Deep Candida infection in children receiving allogeneic bone marrow transplants: incidence, risk factors and diagnosis.
Fifty-eight children, who received 60 allogeneic bone marrow transplants (BMT), were studied with regard to incidence, risk factors and diagnosis of deep Candida infection (DCI). Serum samples were analysed for the presence of Candida IgA, IgM and IgG antibodies and free C. albicans glucoprotein antigen (Ag). Five children (8.7%) had a confirmed DCI and died before engraftment of the new bone marrow. When four patients with suspected deep Candida infection (SDCI) were included, the incidence was 15.6%. Four of the five children (80%) with DCI had pathological Candida IgM antibody (Ab) titers and/or free C. albicans glucoprotein Ag, 2-50 days before DCI was verified by culture, direct microscopy and/or autopsy. Risk factors, using Fisher's exact test for DCI, included not receiving bone marrow from an HLA-identical sibling donor, having a seropositive Herpes simplex virus (HSV) donor and pathological IgA and/or IgM Ab titers against Candida before BMT. In conclusion, a child with the above-mentioned risk factors, runs a risk of acquiring fatal DCI before engraftment. The institution of systemic antifungal prophylactic treatment may prevent death from DCI. After BMT, serological examinations may be of value in the early detection of DCI.
Klingspor
L
L
Paediatric Unit, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
Stintzing
G
G
Fasth
A
A
Tollemar
J
J
D000293:Adolescent; D000908:Antibodies, Fungal / Q000097:blood; D000946:Antigens, Fungal / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002176:Candida albicans / Q000276:immunology; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D014184:Transplantation, Homologous
D000908:Antibodies, Fungal; D000946:Antigens, Fungal; D015725:Fluconazole