小儿血液恶性肿瘤中的侵袭性念珠菌病:热带念珠菌传播风险增加。

IF 2.9 4区 医学 Q3 IMMUNOLOGY
Amira M Said, Faraz Afridi, Michele S Redell, Chelsea Vrana, Candelaria O'Farrell, Michael E Scheurer, Natalie J Dailey Garnes, Maria Monica Gramatges, Ankhi Dutta
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引用次数: 0

摘要

背景:念珠菌是侵袭性真菌病最常见的病因,患有血液系统恶性肿瘤的儿童患病风险更高。非阿氏念珠菌(NAC)目前占所有侵袭性念珠菌病(IC)的一半以上,预后较差。我们旨在比较侵袭性念珠菌病的流行病学、风险因素、器官播散、生物标志物和预后,并评估随着时间推移的抗真菌耐药性趋势:纳入2个中心的0-18岁血液恶性肿瘤合并IC患者。确定了 2011 年至 2022 年的 53 例患者。通过回顾性病历收集了与人口统计学、宿主和风险因素、念珠菌种类和抗真菌敏感性、治疗和结果相关的信息。数据在菌种水平上进行了分析:结果:每 1000 名白血病和淋巴瘤患者中就有 29 人感染念珠菌。从恶性肿瘤确诊到感染的中位时间为 38 天。热带念珠菌(17 人;30%)是最常见的菌种,其次是白念珠菌(14 人;25%)。与白念珠菌或其他新农合患者相比,热带念珠菌感染患者更有可能向眼睛(P = 0.035)、脾脏(P = 0.001)和皮肤(P = 0.003)扩散。在接受视网膜扩张检查的 34 名患者中,24%(n = 8)有眼内念珠菌病的证据。在 8 名患有眼内疾病的患者中,有 7 名患者的念珠菌血症病程较长(3 天或 3 天以上;P = 0.003)。12周的粗死亡率为16.9%:结论:南美念珠菌病,特别是热带念珠菌病,是血液恶性肿瘤患儿中大多数眼内念珠菌病的病因。眼内念珠菌病筛查在IC患者中仍将发挥重要作用,未来的研究需要确定筛查是否可以仅限于具有特定风险因素的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Invasive Candidiasis in Pediatric Hematologic Malignancy: Increased Risk of Dissemination With Candida tropicalis.

Background: Candida species are the most common cause of invasive fungal disease, and children with hematologic malignancy are at increased risk. Non-albicans Candida (NAC) now account for more than half of all invasive candidiasis (IC) and carry a worse prognosis. We aimed to compare the epidemiology, risk factors, organ dissemination, biomarkers and outcomes in IC based on the species implicated and evaluate trends in antifungal resistance over time.

Methods: Patients 0-18 years of age with hematologic malignancy and IC at 2 centers were included. Fifty-three patients from 2011 to 2022 were identified. Information related to demographics, host and risk factors, Candida species and antifungal susceptibilities, treatment and outcomes was collected via retrospective chart review. Data were analyzed at the species level.

Results: The incidence rate of IC was 29 per 1000 patients with leukemia and lymphoma. The median time to infection from diagnosis of malignancy was 38 days. Candida tropicalis (n = 17; 30%) was the most identified species followed by Candida albicans (n = 14; 25%). Patients with C. tropicalis infection were more likely to have dissemination to the eyes (P = 0.035), spleen (P = 0.001) and skin (P = 0.003) than patients with C. albicans or other NAC. Of the 34 patients who underwent dilated retinal examination, 24% (n = 8) had evidence of intraocular candidiasis. Seven of the 8 patients with intraocular disease had prolonged candidemia (3 or more days; P = 0.003). The 12-week crude mortality rate was 16.9%.

Conclusions: NAC, specifically C. tropicalis, accounted for most of the IC in children with hematological malignancies. Screening for intraocular candidiasis continues to play an important role in patients with IC, and future studies are needed to determine if screening can be limited to patients with select risk factors.

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来源期刊
CiteScore
6.30
自引率
2.80%
发文量
566
审稿时长
2-4 weeks
期刊介绍: ​​The Pediatric Infectious Disease Journal® (PIDJ) is a complete, up-to-the-minute resource on infectious diseases in children. Through a mix of original studies, informative review articles, and unique case reports, PIDJ delivers the latest insights on combating disease in children — from state-of-the-art diagnostic techniques to the most effective drug therapies and other treatment protocols. It is a resource that can improve patient care and stimulate your personal research.
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