Benish Marganit, Elitzur Sarah, Arad-Cohen Nira, Barg Assaf Arie, Ben-Harosh Miriam, Bielorai Bella, Fischer Salvador, Gilad Gil, Levy Itzhak, Rosenfeld-Keidar Hila, Shachor-Meyouhas Yael, Soen-Grisaru Galia, Weinreb Sigal, Nirel Ronit, Elhasid Ronit
Department of Pediatric Hemato-Oncology, Sourasky Medical Center, Tel Aviv 6423906, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Fungi (Basel). 2022 Apr 11;8(4):387. doi: 10.3390/jof8040387.
Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20−40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.
免疫功能低下患者的侵袭性镰刀菌属感染主要发生在血液系统恶性肿瘤患者中。据报道，成人的生存率为20%-40%，但儿童的数据有限。我们对儿科血液学/肿瘤学和干细胞移植（SCT）患者的侵袭性镰刀菌病进行了一项全国性多中心回顾性研究，共确定了22例病例。基础疾病包括血液系统恶性肿瘤（n = 16；73%）、实体瘤（n = 2）和非恶性血液系统疾病（n = 4）。19名患者（86%）存在中性粒细胞减少，9名（41%）是SCT接受者，7名（32%）接受了皮质类固醇治疗。16名患者（73%）发生播散性镰刀菌病，5名有局部感染，1名有孤立性真菌血症。15名患者（68%）有皮肤受累，8名（36%）有血流感染。4名患者（18%）出现骨关节受累，4名出现肺部受累。19名患者（86%）一开始接受了联合抗真菌治疗，3名（14%）接受了单药治疗。90天生存率为77%：5例死亡中有4例归因于镰刀菌病，均为复发/难治性急性白血病患者。复发/难治性基础恶性肿瘤患者的90天生存率为33%，而其他患者为94%（p < 0.001）。在这项基于最大儿科人群的研究中，生存率显著高于成人报道的生存率，表明侵袭性镰刀菌病在免疫抑制儿童中是一种危及生命但可挽救的疾病。
