Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 5;40(1):263.
doi: 10.1007/s00383-024-05851-5.

Surgical treatment of invasive pulmonary fungal infections in immunocompromised pediatric patients: Aspergillus spp. and other emerging fungi

Sergio López-Fernández  1 , José Andrés Molino  2 , Pere Soler-Palacín  3 , Natalia Mendoza-Palomar  3 , Maria Luz Uria Oficialdegui  4 , Marta Martos Rodríguez  2 , Manuel López  2 , Gabriela Guillén  2
Affiliations

Surgical treatment of invasive pulmonary fungal infections in immunocompromised pediatric patients: Aspergillus spp. and other emerging fungi

Sergio López-Fernández et al. Pediatr Surg Int. .

Abstract

Purpose: Invasive Pulmonary Fungal Infections (IPFIs) represent a diagnostic and therapeutic challenge. The exact role of surgery is not well defined. This study analyzes our experience with surgical treatment of IPFI in immunocompromised pediatric patients and, secondarily, compares IPFI caused by Aspergillus spp. with other fungal infections.

Methods: This is a retrospective review (2000-2019) of patients with IPFI surgically treated at our pediatric institution. Statistical analysis was used to compare data between Aspergillus spp. and non-Aspergillus IPFI.

Results: Twenty-five patients (64% female) underwent 29 lung resections. Median age at surgery was 7.19 years (1.63-19.14). The most frequent underlying condition (64%) was acute leukemia. Surgical indications included persistence or worsening of symptoms and pathological image findings (52%) or asymptomatic suspicious lesions in patients scheduled for intensive cytotoxic treatments or hematopoietic stem cell transplantation (48%). All patients underwent atypical lung resections, except one lobectomy. Aspergillus spp. was the most frequently isolated pathogen (68%). Follow-up was 4.07 years (0.07-18.07). Surgery-related mortality was 0%, but 4 patients died in the 100 days following surgery (2 due to disseminated fungal infection); the remaining 21 did not show signs of IPFI recurrence. Non-specific consolidations on CT scan were more frequent in non-Aspergillus IPFI (p < 0.05).

Conclusion: Surgical treatment of IPFI should be considered as a part of the treatment in selected pediatric immunocompromised patients, and it may have both diagnostic and therapeutic advantages over non-surgical management. When there is clinical suspicion of IPFI but CT scan shows unspecific alterations, the possibility of a non-Aspergillus IPFI should be considered.

Keywords: Hematologic malignancies; Immunocompromised; Pediatric; Pulmonary fungal infection; Surgery.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Pana ZD, Roilides E, Warris A, Groll AH, Zaoutis T (2017) Epidemiology of invasive fungal disease in children. J Pediatr Infect Dis Soc. 6(1): S3–11. https://doi.org/10.1093/jpids/pix046
    1. Otto WR, Green AM (2020) Fungal infections in children with haematologic malignancies and stem cell transplant recipients. Br J Haematol 189(4):607–624. https://doi.org/10.1111/bjh.16452 - DOI - PubMed - PMC
    1. Kapur S, Louie BE (2010) Hemoptysis and thoracic fungal infections. Surg Clin North Am 90(5):985–1001. https://doi.org/10.1016/j.suc.2010.06.006 - DOI - PubMed
    1. Gamaletsou MN, Walsh TJ, Sipsas NV (2018) Invasive fungal infections in patients with hematological malignancies: emergence of resistant pathogens and new antifungal therapies. Turk J Haematol Off J Turk Soc Haematol 35(1):1–11. https://doi.org/10.4274/tjh.2018.0007 - DOI
    1. Liu N, Tu J, Dong G, Wang Y, Sheng C (2018) Emerging New targets for the treatment of resistant fungal infections. J Med Chem 61(13):5484–5511. https://doi.org/10.1021/acs.jmedchem.7b01413 - DOI - PubMed

LinkOut - more resources