Sutatta Supatharawanich1, Nattee Narkbunnam1, Nassawee Vathana1, Chayamon Takpradit1, Kamon Phuakpet1, Bunchoo Pongtanakul1, Sasima Tongsai2, Phakatip Sinlapamongkolkul3, Popchai Ngamskulrungroj4, Wanatpreeya Phongsamart5, Kleebsabai Sanpakit1 and Jassada Buaboonnam1.
1 Division of
Hematology and Oncology, Department of Pediatrics, Faculty of Medicine,
Siriraj Hospital, Mahidol University, Bangkok, Thailand.
2 Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
3 Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
4 Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
5 Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| This is an Open Access article distributed
under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
the outcomes of childhood leukemia and severe aplastic anemia (SAA)
have improved, infectious complications are still the major concern.
Particularly worrisome are invasive fungal diseases (IFDs), one of the
most common causes of infectious-related deaths in patients with
prolonged neutropenia. A retrospective study was conducted of IFDs in
pediatric patients with newly diagnosed or relapsed acute leukemia, or
with SAA, at Siriraj Hospital, Mahidol University, Thailand. There were
241 patients: 150 with acute lymphoblastic leukemia (ALL), 35 with
acute myeloid leukemia (AML), 31 with relapsed leukemia, and 25 with
SAA. Their median age was 5.4 years (range, 0.3–16.0 years). The
overall IFD prevalence was 10.7%, with a breakdown in the ALL, AML,
relapsed leukemia, and SAA patients of 8%, 11.4%, 19.3%, and 16%,
respectively. Pulmonary IFD caused by invasive aspergillosis was the
most common, accounting for 38.5% of all infection sites. Candidemia
was present in 34.6% of the IFD patients; Candida tropicalis
was the most common organism. The overall case-fatality rate was 38.5%,
with the highest rate found in relapsed leukemia (75%). The incidences
of IFDs in patients with relapsed leukemia and SAA who received fungal
prophylaxis were significantly lower than in those who did not (P
= N/A and 0.04, respectively). IFDs in Thai children with hematological
diseases appeared to be prevalent, with a high fatality rate. The usage
of antifungal prophylaxes should be considered for patients with SAA to
Patients and Methods
1. Patient and clinical characteristics of pediatrics with hematological diseases.
2. Identifiable organisms and sites of infection.
3. The prescribed antifungal prophylaxes of pediatrics with hematological diseases.
1. Independent factors of IFD.