Invasive Fungal Infections in pediatric transplant patients: five year experience at a pediatric reference center in Mexico City

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ID: 327265
2026
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Abstract
Abstract Background Invasive Fungal Infections (IFI) are an important cause of mortality in pediatric transplant patients. International studies report a frequency of 8 – 15% of diagnosis of IFI in hematopoietic stem cell transplant (HSCT) pediatric recipients. Methods We performed an observational and retrospective study to describe the frequency of possible, probable and proven IFI (EORTC/MSG), as well as clinical characteristics and outcome of HSCT pediatric recipients at Instituto Nacional de Pediatria from January 2020 to October 2025. Clinical information was obtained from electronic records. Statistic analysis: univariate analysis of cuantitaive and cualitative variables. Ética: this study adhered to international ethical standards. Results 117 patients underwent HSCT during the study period. IFI was diagnosed in 35 cases (29.9%): 37.1% were classified as posible (n=13), 51.4% as probable (n=18) and 11.4% as proven (n=4). 82.9% (n=29) of patients were male, with a median age of 7 years (1m -17 y). Hematological malignancies were the main underlying diseases of patients with IFI and HSCT, followed by hematological diseases (54.3%, n=19) and 20% (n=7) had inborn errors of immunity. Haploidentic allogenic transplant was the main type of transplant (68.6%; n=24). Graft versus host disease (GVHD) was present in 77.1% (n=27). The time interval from transplant to the diagnois of IFI was 63 days (2–1132). Invasive pulmonary aspergillosis (IPA) was the most frequent type of IFI (85.7%, n=30), with disseminated presentation ocurring in 11.4% (n=4). Proven IFI were Trichosporon asahii and Candida parapsilosis fungemia, and pulmonary mucormycosis with Rhizopus oryzae in pulmonary biopsy. Antifungal treatment was predominantly monotherapy (71.4%, n=25), with voriconazole as the most frequent drug used, 28.6% (n=10) were treated with combined therapy. Antifungal prophylaxis was used in 80% (n=28) of patients, mainly with fluconazole (60%; n=21). Viral coinfection was observed in 45.7% (n=16), with citomegalovirus (CMV) infection in 14.3% (n=5). Resolution of IFI ocurred in 60% (n=21). Death ocurred in 40% (n=14) of all the patients diagnosed with IFI, IFI- associated mortality was stablished in 5.7% (n=2). Conclusion The frequency of IFI in our cohort (29.9%) is higher than that reported in international studies. The predominance of IPA is consistent with both global and Latin American series, although the proportion of disseminated aspergillosis in our center is slightly higher. The high incidence of GVHD, the widespread use of haploidentical transplantation and the lack of mold active antifungal prophylaxis could explain the higher burden of IFI observed. These findings underscore the need to optimize prophylaxis strategies, standardize diagnostic approaches, and strengthen surveillance to improve outcomes for pediatric patients after HSCT.
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Authors Ariadna Meza, Yesica Condori, Haydee Salazar, Deborah Palacios
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.069
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S30/70833309/piag070.069.pdf
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