Abstract:Objective To investigate the clinical features of invasive fungal disease (IFD) in children without underlying diseases. Methods The clinical data of 49 children without underlying diseases who were diagnosed with IFD were retrospectively studied. Results Fungal pathogens were detected in 37 (76%) out of 49 patients, including Cryptococcus neoformans (17 children, 46%), Candida albicans (10 children, 27%), Aspergillus (3 children, 8%), and Candida parapsilosis (3 children, 8%). Fungal pneumonia (17 children, 46%) was the most commonly seen disease, with Candida albicans as the major pathogen (9 children, 53%). The 49 children had at least one high-risk factor for infection, including the use of antibiotics, a long length of hospital stay, and invasive procedures. Of all the children, 82% did not respond well to antibiotic treatment or experienced recurrent pyrexia. Among the 24 children who underwent G tests, 17 (71%) showed positive results. All the children were given antifungal therapy, and among these children, 37 (75%) were cured, 3 (6%) were still in the treatment, 5 (10%) died, and 4 (8%) were lost to follow-up. Conclusions In IFD children without underlying diseases, Cryptococcus neoformans and Candida are the main pathogens, and lung infection is the most common disease. Long-term use of high-dose antibiotics may be an important risk factor for fungal infection. The IFD children without underlying diseases are sensitive to antifungal drugs and have a satisfactory prognosis.
LI Wei-Ran,DENG Si-Yan,SHU Min et al. A clinical study of invasive fungal disease in children without underlying diseases[J]. CJCP, 2016, 18(8): 713-717.
Ozsevik SN,Sensoy G,Karli A,et al.Invasive fungal infections in children with hematologic and malignant diseases[J].J Pediatr Hematol Oncol,2015,37(2):e69-72.
De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Croup[J].Clin Infect Dis,2008,46(12):1813-1821.
[16]
Muskett H,Shahin J,Eyres G,et al.Risk factors for invasive fungal disease in critically ill adult patients:a systematic review[J].Crit Care,2011,15(6):R287.
[3]
Sahbudak Bal Z,Yilmaz Karapinar D,Karadas N,et al.Proven and probable invasive fungal infections in children with acute lymphoblastic leukaemia:results from an university hospital,2005-2013[J].Mycoses,2015,58(4):225-232.
[17]
Zaoutis TE,Prasad PA,Localio AR,et al.Risk Factors and Predictors for Candidemia in Pediatric Intensive Care Unit Patients:Implications for Prevention[J].Clin Infect Dis,2010,51(5):e38-45.
[4]
Kobayashi R,Kaneda K,Sato T,et al.The clinical feature of invasive fungal infection in pediatric patients with hematologic and malignant diseases:a 10-year analysis at a single institution at Japan[J].J Pediatr Hematol Oncol,2008,30(12):886-890.
Jordán I,Hernandez L,Balaguer M,et al.C.albicans,C.parapsilosis and C.tropicalis invasive infections in the PICU:clinical features,prognosis and mortality[J].Rev Esp Quimioter,2014,27(1):56-62.
[20]
Onishi A,Sugiyama D,Kogata Y,et al.Diagnostic accuracy of serum 1,3-beta-D-glucan for pneumocystis jiroveci pneumonia,invasive candidiasis,and invasive aspergillosis:systematic review and meta-analysis[J].J Clin Microbiol,2012,50(1):7-15.