Invasive Fungal Disease in Children with Cancer: a 10 year analysis from a Paediatric Oncology Centre in Soweto, South Africa
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Witwatersrand, Johannesburg
Abstract
Invasive fungal diseases (IFD) pose a significant threat to immunocompromised children, including those with cancer. There is a paucity of data on IFD in children and adolescents undergoing treatment for cancer in low-middle income countries, including South Africa.
Methods
We reviewed the clinical and laboratory characteristics, and factors associated with microbiologically-confirmed IFD in children and adolescents treated at Chris Hani Barag- wanath Academic Hospital (CHBAH) Paediatric Oncology Unit from 01 January 2011 through 31 December 2020.
Results
During the 10-year study period, 211 microbiologically-confirmed IFD episodes occurred in 174 children and adolescents treated in the Oncology Unit. There were sustained reductions in the number of microbiologically-confirmed IFD episodes from 2018, onwards. Most of the episodes (179, 84.8%) occurred in children and adolescents with haematological malignancies (n=93) or solid tumours (n=86). Candida albicans (n=71) and C. parapsilosis (n=66) were isolated in 64.9% of the episodes, other Candida spp in 23.2% (n=49), Aspergillus spp in 1.9% (n=4) and other fungi in 10.0% (n=21) of the IFD episodes. Candida albicans and C. parapsilosis susceptibility to fluconazole remained >80% throughout the study period. In 197 episodes with known clinical outcome, 21 (10.7%) resulted in death. In multivariable Poisson regression analysis, severe malnutrition (adjusted risk ratio (aRR), 2.904; 95% confidence interval (CI) 1.165-6.918) and severe neutropenia (aRR, 4.483; 95%CI, 1.835-12.141) were independently associated with death following the IFD episode.
Conclusions
Microbiologically-confirmed IFD is an uncommon complication of treatment in children with cancer, although associated with high crude case fatality rates. Severe malnutrition and severe neutropenia are independently associated with death. Optimisation of infection prevention and control measures, and fungal prophylaxis targeted at those most likely to die, may impact on survival outcomes in patients with IFD.
Description
A Research Report submitted to the Faculty of Health Sciences in partial fulfillment of the requirements for the degree of Masters of Medicine in Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2024
Keywords
Invasive fungal diseases, Microbiologically-confirmed IF, Children with Cancer, Paediatric Oncology Centre, UCTD
Citation
Keene, Abigail Marriott. (2024). Invasive Fungal Disease in Children with Cancer: a 10 year analysis from a Paediatric Oncology Centre in Soweto, South Africa [Master’s dissertation, University of the Witwatersrand, Johannesburg]. WireDSpace. https://hdl.handle.net/10539/42284