INTRODUCTION
Invasive fungal disease (IFD) is one of the leading causes of morbidity
and mortality among immunocompromised children. In recent years, there
has been a significant increase in pediatric patients at risk, due to
the extended use of immunosuppressive medications. Children who receive
chemotherapy for malignancy or who undergo hematopoietic stem cell
transplant (HSCT) are at the highest risk for an IFD, particularly
invasive aspergillosis (IA) and invasive candidiasis
(IC)1,2. In December 2019, the European Organization
for Research and Treatment of Cancer and the Mycoses Study Group
Education and Research Consortium (EORTC/MSGERC) published an update of
definitions of IFD, including specific considerations for pediatric
patients3. Surveillance of local epidemiology is
essential to understand the pediatric IFD burden to set up preventive
measures, rationalize resources and implement institution-based
infection control strategies1,4.
Management of IFD in immunocompromised children is challenging. Signs
and symptoms may be subtle and often develop late during disease
progression2. Data on imaging tools for the diagnosis
of IFD are scarce and the role of fungal biomarkers may differ from that
of adults5-8. Randomized clinical trials evaluating
antifungal drugs rarely involve children; therefore, these drugs often
must be given ”off-label” for compassionate use. Early diagnosis and
prompt initiation of effective antifungal therapy remain essential to
improve pediatric outcomes1.
The Pediatric Hematology-Oncology Unit (PHOU) of our hospital has
experienced a rising activity and an increase in the complexity of
patients’ pathologies in recent years. This study aimed to describe
demographics, risk factors, diagnostic tools, antifungal treatment and
clinical outcomes of children with IFD admitted to a PHOU. Secondary
objectives were to compare yeast and mold infections, to evaluate
changes over the study period and to compare the characteristics of
surviving and non-surviving patients.