Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome

Author:

Gal Etzioni Tamar Ruth12,Fainshtain Nurit12,Nitzan-Luques Adi123,Goldstein Gal123,Weinreb Sigal123,Temper Violeta14,Korem Maya14ORCID,Averbuch Dina125

Affiliation:

1. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel

2. Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel

3. The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel

4. Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel

5. Pediatric Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel

Abstract

Invasive fungal infections (IFI) cause morbidity and mortality in children with acute leukemia (AL). We retrospectively collected data on febrile neutropenic episodes (FNE) in AL children (2016–2021) and assessed factors associated with proven/probable IFI. Ninety-three children developed 339 FNE. Seventeen (18.3%) children developed 19 proven/probable IFI (11 yeast; eight molds). The proven/probable yeast IFI rate was 6/52 (11.5%) in children who belong to the high risk for IFI category (HR-IFI-AL: high-risk acute lymphocytic leukemia (ALL), acute myeloid leukemia, relapse); and 5/41 (12.2%) in the non-HR-IFI-AL category (standard/intermediate risk ALL). The proven/probable mold IFI rate was 7/52 (13.5%) in HR-IFI-AL children and 1/41 (2.4%) in the non-HR-IFI-AL category. In the multivariable analysis, underlying genetic syndrome, oral mucositis, and older age were significantly associated with proven/probable IFI, while a longer time since AL diagnosis was protective. Two of 13 (15.4%) HR-IFI-AL children died because of IFI. The elevated risks of proven/probable mold IFI and the associated mortality in HR-IFI-AL children, and high risk of invasive candidiasis in the non-HR-IFI-AL group, emphasize the need for the close monitoring of local epidemiology and the adjustment of practices accordingly.

Publisher

MDPI AG

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