ABSTRACT
BACKGROUND. Invasive fungal disease (IFD) is a significant cause of
morbidity and mortality in immunosuppressed children. We aim to describe
the epidemiology and clinical parameters of IFD in a Pediatric
Hematology-Oncology Unit (PHOU) with an increasing activity during the
last 14 years.
METHODS. We retrospectively reviewed the medical records of children (up
to 18 years old) admitted for IFD to the PHOU of a tertiary hospital in
Madrid (Spain), between 2006-2019. Epidemiological, diagnostic and
therapeutic parameters were compared according to the type of infection,
study period (considering 3 equivalent time fractions) and outcome.
RESULTS. Twenty-eight episodes of IFD occurred in 27 out of 471 children
at risk (13 males, median 10 years old). Five episodes of candidemia
(all in the first period) and 23 bronchopulmonary mold diseases were
registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met
criteria for proven, probable and possible IFD, respectively. Most
episodes (71.4%) occurred in high-risk children receiving antifungal
prophylaxis. Eight children required intensive care and six died during
treatment.
Mold infections occurred in older children (126 vs. 21 months;p =0,045), increased over time (p =0.002) and were more
common in high-risk compared to low-risk children (87% vs. 0%;p =0.001). There were no differences in mortality rates between
periods, types of infection or underlying conditions.
CONCLUSIONS. Yeast infections decreased within the study time and mold
infections were more frequent in high-risk patients. A rising activity
in our PHOU and an increase in the complexity of pathologies were not
followed by an increase in mortality rates.