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Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019
Affiliations- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
- Department of Pediatric Transplantology, Hematology and Oncology, Medical University of Wrocław, Wrocław, Poland
- Department of Hematology, Medical University of Białystok, Poland
- Department of Hematology, Poznań University of Medical Sciences, Poznań, Poland
- Department of Pediatric Surgery, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
- Department of Hematology, Collegium Medicum, Jagiellonian University, Kraków, Poland
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
- Department of Pediatric Oncology and Hematology, Medical University, Białystok, Poland
- Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Toruń, Bydgoszcz, Poland
- Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Kraków, Poland
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw
- Department of Pediatric Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
- Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland
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Abstract
No epidemiological data exist so far on invasive mucormycosis (IM) in Polish hematopoietic cell transplantation (HCT) and pediatric hemato-oncology (PHO) centers. The objective of this study was to analyze the incidence, clinical course, therapy, and outcome of IM in pediatric and adult patients undergoing HCT and children with hemato-oncological diseases in Poland. A total number of 12425 at-risk patients were retrospectively analyzed, and the period between 2010 and 2019 was included. Patients were analyzed in three groups: nontransplant children with malignancies, children undergoing HCT, and adults after HCT. Twenty-one patients were diagnosed with IM, including 15 children (10 non-HCT, 5 HCT) and 6 HCT adults. Proven IM was confirmed in 18 patients, probable in 2 patients, and possible in 1 patient. Proven IM was diagnosed in 7.1% of all patients with invasive fungal diseases (IFDs), including 8.1% among PHO patients, 5.4% among pediatric HCT patients, and 7.0% among adult HCT patients. Clinically, pneumonia was diagnosed in 10 (47.6%) patients, involvement of the paranasal sinuses was found in 3 (14.3%) patients, gastrointestinal disease was noted in 2 (9.5%) patients, and disseminated mucormycosis was found in 6 (28.6%) patients. The probability of overall survival in IM patients was 0.50 ± 0.11. Infection-related mortality (IRM) was 10% for pediatric nontransplant IM patients and 82% for transplant IM (pediatric + adult) patients ( = 0.004). Among the transplant patients, all adults died within 120 days. IRM for pediatric HCT patients was 60% ( = 0.038). The only prognostic factor was HCT, which adversely influenced survival in IM patients.
Abstract
No epidemiological data exist so far on invasive mucormycosis (IM) in Polish hematopoietic cell transplantation (HCT) and pediatric hemato-oncology (PHO) centers. The objective of this study was to analyze the incidence, clinical course, therapy, and outcome of IM in pediatric and adult patients undergoing HCT and children with hemato-oncological diseases in Poland. A total number of 12425 at-risk patients were retrospectively analyzed, and the period between 2010 and 2019 was included. Patients were analyzed in three groups: nontransplant children with malignancies, children undergoing HCT, and adults after HCT. Twenty-one patients were diagnosed with IM, including 15 children (10 non-HCT, 5 HCT) and 6 HCT adults. Proven IM was confirmed in 18 patients, probable in 2 patients, and possible in 1 patient. Proven IM was diagnosed in 7.1% of all patients with invasive fungal diseases (IFDs), including 8.1% among PHO patients, 5.4% among pediatric HCT patients, and 7.0% among adult HCT patients. Clinically, pneumonia was diagnosed in 10 (47.6%) patients, involvement of the paranasal sinuses was found in 3 (14.3%) patients, gastrointestinal disease was noted in 2 (9.5%) patients, and disseminated mucormycosis was found in 6 (28.6%) patients. The probability of overall survival in IM patients was 0.50 ± 0.11. Infection-related mortality (IRM) was 10% for pediatric nontransplant IM patients and 82% for transplant IM (pediatric + adult) patients ( = 0.004). Among the transplant patients, all adults died within 120 days. IRM for pediatric HCT patients was 60% ( = 0.038). The only prognostic factor was HCT, which adversely influenced survival in IM patients.
Keywords
invasive fungal disease; invasive mucormycosis; children; adults; leukemia; hematopoietic cell transplantation
About this articleTitle
Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019
Journal
Issue
Pages
157-163
Published online
2020-09-01
Page views
298
Article views/downloads
261
DOI
10.2478/ahp-2020-0028
Bibliographic record
Acta Haematol Pol 2020;51(3):157-163.
Keywords
invasive fungal disease
invasive mucormycosis
children
adults
leukemia
hematopoietic cell transplantation
Authors
Jan Styczyński
Krzysztof Czyżewski
Jowita Frączkiewicz
Małgorzata Salamonowicz
Agnieszka Piekarska
Monika Adamska
Przemysław Gałązka
Patrycja Mensah-Glanowska
Joanna Drozd-Sokołowska
Anna Waszczuk-Gajda
Agnieszka Tomaszewska
Kazimierz Hałaburda
Marcin Płonowski
Olga Gryniewicz-Kwiatkowska
Patrycja Zalas-Więcek
Liliana Chełmecka-Wiktorczyk
Ninela Irga-Jaworska
Tomasz Ociepa
Renata Tomaszewska
Lidia Gil