Invasive fungal infections in pediatric patients with leukemia: Emphasis on pulmonary and dermatological manifestations

Patients of hematological malignancies with neutropenia form one of the most susceptible host groups for microbial infection. In this study, we concentrated on the pulmonary and cutaneous manifestations of invasive fungal infections in leukemic children, aiming to make early diagnosis and intervention. Clinical, laboratory, radiological, and histopathological findings concerning 13 leukemic children who had invasive fungal infection between 1997 and 2002 were retrospectively reviewed. Seventy-seven percent (10/13) of diagnoses were made by fungal cultures and/or by histopathological evidence from various specimens, four from cutaneous lesions and six from pulmonary tissues. Candidiasis was the most common infection (69%), followed by mucormycosis (15%), fusariosis (8%), and aspergillosis (8%). Three episodes of fungemia (23%) were identified. Lung (69%) and skin (69%) were the two most common sites of disseminated fungal infections. A premortem diagnosis was documented in 92% of the patients. Pathogens other than Candida albicans (85%) accounted for the great majority of cases. The case-fatality rate was 31% of disseminated fungal infections. A vigilant assessment of any suspicious lesion by physical and radiological examinations, including a biopsy of the lesions for microbiological and histopathological studies, may provide helpful for early diagnosis of disseminated fungal infections in leukemic children.