Invasive fungal infections in pediatric bone marrow transplant recipients:single center experience of 10 years

Invasive fungal infections (IFI) with substantial mortality constitute an i ncreasing problem among BMT patients. From 1986 to 1996 148 children underw ent BMT, and are included in a retrospective analysis of the incidence, ris k factors and outcome of IFI, By histopathology or culture-proven IFI (Cand ida, 10; Aspergillus, 8) was documented in 12/73 (16%) allogeneic and in 6/ 75 (8%) autologous BMT patients. Of these 18 patients, 15 subsequently died , and in 12 (66%) IFI was regarded as the main cause of death. In addition to the patients with documented IFI, 48 had suspected and 82 no fungal infe ction. Invasive candidal infections were more frequent in patients with sem iquantitatively estimated abundant candidal colonization as compared with t hose with no colonization (18% vs 3%, P = 0.015), In the allogeneic group, 50% of those with severe (grades III-IV aGVHD had IFI as opposed to 8% of t hose with no or mild aGVHD (P < 0.001), Regarding cGVHD, 57% of those with extensive cGVHD vs 5% of those with absent or limited cGVHD had IFI (P < 0. 001), The dose of steroids was associated,vith IFI: 77% of those who receiv ed high-dose steroids (methylprednisolone 0.25-1 g/day for 5 days) vs 5% of those with conventional-dose (prednisone 2 mg/kg/day) had IFI (P < 0.001), Particularly for BMT patients at risk, new, quicker and better diagnostic tests and more effective anti-fungal agents, both for prophylaxis and treat ment, are needed.