Invasive Fungal Disease in Children with Cancer: a 10 year analysis from a Paediatric Oncology Centre in Soweto, South Africa

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.