Invasive fungal infections in pediatric bone marrow transplant recipients: single center experience of 10 years.
Invasive fungal infections (IFI) with substantial mortality constitute an increasing problem among BMT patients. From 1986 to 1996 148 children underwent BMT, and are included in a retrospective analysis of the incidence, risk factors and outcome of IFI. By histopathology or culture-proven IFI (Candida, 10; Aspergillus, 8) was documented in 12/73 (16%) allogeneic and in 6/75 (8%) autologous BMT patients. Of these 18 patients, 15 subsequently died, and in 12 (66%) IFI was regarded as the main cause of death. In addition to the patients with documented IFI, 48 had suspected and 82 no fungal infection. Invasive candidal infections were more frequent in patients with semiquantitatively estimated abundant candidal colonization as compared with those with no colonization (18% vs 3%, P = 0.015). In the allogeneic group, 50% of those with severe (grades III-IV) aGVHD had IFI as opposed to 8% of those with no or mild aGVHD (P < 0.001). Regarding cGVHD, 57% of those with extensive cGVHD vs 5% of those with absent or limited cGVHD had IFI (P < 0.001). The dose of steroids was associated with IFI: 77% of those who received high-dose steroids (methylprednisolone 0.25-1 g/day for 5 days) vs 5% of those with conventional-dose (prednisone 2 mg/kg/day) had IFI (P < 0.001). Particularly for BMT patients at risk, new, quicker and better diagnostic tests and more effective anti-fungal agents, both for prophylaxis and treatment, are needed.
Hovi
L
L
Hospital for Children and Adolescents, University of Helsinki, Finland.
Saarinen-Pihkala
U M
UM
Vettenranta
K
K
Saxen
H
H
D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009503:Neutropenia / Q000150:complications; D011241:Prednisone / Q000009:adverse effects; D011292:Premedication; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone