Application of granulocyte colony stimulating factor in the treatment of invasive fungal infections in congeni-tal immunodeficiency:Two pediatric cases reports and review of literatures

Abstract

Objective To discuss the therapeutic significance of granulocyte colony stimulating factor (G-CSF) in the treatment of invasive Candida infections in congenital immunodeficiency, especially in cases with low level of interleukin 17(IL-17). Methods Therapeutic processes of 2 children suffering from invasive Candida infections secondary to congenital immunodeficiency were retrospectively studied, furthermore, the related literatures were also reviewed. Results Whole-exome sequencing revealed CARD9 mutation in the first patient, who suffered from Candida albicans meningoencephalitis, while the other patient revealed STAT1 mutation suffering from recurrent lung abscess caused by Candida albicans, and both of them showed low level of blood IL-17.Routine antifungal drugs were insufficiency, even treatment period had prolonged for several months.But after the G-CSF adjuvant therapy, their symptoms, signs and images recovered.With 5 to 10 months follow-up, no recurrent infections were found. Conclusion Antifungal drugs combined with G-CSF can effectively improve the treatment effect in invasive fungal infections secondary to immunodeficiency.Further more, genetic screening especially whole-exome sequencing can be suggested to find unusual immunodeficiency, which helps more individualized treatment. Key words: Congenital immunodeficiency; Invasive Candida infection; Granulocyte colony stimulating factor; Caspase-associated recruitment domain-containing protein 9; Signal transducers and activators of transcription 1; Interleukin-17