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Study Evaluates Mortality in Pediatric Invasive Aspergillosis Patients

The most common presentation for pediatric invasive aspergillosis patients was a pulmonary infection.

Invasive aspergillosis (IA) is associated with 25.4% of 12-week all-cause mortality in pediatric immunocompromised patients, according to a poster presented at IDWeek 2019.

Investigators from Boston Children’s Hospital conducted a retrospective evaluation of 20 proven and 47 probable IA cases in order to further examine the epidemiology of pediatric IA. The investigators also wanted to evaluate patient outcomes and associated risk factors for mortality.

The team used the 2008 EORTC/MSG criteria cared for at Boston Children’s Hospital between 2007 and 2019 and included data about demographics, clinical characteristics, diagnosis modality, antifungal treatment, and

Fatima Al Dhaheri, MBBS

survival.

Most of the information about currently known about IA comes from adult immunocompromised patients. Because of these knowledge gaps, there can be delays in diagnoses and timely interventions for pediatric populations which can lead to poorer outcomes. IA remains a leading cause of morbidity and mortality in immunocompromised children, the study authors added.

Two-thirds of proven IA patients and two-thirds of the probable IA patients were white, but the demographics the investigators used also included Hispanic, Middle-Eastern, and “other” categories. The mean age of diagnosis for pediatric IA patients was 11.9 years. There were various underlying conditions detected, most frequently hematopoietic-cell transplantation (HCT; 30 cases), followed by cancer and solid organ transplant. Patients who underwent HCT also had the highest mortality with 15 patient deaths, or 45% of the cases, the study authors noted.

Pulmonary IA was the most common presentation for both the proven and probable cases, the investigators learned. While skin and soft tissue (20%), abdominal (15%) and skeletal (5%) infections -made up the rest of the proven cases’ presentations, patients with probable cases also presented with tracheobronchial, sinus, CNS, and other sites of infection.

The diagnostic modalities included positive microbiology alone (18%), fungal PCR alone (1.5%), galactomannan alone (28%), and multiple modalities for remaining cases. The investigators observed 44.8% of patients were neutropenic at diagnosis and 78.5% of patients with malignancies were receiving chemotherapy.

There was neither a protective nor harmful association that came from a particular antifungal therapy or immunosuppressive regimen, the study authors determined. The immunosuppressive drugs included glucocorticoids in 34.3%, calcineurin inhibitors in 31.3%, and IMDH inhibitors in 25.3% of patients. The investigators learned that voriconazole was the most common treatment used (72%).

The study authors said it was surprising that only 1 death occurred in the primary immunodeficiency cohort of 9 patients. The 6-week mortality was 18% while the 12-week mortality was 25.4%, the study authors said.

“Due to high morbidity and mortality of IA, it is important for physicians to identify patient populations at risk, proper counseling regarding risks of acquiring Aspergillus after transplant or start of immunosuppressive treatment and utilization of optimal prophylactic treatment for higher-risk patients,” study author Fatima Al Dhaheri, MBBS, Boston Children’s Hospital clinical fellow in the Department of Infectious Diseases, told Contagion®. “On the other hand, being cognizant of the best diagnostic modalities, when to utilize them, and early diagnosis and treatment is imperative to improve patient outcomes.”

The poster, titled “Epidemiology and outcomes of invasive aspergillosis (IA) among pediatric immunocompromised patients: a 12-year, single center experience,” was presented on Thursday, October 3, 2019, at IDWeek 2019 in Washington DC.