DEEP CANDIDA INFECTION IN CHILDREN RECEIVING ALLOGENEIC BONE-MARROW TRANSPLANTS - INCIDENCE, RISK-FACTORS AND DIAGNOSIS

Fifty-eight children, who received 60 allogeneic bone marrow transplan ts (BMT), were studied with regard to incidence, risk factors and diag nosis of deep Candida infection (DCI). Serum samples were analysed for the presence of Candida IgA, IgM and IgG antibodies and free C. albic ans glucoprotein antigen (Ag). Five children (8.7%) had a confirmed DC I and died before engraftment of the new bone marrow. When four patien ts with suspected deep Candida infection (SDCI) were included, the inc idence was 15.6%. Four of the five children (80%) with DCI had patholo gical Candida IgM antibody (Ab) titers and/or free C. albicans glucopr otein Ag, 2-50 days before DCI was verified by culture, direct microsc opy and/or autopsy. Risk factors, using Fisher's exact test for DCI, i ncluded not receiving bone marrow from an HLA-identical sibling donor, having a seropositive Herpes simplex virus (HSV) donor and pathologic al IgA and/or IgM Ab titers against Candida before BMT. In conclusion, a child with the above-mentioned risk factors, runs a risk of acquiri ng fatal DCI before engraftment. The institution of systemic antifunga l prophylactic treatment may prevent death from DCI. After BMT, serolo gical examinations may be of value in the early detection of DCI.