Fungal infections in children with cancer - A prospective, multicenter surveillance study
Fungal infections in children with cancer - A prospective, multicenter surveillance study
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DOI：
10.1097/01.inf.0000220256.69385.2e
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发表时间：
2006-07-01
影响因子：
3.6
通讯作者：
Rossi, Mario R.
中科院分区：
文献类型：
--
作者：
Castagnola, Elio;Cesaro, Simone;Rossi, Mario R.
背景资料：癌症患者真菌感染后的流行病学和生存数据主要是基于成人的研究，而很少有数据可在children.Methods：一个前瞻性的，多中心的，为期2年的监测真菌感染的儿童接受抗真菌治疗进行了15个意大利中心。对于每一个情况下，通过EORTC-IFIG/NIAID-MSG定义，收集信息的年龄，治疗阶段，存在的中性粒细胞减少症或淋巴细胞减少症，抗真菌药物的管理和survival.Results：96发作（42证实[19真菌血症，23深部组织感染]，17可能和37可能的侵袭性真菌病）的报告。其中73%的患者接受了积极的化疗，21%接受了异基因造血干细胞移植，只有6%接受了中度积极的治疗。中性粒细胞增多症出现在77%的发作中，并且与真菌血症相比，在深部组织真菌病之前中性粒细胞增多症的持续时间更长（P = 0.020）。在非血小板减少症患者中观察到的75%的发作中存在淋巴细胞减少症。与真菌血症儿童相比，可能患有侵袭性真菌病的儿童死亡风险增加25.7倍，而可能患有侵袭性真菌病的儿童死亡风险增加7.7倍，证实患有深部组织感染的儿童死亡风险增加5倍（P = 0.004）。死亡的风险也是3.8倍高的患者已经接受抗真菌药物的诊断时的感染相比，那些没有接受抗真菌药物。结论：在儿童癌症，积极的化疗，严重和持久的中性粒细胞减少症和淋巴细胞减少症与真菌感染。这些临床特征与成人报告的相似，但在儿童中，总体和感染特异性（flingemia或真菌病伴深部组织感染）死亡率较低。
Background: Data on epidemiology and survival after fungal infections in patients with cancer are primarily based on studies in adults, whereas few data are available on children.Methods: A prospective, multicenter, 2-year surveillance of fungal infections in children receiving antineoplastic treatment was performed in 15 Italian centers. For each case, defined by means of EORTC-IFIG/NIAID-MSG, information was collected on age, phase of treatment, presence of neutropenia or lymphocytopenia, administration of antifungal drugs and survival.Results: Ninety-six episodes (42 proven [19 fungemias, 23 deep tissue infections], 17 probable and 37 possible invasive mycoses) were reported. Most of them (73%) followed aggressive chemotherapy, 21% allogeneic hematopoietic stem cell transplantation and only 6% moderately aggressive treatment. Neutropenia was present in 77% of the episodes, and it had a longer duration before deep tissue mycosis as compared with fungemia (P = 0.020). Lymphocytopenia was present in 75% of the episodes observed in nonneutropenic patients. As compared with children with fungemia, patients with probable invasive mycoses had a 25.7-fold increased risk of death, whereas it was 7.7-fold greater in children with possible invasive mycoses and 5-fold higher in those with proven deep tissue infection (P = 0.004). The risk of death was also 3.8-fold higher in patients already receiving antifungals at the time of diagnosis of infection as compared with those not receiving antimycotic drugs.Conclusions: In children with cancer, aggressive antineoplastic treatment, severe and longlasting neutropenia and lymphocytopenia are associated with fungal infections. These features as the clinical pictures are similar to those reported in adults, but in children, the overall and the infection-specific (flingemia or mycosis with deep tissue infection) mortalities are lower.