Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany.
Int J Infect Dis. 2020 Mar;92:114-122. doi: 10.1016/j.ijid.2019.12.017. Epub 2019 Dec 19.
Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections.
Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected.
Fifty-five children (median age 9 years [IQR: 5-14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment. Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3-28] versus 61 days [IQR: 16-148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35-51.40] and HR 6.12 [95% CI 1.52-24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11-0.99] and HR 0.09 [95% CI 0.02-0.40], respectively).
Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome.
目前关于儿童中鞘孢菌属和 prolificans 属感染的知识有限。因此，我们旨在提供这些感染的风险群体、临床表现和治疗策略概述。
在 PubMed 和 FungiScope®注册处确定了经证实/可能患有鞘孢菌属或 prolificans 属感染的儿科患者（年龄≤18 岁）。收集了有关诊断、治疗和结局的数据。
在 1990 年至 2019 年期间，共发现 55 例患有侵袭性鞘孢菌属（n=33）或 prolificans 属（n=22）感染的儿童。恶性肿瘤、创伤和近乎溺水是最常见的危险因素。感染通常广泛传播。大多数患者接受了系统抗真菌治疗，主要是伏立康唑和两性霉素 B，外加手术治疗。总体而言，第 42 天死亡率为 31%，prolificans 属（50%）高于鞘孢菌属（18%）。与鞘孢菌属相比，prolificans 属感染的中位生存时间更短（6 天[IQR：3-28]与 61 天[IQR：16-148]）。针对恶性肿瘤和严重播散性感染的治疗与特别不良结局相关（HR 8.33[95%CI 1.35-51.40]和 HR 6.12[95%CI 1.52-24.66]）。任何时候使用伏立康唑和为抗真菌治疗进行手术与临床结局改善相关（HR 0.33[95%CI 0.11-0.99]和 HR 0.09[95%CI 0.02-0.40]）。
尽管进行了全面的抗真菌治疗，儿童中鞘孢菌属和 prolificans 属感染仍与高死亡率相关。伏立康唑使用和手术干预与良好结局相关。
