113 Invasive fungal infections among pediatric patients with hematologic malignancies at KFSH&RC/KFCCC&R

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Objectives: To define the magnitude of the problem, study factors associated with increased risk of invasive fungal, infections (IFI) and outcome.
Methods: From June 1998 to March 2003, all, radiological, studies of patients with hematologic/ oncologic disorders were evaluated for inclusion. AII, cases of invasive fungal, infection were reviewed. The criteria for inclusion were obvious lesion suggestive of fungal, infection shown on radiological, studies, and fungal, infections were classified as "proven", "probable', "possible" or "insufficient evidence" according to a prior definitions.
Results: A total, of 1615 patient charts were reviewed. The underlying diagnoses include ALL 410, SCT 293, AML 133, non-malignant hematology 288, NHL/solid tumors 491. 152 (9%) had evidence of fungal, infection (55 [36%] 'definite = proven/probable', 97 [64%] 'possible'). Biopsy was performed in 94 cases and the findings included budding yeast in 10 patients, septated hyphae in 19, and hyphae with no specifications in 12 patients. Delays in performing diagnostic procedures possibly resulted in the lower incidence of 'definite' IFI (36% vs 64% 'possible"). The overall, incidence of fungal, infection was 9%, being highest for AML (39%), followed by ALL (17%). The majority of IFI developed during or immediately after induction (42% of IFI in AML and 53% of IFI in ALL), which can be a target for intervention. The infections included disseminated fungal, infection (36%), CDC (11%), pulmonary fungal, infection (43%) and aspergillosis (9.5%) including pulmonary, Para nasal, sinuses, skin and disseminated. IFI was radiologically diagnosed during neutropenia in 123 patients (81%). Ten patients died due to fungal, infection (7%), 75 (49%) were cured, 26 (17%) were alive with fungal, infection, and 39 patients (26%) died due to primary disease seemingly unrelated to fungal, infection. Mortality due to IFI in this study is less than what is reported in the literature and could be a result of our practice of early intervention. The average LOS for IFI was 56 days compared with the usual. 12 days, which can add to the increased cost.
Conclusions: Invasive fungal, infection is becoming a serious problem. Furthermore, acute invasive fungal, infection is associated with a much higher mortality. Early diagnosis with prompt antifungal, therapy, or even with surgical, intervention, might be warranted to save patients' lives.


This work was published before the author joined Aga Khan University


International Journal of Infectious Diseases