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Hepatosplenic Fungal Infections in Children With Leukemia—Risk Factors and Outcome

A Multicentric Study

Celkan, Tiraje, MD*; Kizilocak, Hande, MD*; Evim, Melike, MD; Meral Güneş, Adalet, MD; Özbek, Namik Y., MD; Yarali, Neşe, MD; Ünal, Ekrem, MD§; Patiroğlu, Türkan, MD§; Yilmaz Karapinar, Deniz, MD; Sarper, Nazan, MD; Zengin, Emine, MD; Karaman, Serap, MD#; Koçak, Ülker, MD**; Kürekçi, Emin, MD††; Özdemir, Canan, MD‡‡; Tuğcu, Deniz, MD#; Uysalol, Ezgi, MD§§; Dikme, Gürcan, MD*; Adaletli, İbrahim, MD∥∥; Kuruoğlu, Sebuh, MD∥∥; Kebudi, Rejin, MD*,¶¶

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p 256–260
doi: 10.1097/MPH.0000000000001431
Original Articles

Background: Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment.

Procedure: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers.

Results: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals.

Conclusions: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.

*Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa

#Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine

∥∥Division of Pediatric Radiology, Cerrahpaşa Faculty of Medicine

¶¶Division of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University

§§Division of Pediatric Hematology-Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul

Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University, Bursa

Ankara Pediatric Hematology-Oncology Training and Research Hospital

**Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University

††Lösante Pediatric Hematology Hospital, Ankara

§Division of Pediatric Hematology-Oncology, Faculty of Medicine, Erciyes University, Kayseri

Division of Pediatric Hematology-Oncology, Faculty of Medicine, Ege University, Bornova

Division of Pediatric Hematology-Oncology, Faculty of Medicine, Kocaeli University, Izmit

‡‡Division of Pediatric Hematology-Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey

T.C. and H.K. contributed equally.

The authors declare no conflict of interest.

Reprints: Rejin Kebudi, MD, Division of Pediatric Hematology-Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, 34098 Turkey (e-mail:

Received May 23, 2018

Accepted January 8, 2019

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