Epidemiology of Invasive Fungal Infections (IFI) in Immunocompromised Children (ICC) at Autopsy

EDUARDO LOPEZ-MEDINA, SARAH JOHNSON-WELCH, JANE D. SIEGEL and MONICA I. ARDURA

Author address: 

University of Texas Southwestern Medical Center, Dallas, TX

Abstract: 

Background: IFI are an important cause of morbidity and mortality in ICC. Reported prevalence may be underestimated, as diagnosis remains a challenge. Objective: Identify the epidemiology and characteristics of IFI at autopsy in ICC. Methods: We reviewed all autopsy-proven IFI in ICC performed at Children's Medical Center, Dallas, from 2000-2011. IFI were classified as possible, probable, or proven as defined by EORTC/MSG criteria. Results: 538 autopsies were performed over the 11 years (overall average autopsy rate 26 %/yr). There were 122 (23%) ICC, 24 (20%) of whom had an IFI at autopsy, 16 males, median age of 7 y [range 1-18 y]: 11 (46%) with malignancy: 7 ALL, 1 AML, 3 other; 2 (8%) HSCT recipients, 5 (21%) SOT recipients: 3 heart, 1 liver, 1 kidney and 6 (25%) with other immunocompromising conditions. Autopsy cultures from blood or tissue were positive in 15 ICC: 11 (46%) for yeast (4 C. albicans , 3 C. tropicalis , 2 C. glabrata , 1 C. lusitaneae, 1 yeast sp), 6 (25%) for molds (2 Aspergillus terreus , 2 A. fumigatus , 1 A. flavus , 1 Rhizopus arrizus ) and 2 mixed. 9 (38%) patients had abnormal histopathology with fungal elements (4 yeast, 6 mold, 1 mixed) but negative autopsy cultures. Extent of disease at autopsy included fungemia alone (n=2), disseminated disease (n= 12: 6 Candida , 6 Aspergillus , 1 Rhizopus , 1 yeast, 2 mixed Candida and Aspergillus ) and local disease of the lung (n=5; 1 Candida , 3 Aspergillus , 1 yeast sp), CNS (n=2, 1 Aspergillus , 1 Rhizopus ), esophagus (n=2, 1 Candida , 1 yeast), peritoneum (n=1, Candida ). IFI was an unexpected finding at autopsy in 10 (42%) ICC and was deemed the cause of death in 4 (4 Aspergillus , 2 Candida , 2 mixed). None had received antifungal therapy and had Aspergillus (n=6), Candida (n=5), yeast sp (n=1), Rhizopus (n=1), mixed Candida and Aspergillus (n=3) with local disease (lung n=3, CNS n=1, esophagus n=1) or disseminated disease (n=5). Conclusion: IFI was not clinically suspected ante-mortem, but found unexpectedly at autopsy in a large percentage of ICC. Autopsies are important epidemiological tools that are necessary for continued clinical quality improvement.
2012

abstract No: 

526

Full conference title: 

ID Week 2012
    • IDWeek 2012