Patients with Primary Immunodeficiencies: How Are They at Risk for Fungal Disease?

Epidemiology and outcomes of invasive aspergillosis among pediatric immunocompromised patients: a 12-year single-center experience

Invasive aspergillosis (IA) remains a common cause of mortality in pediatric immunocompromised populations. Much of our knowledge of IA stems from adult literature. We conducted a retrospective evaluation of cases of proven or probable IA, defined according to the 2019 EORTC/MSG criteria, in patients with underlying immunocompromising conditions at Boston Children's Hospital from January 1, 2007 to January 1, 2019. We estimated survival curves over 12 weeks using the Kaplan-Meier method for all-cause mortality, and we used univariate Cox proportional hazards modeling to evaluate for mortality risk factors. We identified 59 cases, 29% with proven and 71% with probable IA. Pulmonary IA was the most common presentation (78%). The median age at diagnosis was 11 years (range, 0.5-28). Hematopoietic cell transplantation (HCT) was the most frequent predisposing underlying condition (41%). Among affected patients, 44.8% were neutropenic and 59.3% were lymphopenic at diagnosis. The 12-week all-cause mortality rate was 25.4%; HCT recipients comprised the majority of deaths (9/15) with a hazard ratio of 2.47 [95% CI, 0.87-6.95]. No patients with congenital immunodeficiencies (n = 8) died within 12 weeks of IA diagnosis. Other risk factors that were significantly associated with mortality included mechanical ventilation at diagnosis, intensive care unit stay, and lymphopenia; treatment with an Aspergillus-active azole was associated with decreased mortality. In conclusion, our study found that in pediatric immunocompromised hosts, IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the HCT population.

Rapidly progressive necrotizing cellulitis secondary to Candida tropicalis infection in an immunocompromised host

The incidence of invasive fungal infection is increasing as the population of immunosuppressed patients grows. Many species that were previously thought to be benign are now known pathogens. The most commonly isolated organisms (>80 %) include Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus. However, there are several new and emerging organisms. The Non-albicans species of Candida are one of the emerging invasive fungal organisms that are beginning to affect high-risk patients such as those with bone marrow transplant, neutropenia, HIV/AIDS or on immunosuppressive therapy. We present a case of a patient who suffered with angioinvasive non-Albicans Candidal infection, leading to a life-threatening necrotizing cellulitis.