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    Central nervous system fungal infections in children with leukemia and undergoing hematopoietic stem cell transplantation: A retrospective multicenter study
    (2022) Karaman, Serap; Kebudi, Rejin; Kızılocak, Hande; Karakaş, Zeynep; Demirağ, Bengü; Evim, Melike Sezgin; Yaralı, Neşe; Kaya, Zühre; Karagün, Barbaros Şahin; Aydoğdu, Selime; Çalışkan, Ümran; Ayhan, Aylin Canbolat; Bahadır, Ayşenur; Çakır, Betül; Güner, Burçak T.; Albayrak, Canan; Karapınar, Deniz Yılmaz; Kazancı, Elif Güner; Ünal, Ekrem; Türkkan, Emine; Akıcı, Ferhan; Bor, Özcan; Vural, Sema; Yılmaz, Şebnem; Apak, Hilmi; Baytan, Birol; Tahta, Neryal Müminoğlu; Güzelküçük, Zeliha; Koçak, Ülker; Antmen, Bülent; Tokgöz, Hüseyin; Fışgın, Tunç; Özdemir, Nihal; Güneş, Adalet Meral; Vergin, Canan; Ünüvar, Ayşegül; Özbek, Namık; Tuğcu, Deniz; Bay, Sema Büyükkapu; Tanyıldız, Hikmet Gülşah; Celkan, Tiraje
    Background: Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines. Materials and methods: In this multicenter retrospective study, 51 pediatric patients with leukemia, 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combination with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links.lww.com/JPHO/A541). Results: Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus. Sixteen patients received single-agent, 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died, 29 of the CNSFI episodes recovered with a 20% neurological sequelae. Conclusion: CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes.
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    Öğe
    COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group
    (2024) Bozkurt, Ceyhun; Hazar, Volkan; Malbora, Barış; Küpesiz, Alphan; Aygüneş, Utku; Fışgın, Tunç; Karakükçü, Musa; Kuşkonmaz, Barış; Kılıç, Suar Çakı; Bayırlı, Derya; Bilir, Özlem Arman; Yalçın, Koray; Gözmen, Salih; Uygun, Vedat; Elli, Murat; Sarbay, Hakan; Küpesiz, Funda Tayfun; Şaşmaz, Hatice İlgen; Aksoy, Başak Adaklı; Yılmaz, Ebru; Okur, Fatma Visal; Tekkeşin, Funda; Yenigürbüz, Fatma Demir; Özek, Gülcihan; Atay, Abdullah Avni; Bozkaya, İkbal Ok; Çelen, Suna; Öztürkmen, Seda; Güneş, Adalet Meral; Gürsel, Orhan; Güler, Elif; Özcan, Alper; Çetinkaya, Duygu Uçkan; Aydoğdu, Selime; Özbek, Namık Yaşar; Karasu, Gülsün; Sezgin, Gülay; Doğru, Ömer; Albayrak, Davut; Öztürk, Gülyüz; Aksoylar, Serap; Daloğlu, Hayriye; Al, Işık Odaman; Evim, Melike Sezgin; Akbayram, Sinan; Öncül, Yurday; Zengin, Emine; Albayrak, Canan; Timur, Çetin; Kar, Yeter Düzenli; Çakmaklı, Hasan Fatih; Tüfekçi, Özlem; Töret, Ersin; Antmen, Bülent
    Background: Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. Method: In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. Results: The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. Conclusion: While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.