Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Study

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dc.contributor.authorKaraman, Serap
dc.contributor.authorKebudi, Rejin
dc.contributor.authorKizilocak, Hande
dc.contributor.authorKarakas, Zeynep
dc.contributor.authorDemirag, Bengu
dc.contributor.authorEvim, Melike S.
dc.contributor.authorYarali, Nese
dc.date.accessioned2024-02-23T14:49:31Z
dc.date.available2024-02-23T14:49:31Z
dc.date.issued2022
dc.departmentNEÜen_US
dc.description.abstractBackground: Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines. Materials and Methods: In this multicenter retrospective study. 51 pediatric patients with leukemia. 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combi-nation with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links lww.com/JPHO/A541). Results: Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus. Sixteen patients received single-agent. 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died. 29 of the CNSFI episodes recovered with a 20% neurological sequelae. Conclusion: CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes.en_US
dc.identifier.endpageE1045en_US
dc.identifier.issn1077-4114
dc.identifier.issn1536-3678
dc.identifier.issue8en_US
dc.identifier.pmid36036521en_US
dc.identifier.scopusqualityQ3en_US
dc.identifier.startpageE1039en_US
dc.identifier.urihttps://hdl.handle.net/20.500.12452/18243
dc.identifier.volume44en_US
dc.identifier.wosWOS:000874691500018en_US
dc.identifier.wosqualityQ4en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherLippincott Williams & Wilkinsen_US
dc.relation.ispartofJournal Of Pediatric Hematology Oncologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectCentral Nervous Systemen_US
dc.subjectFungal Infectionsen_US
dc.subjectLeukemiaen_US
dc.subjectPediatricsen_US
dc.titleCentral Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Studyen_US
dc.typeArticleen_US

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