TY - JOUR
T1 - Invasive Fusariosis in Pediatric Hematology/Oncology and Stem Cell Transplant Patients
T2 - A Report from the Israeli Society of Pediatric Hematology-Oncology
AU - Benish, Marganit
AU - Elitzur, Sarah
AU - Arad-Cohen, Nira
AU - Barg, Assaf Arie
AU - Ben-Harosh, Miriam
AU - Bielorai, Bella
AU - Fischer, Salvador
AU - Gilad, Gil
AU - Levy, Itzhak
AU - Rosenfeld-Keidar, Hila
AU - Shachor-Meyouhas, Yael
AU - Soen-Grisaru, Galia
AU - Weinreb, Sigal
AU - Nirel, Ronit
AU - Elhasid, Ronit
N1 - Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/4
Y1 - 2022/4
N2 - Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20–40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.
AB - Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20–40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.
KW - cancer
KW - children
KW - fusarium
KW - immunocompromised
KW - invasive fungal infections
KW - leukemia
KW - pediatric hematology oncology
KW - stem cell transplantation
UR - http://www.scopus.com/inward/record.url?scp=85129035180&partnerID=8YFLogxK
U2 - 10.3390/jof8040387
DO - 10.3390/jof8040387
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 35448618
AN - SCOPUS:85129035180
SN - 2309-608X
VL - 8
JO - Journal of Fungi
JF - Journal of Fungi
IS - 4
M1 - 387
ER -