Belgin GÜLHAN, Saliha Kanık YÜKSEK, Aslınur Özkaya PARLAKAY, Neşe YARALI, Hasan TEZER, Namık Yaşar ÖZBEK

Invasive fungal infection in children with hematologic malignancy

Despite improvements in diagnosis and treatment, invasive fungal infection(IFI) is still a major cause of morbidity and mortality in immunocompromisedpatients. In patients with hematologic malignancy, the most invasive fungalinfections are caused by Candida and Aspergillus fumigatus. This study wasdesigned retrospectively to summarize data in pediatric patients with acutelymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) includingrisk factors for IFI, epidemiological and clinical features and treatment choicesinvolving combination therapy from January 2006 through December 2014.We analyzed the records of 154 pediatric patients (125 ALL and 29 AML)receiving chemotherapy for hematologic malignancy. During follow-up 60 IFIepisodes were observed. IFI episodes were observed more common in AML,compared to ALL (p=0.002). Among 60 IFI episodes, eight were proven, sevenwere probable and 45 were possible IFI episodes. Galactomannan antigenwas investigated in 37 IFI episodes and found positive in seven probable IFIepisodes. Fungemia was detected in seven patients with proven IFI and themost common microorganism was non-albicans candida spp. The most commonantifungal drug was fluconazole (14.8%). A total of 29 patients (48%) hadreceived empirically liposomal amphotericin B and 10 patients (16.6%) hadreceived caspofungin. Crude mortality was 10.3% and attributable mortalitywas 6.4% during the study period. Invasive fungal infections continue tobe a major cause of morbidity and mortality in children with hematologiccancer. The most common isolated agent from hemoculture was non-albicansCandida spp.

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