SYSTEMIC CANDIDA INFECTION IN PEDIATRIC BM AUTOTRANSPLANTATION - CLINICAL SIGNS, OUTCOME AND PROGNOSIS

Of the 393 children who underwent BM autotransplantation in the pediat ric oncology unit of the Institut Gustave Roussy between February 1979 and September 1991, 14 (3.56%) developed disseminated Candida infecti on within 3 months. This incidence was far lower than in other publish ed series. Eleven of the 14 patients recovered from the infection, giv ing a far higher survival rate (78%) than among adult BM transplant re cipients (usually < 30%). All 14 patients had four or more risk factor s and persistent BM aplasia (median, 25 days); six had Candida tropica lis infection. Four cases of deep visceral involvement were documented , two of which were lethal. Clinical signs were relatively uniform and included secondary high-grade fever (>40-degrees-C) for 8 days; half the patients developed cardiovascular impairment, respiratory distress , neurological disturbances (altered consciousness or delirium) and se vere diarrhoea, within as little as 10 days after transplantation. Blo od cultures rapidly became positive after the onset of clinical signs and this permitted prompt treatment with a combination of amphotericin B and 5-fluorocytosine; in addition, central catheters were removed. Blood cultures became sterile within 4 days of treatment in 10 of the 14 cases. The generally favourable outcome in this series could be rel ated to the young age of the patients, the absence of GVHD, the absenc e of total body irradiation in the conditioning regimen, and early ant ifungal treatment.