Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia.
Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.
Children's Hospital, Department of Pediatric Hematology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey. Electronic address: dyilmazk@yahoo.com.
Deniz
D
Yilmaz Karapinar
Children's Hospital, Department of Pediatric Hematology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Nihal
N
Karadaş
Children's Hospital, Department of Pediatric Hematology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Zühal
Z
Önder Siviş
Children's Hospital, Department of Pediatric Intensive Care, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Pinar
P
Yazici
Children's Hospital, Department of Pediatric Intensive Care, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Muhterem
M
Duyu
Medical Microbiology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Dilek
D
Metin
Children's Hospital, Department of Pediatric Intensive Care, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Bülent
B
Karapinar
Children's Hospital, Department of Pediatric Hematology, Ege University Faculty of Medicine, Bornova-İzmir, Turkey.
Yeşim
Y
Aydinok
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D054714:Echinocandins / Q000627:therapeutic use*; D064147:Febrile Neutropenia / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005847:Geotrichosis / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D055666:Lipopeptides; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology; D035583:Rare Diseases; D012720:Severity of Illness Index; D060586:Trichosporonosis / Q000175:diagnosis* / Q000382:microbiology
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin
Febrile neutropenia; Geotrichum capitatum; Invazive fungal infection; Trichosporon asahii