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Gal Etzioni TR, Fainshtain N, Nitzan-Luques A, Goldstein G, Weinreb S, Temper V, Korem M, Averbuch D. Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome. Microorganisms 2024; 12:145. [PMID: 38257971 PMCID: PMC10820110 DOI: 10.3390/microorganisms12010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Invasive fungal infections (IFI) cause morbidity and mortality in children with acute leukemia (AL). We retrospectively collected data on febrile neutropenic episodes (FNE) in AL children (2016-2021) and assessed factors associated with proven/probable IFI. Ninety-three children developed 339 FNE. Seventeen (18.3%) children developed 19 proven/probable IFI (11 yeast; eight molds). The proven/probable yeast IFI rate was 6/52 (11.5%) in children who belong to the high risk for IFI category (HR-IFI-AL: high-risk acute lymphocytic leukemia (ALL), acute myeloid leukemia, relapse); and 5/41 (12.2%) in the non-HR-IFI-AL category (standard/intermediate risk ALL). The proven/probable mold IFI rate was 7/52 (13.5%) in HR-IFI-AL children and 1/41 (2.4%) in the non-HR-IFI-AL category. In the multivariable analysis, underlying genetic syndrome, oral mucositis, and older age were significantly associated with proven/probable IFI, while a longer time since AL diagnosis was protective. Two of 13 (15.4%) HR-IFI-AL children died because of IFI. The elevated risks of proven/probable mold IFI and the associated mortality in HR-IFI-AL children, and high risk of invasive candidiasis in the non-HR-IFI-AL group, emphasize the need for the close monitoring of local epidemiology and the adjustment of practices accordingly.
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Affiliation(s)
- Tamar Ruth Gal Etzioni
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Nurit Fainshtain
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Adi Nitzan-Luques
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Gal Goldstein
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Sigal Weinreb
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Violeta Temper
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- Pediatric Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
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Hassanpour P, Spotin A, Morovati H, Aghebati-Maleki L, Raeisi M, Rezaee MA, Hasani A, Aghebati-Maleki A, Abdollahzadeh H, Nami S. Molecular diagnosis, phylogenetic analysis, and antifungal susceptibility profiles of Candida species isolated from neutropenic oncological patients. BMC Infect Dis 2023; 23:765. [PMID: 37932679 PMCID: PMC10629196 DOI: 10.1186/s12879-023-08774-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Neutropenia is the most important cause of life-threatening invasive fungal infections (IFIs). Here, we studied the frequency and antifungal susceptibility profiles of Candida species that colonized or caused infections among neutropenic patients with solid or hematological malignancies. METHODS A total of 362 clinical samples were collected from 138 patients. After initial isolation using a mix of mycological methods, isolates were screened using chromogenic culture media. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied for molecular identification. Positive or suspected cases were confirmed using the reference method of sequencing. Antifungal susceptibility testing for voriconazole and caspofungin was carried out using the microbroth dilution method. An in-silico assay was applied for phylogenetic analysis. RESULTS Thirty-four Candida strains were isolated. C. albicans (47.06%) and C. glabrata (29.41%) were the most frequent strains. Antifungal treatment reduced the chance of Candida colonization by almost 76% in neutropenic patients (OR: 1.759; 95% CI: 1.349 to 2.390; p value: 0.000). An unusual and non-resistant strain, C. lambica, was reported from the bloodstream of a 56-year-old man with hematologic malignancy (HM). Eight isolates were non-susceptible, and one isolate was resistant to voriconazole. Also, four isolates were non-susceptible to caspofungin. CONCLUSION We can conclude that there is a cause-and-effect relationship between neutropenia, HM background, and Candida species separated from neutropenic patients, which can lead to possible infections. Further and repetitive studies are recommended using different molecular methods for better prediction and management of fungal infections in neutropenic patients.
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Affiliation(s)
- Parviz Hassanpour
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Spotin
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Morovati
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mortaza Raeisi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alka Hasani
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Aghebati-Maleki
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Abdollahzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Nami
- Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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