Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Study.

Autor:	Karaman S; Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University., Kebudi R; Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute., Kizilocak H; Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa., Karakas Z; Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University., Demirag B; Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital., Evim MS; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University., Yarali N; Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital., Kaya Z; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara., Karagun BS; Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana., Aydogdu S; Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital., Caliskan U; Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya., Ayhan AC; Division of Pediatric Hematology-Oncology, Medeniyet University, Faculty of Medicine., Bahadir A; Division of Pediatric Hematology-Oncology, Karadeniz Technical University, Faculty of Medicine, Trabzon., Cakir B; Division of Pediatric Hematology-Oncology, Bezmiâlem Vakif University., Guner BT; Division of Pediatric Hematology-Oncology, Izmir University of Health Sciences Tepecik Training and Research Hospital., Albayrak C; Division of Pediatric Hematology-Oncology, Ondokuz Mayis University, Faculty of Medicine, Samsun., Karapinar DY; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Ege University., Kazanci EG; Division of Pediatric Hematology-Oncology, Health Sciences University Bursa High Specialist Training and Research Hospital, Bursa., Unal E; Division of Pediatric Hematology-Oncology, Erciyes University Faculty of Medicine, Kayseri., Turkkan E; Division of Pediatric Hematology-Oncology, University of Health Sciences, Okmeydani Training and Research Hospital., Akici F; Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital., Bor O; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey., Vural S; Division of Pediatric Hematology-Oncology, Health Sciences University Istanbul Sariyer Hamidiye Etfal Health Practice and Research Center, Istanbul., Yilmaz S; Division of Pediatric Hematology-Oncology, Dokuz Eylul University Faculty of Medicine, Izmir., Apak H; Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa., Baytan B; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University., Tahta NM; Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital., Güzelkucuk Z; Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital., Kocak U; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara., Antmen B; Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana., Tokgöz H; Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya., Fisgin T; Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital., Özdemir N; Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital., Gunes AM; Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University., Vergin C; Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital., Unuvar A; Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University., Ozbek N; Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital., Tugcu D; Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University., Bay SB; Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute., Tanyildiz HG; Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University., Celkan T; Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa.
Jazyk:	angličtina
Zdroj:	Journal of pediatric hematology/oncology [J Pediatr Hematol Oncol] 2022 Nov 01; Vol. 44 (8), pp. e1039-e1045. Date of Electronic Publication: 2022 Aug 25.
DOI:	10.1097/MPH.0000000000002499
Abstrakt:	Background: Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines. Materials and Methods: In this multicenter retrospective study, 51 pediatric patients with leukemia, 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combination with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links.lww.com/JPHO/A541 ). Results: Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus . Sixteen patients received single-agent, 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died, 29 of the CNSFI episodes recovered with a 20% neurological sequelae. Conclusion: CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes. Competing Interests: The authors declare no conflict of interest.
Databáze:	MEDLINE
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