FUNGAL PNEUMONIA - THE PREDOMINANT LUNG INFECTION CAUSING DEATH IN CHILDREN UNDERGOING BONE-MARROW TRANSPLANTATION

The study included 6 children (aged 4-14 years) receiving a conditioni ng regimen for bone marrow transplantation (BMT) and 14 children (aged 2-14 years) with bone marrow transplants (13 allogeneic, 1 autologous ). The children underwent flexible fibre-optic bronchoscopy (FFB) with bronchoalveolar lavage during 6 and 17 episodes of pneumonia, respect ively. The aim was to compare the results of the two groups with respe ct to bronchoscopy findings, pneumonia-causing agents and outcome. Dur ing the conditioning regimen, the aetiological agents were recovered b y bronchoscopy in 1/6 (17%) episodes and revealed by autopsy in anothe r episode. In three episodes where the aetiology was uncertain, bacter ial pneumonia was suspected in two, and Candida pneumonia in one. In e pisodes after transplantation the aetiological agents were recovered f rom bronchoscopy material in 14/17 (82%) patients. Autopsy confirmed t he premortal diagnosis in the four children who died. In three episode s, bacterial pneumonia was clinically suspected. Based on clinical man ifestations, FFB and autopsy findings, bacterial and fungal pneumonia were the most common diagnoses both during conditioning and after BMT. Fungal pneumonia was the most common cause of death in both groups.