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Identifier

000463849

Title

Αναδρομική μελέτη των μυκητιασικών λοιμώξεων σε παιδό-ογκολογική κλινική : Βιβλιογραφική ανασκόπηση και εμπειρία 10 ετών

Alternative Title

Retrospective study of fungal infections in a paediatric oncology center

Author

Μωραϊτάκη, Ελένη

Thesis advisor

Στειακάκη, Ευτυχία

Reviewer

Χαμηλός, Γεώργιος
Τραγιαννίδης, Αθανάσιος

Abstract

Introduction. Although the current management of paediatric neoplasia has dramatically reduced infections, invasive fungal infections (IFDs) continue to be a significant cause of morbidity and mortality in children and adolescents with neoplasia. The global prevalence of IFDs in children with neoplasia has an increasing trend, while in children with acute myeloid leukemia it may reach up to 23.1%. Their epidemiological monitoring can provide data for their better control and prevention. Methods. Retrospective, single-center study with aim to estimate incidence and describe the clinical and epidemiological characteristics recorded in the medical files of all pediatric and adolescent patients at the pediatric hematology-oncology clinic of Heraklion University Hospital (n=154) for the period 2013-2022. Various demographic, clinical and laboratory parameters were studied as possibly associated with the presence of IFD. Possible, probable or confirmed IFD was defined according to the revised EORTC criteria. Results. In the patients studied (n=154, where 57% males, 58% hematological malignancies, average age of 8.7 years, with a history of chronic respiratory conditions in 17%), the crude average incidence of IFDs was estimated to be 8% (12/154). The mean age at diagnosis of IFD was 9.8 years (SD ± 6.4). The most common IFD was possible pulmonary aspergillosis (in 50%) of the cases, followed by candidemia (in 38%). Patients who were colonized by fungi in sites other than the oral cavity (pharynx, urinary bladder, drainage devices, central venous catheters) were at a higher risk for IFD, compared to those who were not colonized (p=0.001). IFDs had a statistically significant association with ICU hospitalization for more than 7 days, as well as with the administration of a high number of different antimicrobials (p=0.010), with the duration of severe neutropenia for > 44 days (p=0.011). Theadministration of intravenous globulin (IVIG) seems to be related to the development of IFD (p=0.024). Six percent of the patients developed superficial fungal infections (9/154). Candida albicans and Candida parapsilosis were identified in equal number of cases as the causative agent of superficial mycosis whereas Candida parapsilosis was the main causative agent of fungemia (4/6). Two children out of a total of twelve with IFD died due to resilient disease or relapse. Conclusions. In the present study, the incidence of fungal infections in paediatric patients with neoplasia remains high, but comparable to the literature. More detailed epidemiological description of fungal infections in the population of paediatric patients suffering from hematological or solid neoplasms can contribute to optimization of prevention and treatment.

Language

Greek

Subject

Children

Epidemiology

Invasive fungal diseases

Malignancy

Risk factors

Διεισδυτικές μυκητιασικές λοιμώξεις

Επιδημιολογία

Νεοπλασία

Παιδιά