title: Prevention and monitoring of invasive fungal infections in pediatric patients with cancer and hematologic disorders.
abstract: BACKGROUND
  The occurrence of invasive fungal infection (IFIs) in a pediatric hematology/oncology unit after renovation of the ventilation system, and initiating routine azole antifungal prophylaxis was monitored. In addition, the value of serial screening for Aspergillus galactomannan (GM) for diagnosing invasive aspergillosis was assessed.
  
  
  METHODS
  A total of 98 consecutive high-risk pediatric patients were prospectively surveyed for signs of IFI and weekly monitored for serum GM. The data was not made available to treating physicians.
  
  
  RESULTS
  Only 2 patients had proven and 27 possible IFI based on the European Organization for Research and Treatment of Cancer/Mycoses Study Group definitions. The incidence of proven IFI was 1/31 (3.2%) in the allogeneic stem cell transplant (SCT) (Aspergillus spp), 0/26 in the autologous SCT, and 1/60 (1.6%) in the induction therapy group (C. krusei). GM was detected at least in one tested sample in 12/98 patients (12.2%), in five patients in two or more sequential samples. In the latter group, IFI was proven in one patient and could not be excluded in the others. Four of the five patients belonged to the 31 allogeneic and one to the 26 autologous SCT patients. In patients with only one positive GM test none developed signs of IFI and only one received empirical amphotericin B.
  
  
  CONCLUSIONS
  With the currently used preventative and prophylactic measures, IFI is uncommon in children with high-risk for infection. Regular screening for GM could be useful among allogeneic SCT patients and two positive samples should prompt further investigative procedures and pre-emptive antifungal therapy.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. liisa.hovi@hus.fi
authors.forename: Liisa
authors.initials: L
authors.lastname: Hovi
authors.forename: Harri
authors.initials: H
authors.lastname: Saxen
authors.forename: Ulla M
authors.initials: UM
authors.lastname: Saarinen-Pihkala
authors.forename: Kim
authors.initials: K
authors.lastname: Vettenranta
authors.forename: Taru
authors.initials: T
authors.lastname: Meri
authors.forename: Malcolm
authors.initials: M
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001228:Aspergillosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D008351:Mannans / Q000097:blood; D008991:Monitoring, Physiologic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose