Mortality and Treatment Outcomes in Pediatric Malignancy Patients with Invasive Cutaneous Fungal Infections: Evaluating the Impact of Combination Therapy and Surgical Debridement, Experience from Referral Oncology Teaching Hospital.
Seyed Reza Abdipour Mehrian, Hadi Mottaghipisheh, Hadis Jafarian, Fatemeh Homayounifar, Alireza Abbasi, Yaser Pourasghar, Fateme Noushadi, Armina Farkarian, Elahe Meftah, Sadra Valiee, Ali Amanati
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Abstract
Background and aims: Invasive cutaneous fungal infections (ICFIs) are life-threatening complications in pediatric cancer patients. This study aimed to investigate the prevalence, clinical characteristics, and outcomes of ICFIs among pediatric cancer patients hospitalized at a referral oncology teaching Hospital in Shiraz, Iran.
Methods: This cross-sectional study included pediatric patients with malignancies and suspected ICFIs who were admitted to the Amir Oncology Teaching Hospital between 2015 and 2022. Diagnosis was based on the EORTC/MSG criteria and confirmed using clinical, microbiological, and histopathological methods. Data were analyzed using descriptive statistics, Kaplan-Meier survival analysis, and comparative tests, with a significance threshold of p < 0.05.
Results: Among the 24 patients, 58.3% were boys, and 45.8% were aged 1-5 years. Acute lymphoblastic leukemia was the most common malignancy (27.3%). Mucoralean fungi (36.4%) and Aspergillus (59.1%) were the most common. The overall survival rate was 54.2%. Proven ICFIs had the poorest outcomes, with a survival probability declining to zero by month 26. Patients with lower CRP levels and febrile neutropenia had better outcomes (p < 0.001 and p = 0.041, respectively), but survival rates did not vary significantly according to sex, age, or treatment approach (monotherapy versus combination therapy).
Conclusion: In pediatric oncology patients, ICFIs are associated with high mortality, particularly in cases of mucormycosis or proven infections. Improving survival depends on early diagnosis, risk stratification, and rapid management, particularly in patients with neutropenia and fever.
期刊介绍：
Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.
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