Journal of Fungi (Apr 2022)

Invasive Fusariosis in Pediatric Hematology/Oncology and Stem Cell Transplant Patients: A Report from the Israeli Society of Pediatric Hematology-Oncology

  • Marganit Benish,
  • Sarah Elitzur,
  • Nira Arad-Cohen,
  • Assaf Arie Barg,
  • Miriam Ben-Harosh,
  • Bella Bielorai,
  • Salvador Fischer,
  • Gil Gilad,
  • Itzhak Levy,
  • Hila Rosenfeld-Keidar,
  • Yael Shachor-Meyouhas,
  • Galia Soen-Grisaru,
  • Sigal Weinreb,
  • Ronit Nirel,
  • Ronit Elhasid

DOI
https://doi.org/10.3390/jof8040387
Journal volume & issue
Vol. 8, no. 4
p. 387

Abstract

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Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20–40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.

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