persistent febrile neutropenia, invasive fungal infections (IFI) occur with high mortality. Aspergillosis, candidiasis, fusariosis, mucormycosis, cryptococcosis and trichosporonosis are the most important infections reported in patients with hematologic malignancies that undergo hematopoietic stem cell transplantation. These infections are caused by opportunistic fungal pathogens that do not cause severe issues in healthy individuals, but in patients with hematologic malignancies lead to disseminated infection with different clinical manifestations. Prophylaxis and creating a safe environment with proper filters and air pressure for patients to avoid contact with the pathogens in the surrounding environment can prevent IFI. Furthermore, due to the absence of specific symptoms in IFI, rapid and accurate diagnosis reduces the mortality rate of these infections and using molecular techniques along with standard mycological methods will improve the diagnosis of disseminated fungal infection in patients with hematologic disorders. Amphotericin B products, extended-spectrum azoles, and echinocandins are the essential drugs to control invasive fungal infections in patients with hematologic malignancies, and according to various conditions of patients, different results of treatment with these drugs have been reported in different studies. On the other hand, drug resistance in recent years has led to therapeutic failures and deaths in patients with blood malignancies, which indicates the need for antifungal susceptibility tests to use appropriate therapies. Life-threatening fungal infections have become more prevalent in patients with hematologic malignancies in recent years due to the emergence of new risk factors, new species, and increased drug resistance. Therefore, in this review, we discuss the different dimensions of the most critical invasive fungal infections in patients with hematologic malignancies and present a list of these infections with different clinical manifestations, treatment, and outcomes.

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“…While the frequency of Aspergillus spp. isolation in lung samples has been rising according to multiple studies [25,40,41], the incidence of Pneumocystis jirovecii pneumonia has dropped significantly since effective chemoprophylaxis with co-trimoxazole was established in children undergoing chemotherapy for hematologic malignancies [42,43].…”

Section: Identified Causesmentioning

confidence: 99%

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

Voulgaridou

Athanasiadou

et al. 2020

Diseases

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Infections frequently complicate the treatment course in children with hematologic malignancies undergoing chemotherapy. Febrile neutropenia (FN) remains a major cause of hospital admissions in this population, and respiratory tract is often proven to be the site of infection even without respiratory signs and symptoms. Clinical presentation may be subtle due to impaired inflammatory response. Common respiratory viruses and bacteria are widely identified in these patients, while fungi and, less commonly, bacteria are the causative agents in more severe cases. A detailed history, thorough clinical and basic laboratory examination along with a chest radiograph are the first steps in the evaluation of a child presenting signs of a pulmonary infection. After stratifying patient’s risk, prompt initiation of the appropriate empirical antimicrobial treatment is crucial and efficient for the majority of the patients. High-risk children should be treated with an intravenous antipseudomonal beta lactam agent, unless there is suspicion of multi-drug resistance when an antibiotic combination should be used. In unresponsive cases, more invasive procedures, including bronchoalveolar lavage (BAL), computed tomography (CT)-guided fine-needle aspiration or open lung biopsy (OLB), are recommended. Overall mortality rate can reach 20% with higher rates seen in cases unresponsive to initial therapy and those under mechanical ventilation.

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Prevalence and Predictors of Invasive Fungal Infections in Children with Persistent Febrile Neutropenia Treated for Acute Leukemia – A Prospective Study

Abstract: Thus, prevalence of IFI is very high in children with persistent febrile neutropenia who are not on antifungal prophylaxis. Abnormal chest x- ray and clinical sinusitis are important predictors of IFI.

Cited by 34 publications

References 13 publications

Clinical Characteristics and Predictive Factors of Invasive Fungal Disease in Pediatric Oncology Patients with Febrile Neutropenia in a Country with Limited Resources

Clinical Characteristics and Predictive Factors of Invasive Fungal Disease in Pediatric Oncology Patients with Febrile Neutropenia in a Country with Limited Resources

<p>An Overview of the Management of the Most Important Invasive Fungal Infections in Patients with Blood Malignancies</p>

Pulmonary Infectious Complications in Children with Hematologic Malignancies and Chemotherapy-Induced Neutropenia

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