Central Nervous System Fungal Diseases in Children with Malignancies: A 15-Year Study from the Infection Working Group of The Hellenic Society of Pediatric Hematology Oncology

• DOI: 10.20944/preprints202408.0531.v1
• Publication Date: 2024-08-14T07:55:45Z
• Authors: Loizos Petrikkos; Maria Kourti; Kondylia Antoniadi; Tatiana-Sultana T...; Angeliki-Eleni Sf...; Vasiliki Antari; Sofia Savoukidou; Georgia Avgerinou; Maria Filippidou; Eugenia Papakonst...; Sophia Polychrono...; Emmanuel Hatzipan...; Dimitrios Doganis; Antonis Kattamis; Vassilios Papadakis; Emmanuel Roilides; Athanassios Tragi...

We analyzed data of pediatric invasive fungal diseases of the central nervous system (CNS-IFDs) reported by five of total eight Pediatric Hematology-Oncology Departments in Greece for 15 years (2007-2022). A total of twelve patients (11 boys, median age: 9.5yrs range: 2-16) were reported suffering from CNS-IFDs. Underlying malignancy was acute lymphoblastic leukemia in 9/12, and acute myeloid leukemia, Ewing sarcoma and rhabdomyosarcoma in one each. Eleven patients presented with CNS-related symptoms (i.e seizures, headache, cerebral palsy, ataxia, hallucination, seizures, blurred vision, amaurosis). All patients had pathological MRI findings. Multifocal fungal disease was observed in 6/12 patients. Nine proven and three probable CNS-IFD cases were diagnosed. Causative pathogens in proven cases were Aspergillus spp. and Candida albicans (n=2 each), Mucor spp., Rhizopus arrhizus, Absidia spp., Fusarium oxysporum and Cryptococcus neoformans (n=1 each). Causative pathogens in probable cases were Aspergillus spp. (n=2) and Candida spp. (n=1). All patients received appropriate antifungal therapy (median duration: 69.5 days, range 19-364). Two patients underwent additional surgical treatment. Six patients admitted to ICU due to complications. Three patients (25%) died, two due to IFD and one due to underlying disease. Early recognition and prompt intervention of CNS-IFDs may rescue the patients and improve overall survival.