Fungal infections in children with cancer: a prospective, multicenter surveillance study.
BACKGROUND
Data on epidemiology and survival after fungal infections in patients with cancer are primarily based on studies in adults, whereas few data are available on children.


METHODS
A prospective, multicenter, 2-year surveillance of fungal infections in children receiving antineoplastic treatment was performed in 15 Italian centers. For each case, defined by means of EORTC-IFIG/NIAID-MSG, information was collected on age, phase of treatment, presence of neutropenia or lymphocytopenia, administration of antifungal drugs and survival.


RESULTS
Ninety-six episodes (42 proven [19 fungemias, 23 deep tissue infections], 17 probable and 37 possible invasive mycoses) were reported. Most of them (73%) followed aggressive chemotherapy, 21% allogeneic hematopoietic stem cell transplantation and only 6% moderately aggressive treatment. Neutropenia was present in 77% of the episodes, and it had a longer duration before deep tissue mycosis as compared with fungemia (P = 0.020). Lymphocytopenia was present in 75% of the episodes observed in nonneutropenic patients. As compared with children with fungemia, patients with probable invasive mycoses had a 25.7-fold increased risk of death, whereas it was 7.7-fold greater in children with possible invasive mycoses and 5-fold higher in those with proven deep tissue infection (P = 0.004). The risk of death was also 3.8-fold higher in patients already receiving antifungals at the time of diagnosis of infection as compared with those not receiving antimycotic drugs.


CONCLUSIONS
In children with cancer, aggressive antineoplastic treatment, severe and longlasting neutropenia and lymphocytopenia are associated with fungal infections. These features as the clinical pictures are similar to those reported in adults, but in children, the overall and the infection-specific (fungemia or mycosis with deep tissue infection) mortalities are lower.
Castagnola
Elio
E
G. Gaslini Children Hospital, Genova, Italy.
Cesaro
Simone
S
Giacchino
Mareva
M
Livadiotti
Susanna
S
Tucci
Fabio
F
Zanazzo
Giulio
G
Caselli
Desirè
D
Caviglia
Ilaria
I
Parodi
Stefano
S
Rondelli
Roberto
R
Cornelli
Pier Emilo
PE
Mura
Rossella
R
Santoro
Nicola
N
Russo
Giovanna
G
De Santis
Raffaella
R
Buffardi
Salvatore
S
Viscoli
Claudio
C
Haupt
Riccardo
R
Rossi
Mario R
MR
D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents