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.