Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From Latin America.

Autor: Carlesse F; Instituto de Oncologia Pediátrica-IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil.; Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil., Paixão de Sousa da Silva AM; Instituto de Oncologia Pediátrica-IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil., Sztajnbok J; Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.; Instituto de Infectologia Emilio Ribas, Intensive Care Unit, Department of Emergency Medical Care, São Paulo, Brazil., Litivinov N; Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Peron K; Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil., Otsuka M; Hospital Infantil Darcy Vargas, São Paulo, Brazil., Volpe Arnoni M; Hospital Infantil Darcy Vargas, São Paulo, Brazil., Schirmer M; Instituto Nacional do Cancer-INCA, Department of Pediatrics, Rio de Janeiro, Brazil., de Oliveira Costa P; Instituto Nacional do Cancer-INCA, Department of Pediatrics, Rio de Janeiro, Brazil., Munhoz Cavalcanti de Albuquerque AL; Hospital Federal da Lagoa Rio de Janeiro, Department of Pediatrics, Rio de Janeiro, Brazil., Morales H; Hospital Erasto Gaertner, Department of Pediatrics, Curitiba, Brazil., Lopez-Medina E; Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia., A Portilla C; Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia., Valenzuela R; Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile., Motta F; Santa Casa de Misericórdia de Porto Alegre, Department of Pediatrics, Porto Alegre, Brazil., Motta FA; Hospital Pequeno Príncipe, Curitiba, Brazil., de Almeida Junior JN; Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.; Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil., Santolaya ME; Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile., Lopes Colombo A; Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.; Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2024 May 17; Vol. 11 (6), pp. ofae285. Date of Electronic Publication: 2024 May 17 (Print Publication: 2024).
DOI: 10.1093/ofid/ofae285
Abstrakt: Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.
Competing Interests: Potential conflicts of interest. F. C. reports serving as a speaker for Pfizer, Gilead, Knight, and Sandoz and on an advisory board for Pfizer. F. M. reports serving as a speaker for Pfizer. M. S. reports serving as a speaker for MSD. A. L. C. reports the following: a grant from FAPESP–Fundação de Apoio a Pesquisa do Estado de São Paulo (The ARIES Project: Antimicrobial Resistance Institute of São Paulo; grant 2021/10599-3; payment for University Federal of São Paulo); consulting fees from ACHE, Mundipharma, and Sandoz; serving as a speaker for Gilead, Knight United Medical, Eurofarma, and Mundipharma; support for attending meetings from Gilead, Knight United Medical, and Mundipharma; and membership on advisory boards for Mundipharma and Sandoz. All other authors report no potential conflicts.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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