Clinical Features and Outcomes of Invasive Fusariosis in Pediatric Patients with Acute Lymphoblastic Leukemia (ALL): A Case Series in a Single Tertiary Center in North-Eastern Mexico

Abstract

Abstract Background Fusariosis is a pathology that is of great clinical concern in certain at-risk patient groups. Pediatric patients with ALL are in the greatest at-risk population as they are frequently in a post-chemotherapy state. The diagnosis for IFIs can be carried out by the criteria established in the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) and the notable intrinsic resistance of the Fusarium species to most of the antifungal agents available lead to high mortality rates in immunocompromised patients. Starting in 2002, the use of voriconazole was approved as empiric monotherapy as a first line therapy for the treatment of disseminated fusariosis. Other options are liposomal amphotericin B (LAB), Posaconazole or Isavuconazole. There are a few reports combined antifungal treatment in a pediatric population. In pediatric patients, the empirical and specific antifungal treatment is mostly inferred from clinical experience in adult patients. Methods We identified six patients with culture-proven fusariosis at a tertiary healthcare center in North-Eastern Mexico from May 2018- August 2021. We reported six cases of fusariosis categorized according to the EORTC/MSG. B cell ALL diagnosis was defined as a positive result in a B-cell leukemia panel. In terms of the descriptive statistics, continuous variables were reported as medians and [Interquartile range], while categorical variables were described via counts, frequencies, and (prevalence). Results The median age was 8 [6-12], 2 of the patients were female. All of the included patients were in the remission induction phase of their therapy and all patients had a confirmed B cell ALL and all patients presented with neutropenia. Four patients had a central venous catheter present, 3 of patients had a bacterial co-infection (E. coli, S. pneumoniae, Klebsiella blee). LAB was given as empirical therapy in 3 of patients while one patient received a combination of amphotericin B and voriconazole and the remaining patient received voriconazole monotherapy. Five patients had resistance to LAB, two patients showed voriconazole resistance. The definitive treatment was LAB plus Voriconazole in 5 (83.3%) patients. Five (83.3%) patients survived. Conclusions There are no clearly established guidelines for treatment options for fusariosis in pediatric patients. The majority of our reported patients presented with LAB-resistance and the combination of LAB with voriconazole has been used to control this pathology. There is still much more to explore and further research is needed into the indicated treatment plan and the susceptibility and therapeutic strategy for this specific population.