Invasive fungal disease in PICU: epidemiology and risk factors

Abstract

Candida and Aspergillus spp. are the most common agents responsible for invasive fungal infections in children. They are associated with a high mortality and morbidity rate as well as high health care costs. An important increase in their incidence has been observed during the past two decades. In infants and children, invasive candidiasis is five times more frequent than invasive aspergillosis. Candida sp. represents the third most common agent found in healthcare-associated bloodstream infections in children. Invasive aspergillosis is more often associated with hematological malignancies and solid tumors. Recommendations concerning prophylactic treatment for invasive aspergillosis have been recently published by the Infectious Diseases Society of America. Candida albicans is the main Candida sp. associated with invasive candidiasis in children, even if a strong trend toward the emergence of Candida non-albicans has been observed. The epidemiology and the risk factors for invasive fungal infections are quite different if considering previously healthy children hospitalized in the pediatric intensive care unit, or children with a malignancy or a severe hematological disease (leukemia). In children, the mortality rate for invasive aspergillosis is 2.5 to 3.5 higher than for invasive candidiasis (respectively 70% vs. 20% and 30%).

Figure 1

Mortality associated with type of Candida spp. among patients with candidemia younger (n = 144) and older (n = 1,447) than 13 years [6].

Figure 2

Aspergillus species encountered in invasive aspergillosis in 139 children [1].

Figure 3

Underlying condition of the 139 cases of invasive aspergillosis in the study by Burgos et al. [1].

Figure 4

Details of the 87 underlying haematological disease in children with invasive aspergillosis in the study by Burgos et al. [1].