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P-013 Acute Lymphoblastic Leukaemia PREVALENCE OF INVASIVE FUNGAL

INFECTIONS (IFI) IN CHILDREN WITH FEBRILE NEUTROPENIA BETWEEN 1-12 YEARS
TREATED FOR ACUTE LEUKEMIA-A PROSPECTIVE...

Poster · October 2014

DOI: 10.13140/RG.2.1.2836.9522

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6 authors, including:

Amitabh Singh Sushil Kumar Kabra

Vardhman Mahavir Medical College and Safdarjung Hospital All India Institute of Medical Sciences
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Manisha Jana
All India Institute of Medical Sciences
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 P-013
Acute Lymphoblastic Leukaemia
PREVALENCE OF INVASIVE FUNGAL INFECTIONS (IFI) IN CHILDREN WITH
FEBRILE NEUTROPENIA BETWEEN 1- 12 YEARS TREATED FOR ACUTE
LEUKEMIA- A PROSPECTIVE STUDY
J. Yadav1, S. Amitabh2, R. Seth2, S.k. Kabra2, I.M.A. Xess3, M. Jana4
1
Pediatrics, ALl India Institute of Medical Sciences, Delhi, India
2
Pediatrics, All India Institute of Medical Sciences, Delhi, India
3
Microbiology, All India Institute of Medical Sciences, Delhi, India
4
Radiology, All India Institute of Medical Sciences, Delhi, India
Objectives
The objective of our study was to ascertain the prevalence, determinants, etiological
species of invasive fungal infections (IFI) and outcome (discharge/ death) during
febrile neutropenic episodes in children with acute leukemia between 1-12 years age
group during chemotherapy.
Methods
Episodes of febrile neutropenia of duration ≥96 hrs were enrolled and investigated for
fungal infection. Blood investigations including Galactomannan antigen, aspergillus
serology, Bactac fungal culture and radiological investigations were done. Serial
monitoring of Galactomannan Ag was done to assess treatment response. Revised
definitions of IFI from the European Organization for Research and Treatment of
Cancer (EORTC) were used for analysis.
Results
Total 254 febrile neutropenic episodes were screened and 60 patients fulfilled the
enrollment criteria. Out of 60, thirteen (21%) had IFI.As per EORTC out of thirteen,
three (23%) classified as proven, seven (54%) probable and three (23%) as possible.
Two (3%) patients died during same admission. Most common fungal isolate (n=3)
from blood was Candida (67%) and one patient had trichosporon. Radiological
findings suggestive of IFI was present in ten patients, nodular opacity in lung was
most consistent findings. Galactomannan Antigen was positive in thirty patients.
Conclusions
This study is ongoing and preliminary analysis showed Candida is most common
fungal agent causing proven IFI. Aspergillus was most commonly associated with
radiological abnormalities. Galactomannan Ag was found to be useful in early
diagnosis and monitoring of response to antifungal therapy. Prolonged neutropenia (>
14 days) was most consistently associated risk factor for IFI. EORTC guidelines for
IFI has limitations as children with nasal/Oral swab or urine culture showing fungal
growth, CT showing fungal ball in solid organs( Kidney) with positive Galactomannan
Ag test also benefited with antifungal therapy suggesting likely systemic fungal
infection although these were not included in criteria of IFI.

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