Epidemiology of invasive pulmonary mycoses in children and adolescents after allogeneic hematopoietic stem cells transplantation (allo-HSCT)

Ref ID: 19399

Author:

A. G. Volkova,1 M. O. Popova,1 O. V. Shadrivova,2
T. S. Bogomolova,2 S. M. Ignatyeva,2 I. S. Zyuzgin,3
L. S. Zubarovskaya,1 N. N. Klimko2 and B. V. Afanasyev1

Author address:

1I. Pavlov State Medical University, Saint-Petersburg, Russian
Federation; 2Kashkin Research Institute of Medical Mycology,
Department of Clinical Mycology, Saint-Petersburg, Russian
Federation and 3Leningrad Regional Clinical Hospital, Saint-Pete

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Background Changing of the management in transplant practices
has led to changes in patterns of invasive fungal infections. We
reviewed the spectrum of invasive pulmonary mycoses (IPM) and
times of occurrence of the disease in children and adolescents after
allo-HSCT.
Materials and methods We prospectively analyzed the medical
records of 151 allo-HSCT recipients of pediatric and adolescent units
from 2009 to 2012 with lungs lesions on CT scan. All the patients
underwent CT guided bronchoscopy with a comprehensive study of
broncho-alveolar lavage (BAL) fluid. During the study period we per-
formed 229 bronchoscopic procedures. We used EVIS EXERA II
Olympus endoscopic video system with an external diameter of the
distal end tubes of the 3.6 mm and 4.9 mm in a specialized endos-
copy room or ICU. Different methods of anesthesia were performed,
depending on the age and the degree of respiratory failure of patients
with mandatory monitoring of vital functions of the body and oxy-
gen levels. The samples obtained were sent immediately to the labo-
ratory for cytology assessment, GM detection, direct microscopy,
bacterial, fungal, and mycobacterial culture. Viral screening was per-
formed by PCR.
Results Invasive pulmonary mycoses were seen in 40 (26%) patients
according to EORTC/MCG 2008 criteria, 8.3% of them were proven
by biopsy. The results of galactomannan (GM) tests in BAL fluid were
positive in 60% of the samples. Direct microscopy and culture meth-
ods were positive in 38% of the specimens. Most of the pathogens
were Aspergillus spp. (74%) and Mucorales spp. (20%). Among the
rare pathogens were detected Trichoderma spp. and P.jiroveci. In 32
patients (54%) the diagnosis was established after D + 100 allo-
HSCT. Overall survival within 100 days from the diagnosis was
41%. No major complications occurred during bronchoscopy and
biopsy.
Conclusion – The incidence of fungal infections among children and
adolescents after allo-HSCT with lung lesions on CT was 26%.
– Complex investigation of BAL fluid can reliably detect significant
pathogens. The use of the indirect diagnostic tests (GM) significantly
increases the diagnostic value of BAL. Culture and direct microscopy
remains an important diagnostic tool allowing to reveal the local
epidemiology.
– Bronchoscopy performed with modern video endoscopy equip-
ment and adequate anesthetic can safely be used in children after
allo-HSCT.
– Our data illustrate a shift towards a later occurrence of invasive
pulmonary mycosis after allo-HSCT.

Abstract Number: p117

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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