Clinical features in proven and probable invasive fungal disease in children and adolescents at a pediatric referral cen
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ORIGINAL ARTICLE
Clinical features in proven and probable invasive fungal disease in children and adolescents at a pediatric referral center: a 5‑year experience Kenji Kishimoto1 · Masashi Kasai2 · Noriko Kawamura3 · Yusuke Ito2 · Makiko Yoshida4 · Daiichiro Hasegawa1 · Keiichiro Kawasaki5 · Yoshiyuki Kosaka1 Received: 11 December 2018 / Accepted: 12 April 2019 © Children’s Hospital, Zhejiang University School of Medicine 2019
Abstract Background There is limited information concerning the overall epidemiology of invasive fungal disease (IFD) in children. The aim of this study was to clarify the clinical features of IFD in a tertiary pediatric care hospital. Methods Patients diagnosed with proven or probable IFD at our hospital between 2011 and 2015 were retrospectively reviewed. Proven and probable IFD were defined according to the European Organization for Research and Treatment of Cancer/Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group consensus. Patients with possible IFD were excluded. Results The incidence of proven or probable IFD was 26 of 20,079 hospitalized patients (0.13%). The predominant underlying disease was malignancy (54%) and congenital anomaly (27%). The most common diagnosis was candidemia among the patients with proven IFD (8 of 13, 62%). All the isolated pathogens in the candidemia patients were non-albicans Candida spp. The most common site of infection was the lungs in patients with probable IFD (11 of 13 patients, 85%). In probable IFD episodes, positive β-D-glucan and galactomannan were found in 12 of 13 (92%) and 5 of 13 (38%) patients, respectively. All but one patient (96%) received empirical antifungal therapy. No patients underwent surgical resection of residual lesions. The overall mortality was 23% and the attributable mortality of IFD was 12%. Conclusion Our results suggest the emergence of non-albicans Candida species as important pathogens in childhood IFD. Keywords Children · Invasive fungal disease · Incidence · Mortality
Introduction
* Kenji Kishimoto [email protected] 1
Department of Hematology and Oncology, Children’s Cancer Center, Kobe Children’s Hospital, Minatojima‑Minamimachi 1‑6‑7, Chuo‑ku, Kobe 650‑0047, Japan
2
Department of Infectious Disease, Kobe Children’s Hospital, Kobe, Japan
3
Department of Clinical Laboratory, Kobe Children’s Hospital, Kobe, Japan
4
Department of Diagnostic Pathology, Kobe Children’s Hospital, Kobe, Japan
5
Department of Pediatrics, Kita-Harima Medical Center, Kobe, Japan
Invasive fungal disease (IFD) is a major cause of morbidity and mortality among immunocompromised patients [1, 2]. Despite the development of novel antifungal agents, diagnostic tests, and prophylactic antifungal strategies, the incidence of IFD has increased in recent years [3, 4]. In addition, IFD has been shown to have a substantial financial burden to the health care system [5, 6]. The majority of information regarding the epidemiology, diagnosis, treatmen
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