How different is invasive fusariosis in pediatric patients than in adults? A systematic review

• Published in: Current opinion in infectious diseases Vol. 34; no. 6; pp. 619 - 626
• Main Authors: Rossato, Luana, Carlesse, Fabianne, Nobrega de Almeida, João, Kontoyiannis, Dimitrios P., Colombo, Arnaldo Lopes
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2021
• Subjects: Adult; Antifungal Agents - therapeutic use; Child; Fusariosis - diagnosis; Fusariosis - drug therapy; Hematologic Neoplasms; Humans; Triazoles; Voriconazole - therapeutic use
• ISSN: 0951-7375; 1473-6527
• DOI: 10.1097/QCO.0000000000000776

To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients.
We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021.
One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous system involvement (8%, 9/106). Fusarium solani, followed by Fusarium oxysporum, were the most commonly reported species. In disseminated fusariosis, relapsed or refractory baseline disease (P < 0.001, OR=10.555, CI 95% 3.552-31.365) was associated with poor outcome, whereas voriconazole-based therapy was associated with better prognosis (P  = 0.04, OR = 0.273, CI 95% 0.076-0.978).
Hematologic malignancies and solid tumors requiring intensive immunosuppression are the main conditions related to IF in children where other organs than skin, blood, and lungs were frequently involved. Voriconazole therapy appears to be also effective in children with IF, despite the wide pharmacokinetic variability of this triazole in pediatric patients.