Gal Etzioni Tamar Ruth, Fainshtain Nurit, Nitzan-Luques Adi, Goldstein Gal, Weinreb Sigal, Temper Violeta, Korem Maya, Averbuch Dina
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel.
Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel.
Microorganisms. 2024 Jan 11;12(1):145. doi: 10.3390/microorganisms12010145.
Invasive fungal infections (IFI) cause morbidity and mortality in children with acute leukemia (AL). We retrospectively collected data on febrile neutropenic episodes (FNE) in AL children (2016-2021) and assessed factors associated with proven/probable IFI. Ninety-three children developed 339 FNE. Seventeen (18.3%) children developed 19 proven/probable IFI (11 yeast; eight molds). The proven/probable yeast IFI rate was 6/52 (11.5%) in children who belong to the high risk for IFI category (HR-IFI-AL: high-risk acute lymphocytic leukemia (ALL), acute myeloid leukemia, relapse); and 5/41 (12.2%) in the non-HR-IFI-AL category (standard/intermediate risk ALL). The proven/probable mold IFI rate was 7/52 (13.5%) in HR-IFI-AL children and 1/41 (2.4%) in the non-HR-IFI-AL category. In the multivariable analysis, underlying genetic syndrome, oral mucositis, and older age were significantly associated with proven/probable IFI, while a longer time since AL diagnosis was protective. Two of 13 (15.4%) HR-IFI-AL children died because of IFI. The elevated risks of proven/probable mold IFI and the associated mortality in HR-IFI-AL children, and high risk of invasive candidiasis in the non-HR-IFI-AL group, emphasize the need for the close monitoring of local epidemiology and the adjustment of practices accordingly.
侵袭性真菌感染（IFI）可导致急性白血病（AL）患儿发病和死亡。我们回顾性收集了2016年至2021年期间AL患儿发热性中性粒细胞减少发作（FNE）的数据，并评估了与确诊/疑似IFI相关的因素。93名儿童出现了339次FNE。17名（18.3%）儿童出现了19例确诊/疑似IFI（11例酵母菌感染；8例霉菌感染）。在属于IFI高风险类别（HR-IFI-AL：高危急性淋巴细胞白血病（ALL）、急性髓细胞白血病、复发）的儿童中，确诊/疑似酵母菌IFI发生率为6/52（11.5%）；在非HR-IFI-AL类别（标准/中度风险ALL）中为5/41（12.2%）。HR-IFI-AL儿童中确诊/疑似霉菌IFI发生率为7/52（13.5%），非HR-IFI-AL类别中为1/41（2.4%）。在多变量分析中，潜在遗传综合征、口腔黏膜炎和年龄较大与确诊/疑似IFI显著相关，而自AL诊断以来时间较长具有保护作用。13名HR-IFI-AL儿童中有2名（15.4%）因IFI死亡。HR-IFI-AL儿童确诊/疑似霉菌IFI风险升高及相关死亡率，以及非HR-IFI-AL组侵袭性念珠菌病的高风险，强调了密切监测当地流行病学并相应调整治疗方法的必要性。
