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. 2024 Jan 11;12(1):145.
doi: 10.3390/microorganisms12010145.

Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome

Tamar Ruth Gal Etzioni  1   2 , Nurit Fainshtain  1   2 , Adi Nitzan-Luques  1   2   3 , Gal Goldstein  1   2   3 , Sigal Weinreb  1   2   3 , Violeta Temper  1   4 , Maya Korem  1   4 , Dina Averbuch  1   2   5
Affiliations

Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome

Tamar Ruth Gal Etzioni et al. Microorganisms. .

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.

Keywords: acute leukemia; children; invasive fungal infections; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest related to the current study.

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