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

Publisher: Published by Oxford University Press on behalf of the Infectious Diseases Society of America Country of Publication: United States NLM ID: 101637045 Publication Model: eCollection Cited Medium: Print ISSN: 2328-8957 (Print) Linking ISSN: 23288957 NLM ISO Abbreviation: Open Forum Infect Dis Subsets: PubMed not MEDLINE

Original Publication: Cary, NC : Published by Oxford University Press on behalf of the Infectious Diseases Society of America, [2014]-

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.)

Lancet Infect Dis. 2021 Aug;21(8):e246-e257. (PMID: 33606997)
Diagn Microbiol Infect Dis. 2012 Apr;72(4):367-9. (PMID: 22280997)
Clin Infect Dis. 2004 May 1;38(9):1237-42. (PMID: 15127334)
PLoS One. 2014 Jan 28;9(1):e87784. (PMID: 24489964)
Cancer. 2003 Jul 15;98(2):315-9. (PMID: 12872351)
Clin Microbiol Rev. 2007 Oct;20(4):695-704. (PMID: 17934079)
Clin Microbiol Infect. 2014 Jun;20(6):580-5. (PMID: 24118322)
J Infect. 2010 May;60(5):331-7. (PMID: 20138081)
J Fungi (Basel). 2022 Apr 11;8(4):. (PMID: 35448618)
J Antimicrob Chemother. 2012 Mar;67(3):700-6. (PMID: 22190607)
Mycopathologia. 2018 Dec;183(6):941-949. (PMID: 29564632)
J Pediatric Infect Dis Soc. 2015 Jun;4(2):163-70. (PMID: 26407418)
Mycoses. 2019 Apr;62(4):399-404. (PMID: 30687957)
J Antimicrob Chemother. 2021 Jun 18;76(7):1907-1915. (PMID: 33890055)
PLoS Med. 2018 Nov 1;15(11):e1002685. (PMID: 30383787)
Clin Microbiol Infect. 2015 Mar;21(3):268.e1-7. (PMID: 25658562)
Pediatr Blood Cancer. 2019 Aug;66(8):e27806. (PMID: 31066209)
J Pediatr Hematol Oncol. 2021 Apr 1;43(3):e408-e413. (PMID: 32097283)
Mycoses. 2014 Nov;57(11):652-8. (PMID: 24943384)
Transfus Apher Sci. 2021 Aug;60(4):103134. (PMID: 33858754)
Clin Infect Dis. 2020 Sep 12;71(6):1367-1376. (PMID: 31802125)
Cytotherapy. 2011 Apr;13(4):490-8. (PMID: 21090917)
Cancer. 2020 Dec 15;126(24):5303-5310. (PMID: 32914879)
J Fungi (Basel). 2020 Oct 09;6(4):. (PMID: 33050258)
Pediatr Infect Dis J. 2017 Feb;36(2):230-231. (PMID: 27846057)
Antimicrob Resist Infect Control. 2017 Sep 7;6:93. (PMID: 28912948)
J Chemother. 2021 Dec;33(8):519-527. (PMID: 33563140)
Curr Opin Infect Dis. 2021 Dec 1;34(6):619-626. (PMID: 34751181)
J Clin Oncol. 2023 Mar 20;41(9):1774-1785. (PMID: 36689694)
Open Forum Infect Dis. 2015 Jul 04;2(3):ofv099. (PMID: 26258156)
Medicine (Baltimore). 2013 Nov;92(6):305-316. (PMID: 24145697)
J Fungi (Basel). 2021 Sep 28;7(10):. (PMID: 34682236)
Curr Fungal Infect Rep. 2015;9(3):135-143. (PMID: 26301000)
Antimicrob Agents Chemother. 2013 Jan;57(1):235-40. (PMID: 23114771)
Annu Rev Phytopathol. 2019 Aug 25;57:323-339. (PMID: 31226019)

Keywords: Fusarium; febrile neutropenia; fusariosis; opportunistic fungal infections; pediatric cancer

Date Created: 20240614 Latest Revision: 20240615

20250114

PMC11170500

10.1093/ofid/ofae285

38872851