Invasive candidiasis in children after hematopoietic stem cell transplantation

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Abstract

Invasive fungal disease due to Candida spp. – Invasive candidiasis/candidaemia, is a life-threatening complication in immunosuppressed patients. The publications on epidemiology of invasive candidiasis (IC) in children after hematopoietic stem cell transplantation (HSCT) is limited. The purpose of the study was to study the epidemiology of IC in children after HSCT for the 7 years in Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation. In 2009–2016 yy have been performed 754 HSCT in children: 494 allogeneic and 260 autologous. The study was approved by the Independent Ethics Committee of the Raisa Gorbacheva Memorial Research Institute of Children's Oncology, Hematology and Transplantation. A retrospective study included 22 cases of invasive candidiasis in after HSCT. EORTC/MSG 2008 criteria were used for the diagnosis of proven invasive candidiasis as well as to evaluate response to therapy. Incidence of IC was 2.9%: allo-HSCT – 3% (n = 15), auto-HSCT – 2,7% (n = 7). The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. The etiology: Candida parapsilosis – 50%, Candida albicans – 27%, Candida krusei – 14%, Candida tropicalis – 5%, Candida dubliniensis – 4%. The most frequent underlying diseases was acute leukemia – 45% (n = 10). The median age was 8 y.o. (3 month–18 years). The median day of onset of IC after allo-HSCT was 63 days (4–243), auto-HSCT – 12 days (3–20). Febrile fever was the main clinical symptom; septic syndrome develops in 32% cases. Antifungal therapy was with echinocandins – 23%, lipid ampho B – 27%, triazole (fluconazole, voriconazole) – 32%, without therapy (due to early mortality) – 18%. Overall survival (OS) at 30 days from diagnosis invasive candidiasis was 50%. The central venous catheter (CVC) removal was the only factor significantly improved OS (70% vs 33%, p = 0,035). Incidence of Invasive candidiasis in children after hematopoietic stem cell transplantation was 2.9%. The main etiology agent was Candida parapsilosis. Invasive candidiasis infections most often affect leukemia patients, after allo-HSCT developed later than auto-HSCT. Overall survival at 30 days from the diagnosis was 50%. Removing of CVC improved overall survival in children with invasive candida infections after HSCT

About the authors

I. V. Markova

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0001-5861-7319
Russian Federation

Yu. A. Rogacheva

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0001-8270-4535
Russian Federation

M. O. Popova

First Pavlov State Medical University of Saint-Petersburg

Author for correspondence.
Email: marina.popova.spb@gmail.com
ORCID iD: 0000-0001-8536-5495

Marina О. Popova, MD, PhD, hematologist at BMT department for adults Raisa Gorbacheva Memorial Research Institute of Children's Oncology, Hematology and Transplantation, Associate Professor at the Department of hematology, transfusiology and transplantation.

197022, Saint-Petersburg, Tolstoy st., 6/8.

Russian Federation

A. G. Volkova

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0003-3183-3462
Russian Federation

K. A. Ekushov

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-1104-6499
Russian Federation

A. S. Frolova

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0003-1143-4851
Russian Federation

A. N. Shvetcov

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0001-7173-7673
Russian Federation

I. Y. Nikolaev

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-8589-4618
Russian Federation

S. M. Ignatyeva

I. Metchnikov North-Western State Medical University, Kashkin Research Institute of Medical Mycology

ORCID iD: 0000-0002-0306-3694
Russian Federation

T. S. Bogomolova

I. Metchnikov North-Western State Medical University, Kashkin Research Institute of Medical Mycology

ORCID iD: 0000-0002-2450-687X
Russian Federation

O. N. Pinegina

First Pavlov State Medical University of Saint-Petersburg

Russian Federation

A. G. Gevorgian

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0003-2905-8209
Russian Federation

O. V. Paina

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0001-7263-4326
Russian Federation

T. A. Bykova

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-4456-2369
Russian Federation

O. V. Goloshchapov

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-0736-1269
Russian Federation

M. D. Vladovskaya

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-0215-4623
Russian Federation

I. S. Moiseev

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-4332-0114
Russian Federation

L. S. Zubarovskaya

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0003-2594-7703
Russian Federation

N. N. Klimko

First Pavlov State Medical University of Saint-Petersburg; I. Metchnikov North-Western State Medical University, Kashkin Research Institute of Medical Mycology

ORCID iD: 0000-0001-6095-7531
Russian Federation

B. V. Afanasyev

First Pavlov State Medical University of Saint-Petersburg

ORCID iD: 0000-0002-1235-4530
Russian Federation

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Copyright (c) 2019 Markova I.V., Rogacheva Y.A., Popova M.O., Volkova A.G., Ekushov K.A., Frolova A.S., Shvetcov A.N., Nikolaev I.Y., Ignatyeva S.M., Bogomolova T.S., Pinegina O.N., Gevorgian A.G., Paina O.V., Bykova T.A., Goloshchapov O.V., Vladovskaya M.D., Moiseev I.S., Zubarovskaya L.S., Klimko N.N., Afanasyev B.V.

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