Clinicopathologic Characterization of Invasive Fungal Intestinal Infections in Pediatric Patients

Abstract

Background: Invasive fungal intestinal infections are rare in pediatric patients with limited studies reported to date. Methods: Retrospective study of invasive intestinal fungal infections in pediatric patients. For fungal specification, 18S rRNA gene PCR was performed using formalin-fixed paraffin-embedded tissues. Results: A total of 19 cases from 18 patients were included (13 males, 72%) with a median age of 20 days (8 days–14 years). About 13 patients (72%) presented within 67 days of birth and 11 patients (61%) were premature and 14 patients (78%) had a significant medical history. The most common location was the jejunum/ileum (56%) followed by the right colon and terminal ileum (22%). In 10 patients, the fungal elements were seen in the mucosa with 3 extending into the submucosa, and only 3 patients showed full-thickness involvement. Tissue necrosis and angioinvasion were seen in 13 (72%) and 8 (44%) patients, respectively. Morphologically, organisms consistent with Candida spp. were seen in 17 patients and with a mucoraceous mold in 1 patient. A 18S rRNA gene sequencing performed in 18 cases identified Candida dubliniensis in 16 cases and Candida spp. in 2 cases. During the study follow-up period, 56% of the patients died. Conclusion: In our experience, most cases were due to Candida spp. and predominantly in premature infants and associated with poor outcomes.