Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection

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Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection. Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs. Patients and Methods: our study was done over period from October 2017 to June 2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included (8 male, and 14 female) with age range (14m- 16 yrs.). We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection. Results: in our case group; the most common underlying disease was ALL-B cell (n=6, 40%), followed by ALL-T cell (n=2, 13.3%), AML (n=2, 13.3%), aplastic (n=3, 20%), hepatobalstoma (n=1, 6.7%) and auto-immunodeficiency (n=1, 6.7%).Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection (53.3% vs. 0% respectively, p=0.015), followed by consolidation (40% vs. 57.1%, p=0.45) and ground glassing (26.7% vs. 14.3%.Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics.