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Prevalence and Predictors of Invasive Fungal Infections in Children with Persistent Febrile Neutropenia Treated for Acute Leukemia – A Prospective Study

  • Jogender Kumar
  • Amitabh Singh
  • Rachna Seth
  • Immaculata Xess
  • Manisha Jana
  • Sushil Kumar Kabra
Original Article

Abstract

Objective

To ascertain the prevalence of invasive fungal infections (IFI), predictors of IFI, identify etiological species and outcome (mortality/discharge) in persistent febrile neutropenia in children with acute leukemia.

Methods

It was a prospective, observational study conducted from January 2013 through June 2014 in a tertiary care centre in New Delhi. Children between 1 and 12 y of age, on chemotherapy for acute leukemia with persistent febrile neutropenia (> 96 h) were enrolled. These children were not on any antifungal prophylaxis. Diagnosis of IFI was based on European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. Prevalence and outcome was reported in mean ± 95% CI form and etiological species were presented in the form of the frequency distribution.

Results

Three hundred nineteen episodes involving 187 children of febrile neutropenia were screened and 74 were enrolled. Prevalence of IFI was 22.97% (13.99–34.21). Positive cases were further classified into proven 3(17.6%), probable 11(64.8%) and possible 3(17.6%) according to EORTC/MSG criteria. On multivariate analysis, abnormal CXR and clinical sinusitis were important predictors of IFI. Most common fungi isolated was Aspergillus sp. followed by Candida sp. Mortality rate was 9.45% (3.89–18.52).

Conclusions

Thus, prevalence of IFI is very high in children with persistent febrile neutropenia who are not on antifungal prophylaxis. Abnormal chest x- ray and clinical sinusitis are important predictors of IFI.

Keywords

Febrile neutropenia Leukemia Invasive fungal infection Prevalence Predictors 

Notes

Contributions

JK: Conceived idea, collected data, prepared the manuscript; AS: Involved in data collection, analysis and preparing the manuscript; RS: Involved in idea, preparing the manuscript, evidence review and analysis; IX: Involved in microbiological support for fungal culture and serum galactomannan antigen test; MJ: Involved in reporting of X-rays, tomography and ultrasounds; SKK: Involved in idea, preparing the manuscript, evidence review and analysis. RS will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

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Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Jogender Kumar
    • 1
  • Amitabh Singh
    • 1
  • Rachna Seth
    • 1
  • Immaculata Xess
    • 2
  • Manisha Jana
    • 3
  • Sushil Kumar Kabra
    • 1
  1. 1.Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of MicrobiologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiodiagnosisAll India Institute of Medical SciencesNew DelhiIndia

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