Surgical treatment of invasive pulmonary fungal infections in immunocompromised pediatric patients: Aspergillus spp. and other emerging fungi.

Autor: López-Fernández S; Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain. sergio.lopez@vallhebron.cat., Molino JA; Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain., Soler-Palacín P; Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain., Mendoza-Palomar N; Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain., Uria Oficialdegui ML; Department of Pediatric Oncology and Hematology, Vall d'Hebron University Hospital, Barcelona, Spain., Martos Rodríguez M; Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain., López M; Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain., Guillén G; Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Pediatric surgery international [Pediatr Surg Int] 2024 Oct 05; Vol. 40 (1), pp. 263. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1007/s00383-024-05851-5
Abstrakt: Purpose: Invasive Pulmonary Fungal Infections (IPFIs) represent a diagnostic and therapeutic challenge. The exact role of surgery is not well defined. This study analyzes our experience with surgical treatment of IPFI in immunocompromised pediatric patients and, secondarily, compares IPFI caused by Aspergillus spp. with other fungal infections.
Methods: This is a retrospective review (2000-2019) of patients with IPFI surgically treated at our pediatric institution. Statistical analysis was used to compare data between Aspergillus spp. and non-Aspergillus IPFI.
Results: Twenty-five patients (64% female) underwent 29 lung resections. Median age at surgery was 7.19 years (1.63-19.14). The most frequent underlying condition (64%) was acute leukemia. Surgical indications included persistence or worsening of symptoms and pathological image findings (52%) or asymptomatic suspicious lesions in patients scheduled for intensive cytotoxic treatments or hematopoietic stem cell transplantation (48%). All patients underwent atypical lung resections, except one lobectomy. Aspergillus spp. was the most frequently isolated pathogen (68%). Follow-up was 4.07 years (0.07-18.07). Surgery-related mortality was 0%, but 4 patients died in the 100 days following surgery (2 due to disseminated fungal infection); the remaining 21 did not show signs of IPFI recurrence. Non-specific consolidations on CT scan were more frequent in non-Aspergillus IPFI (p < 0.05).
Conclusion: Surgical treatment of IPFI should be considered as a part of the treatment in selected pediatric immunocompromised patients, and it may have both diagnostic and therapeutic advantages over non-surgical management. When there is clinical suspicion of IPFI but CT scan shows unspecific alterations, the possibility of a non-Aspergillus IPFI should be considered.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: