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Background <p>Invasive fungal infections (IFIs) cause significant morbidity and mortality in immunocompromised pediatric patients; systematic data comparing mold- and yeast-related infections remain limited.</p> Objectives <p>To evaluate epidemiology, clinical features, antifungal treatment, and outcomes of proven infectious fungal infections (IFIs) in immunocompromised children, comparing mold and yeast infections.</p> Patients/Methods <p>This single-center retrospective study included 65 immunocompromised patients aged ≤ 18&#xa0;years with proven IFIs diagnosed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) criteria.</p> Results <p>Of 65 patients (75.4% male; median age 62&#xa0;months), mold infections occurred in 21 (32.3%) and yeast infections in 44 (67.7%). <i>Aspergillus</i> spp. (n = 6) and <i>Mucor</i> spp. (n = 3) were common molds; <i>Candida parapsilosis</i> (n = 15) predominated among yeasts. ALL was more prevalent in the mold group (38.1% vs. 11.4%; <i>p</i> = 0.019), while other oncological malignancies predominated in the yeast group (50.0% vs. 19.0%; <i>p</i> = 0.017). Combination therapy (66.7% vs. 9.1%; <i>p</i> &lt; 0.001), salvage therapy (52.4% vs. 27.3%; <i>p</i> = 0.048), and treatment duration (median 56 vs. 21&#xa0;days; <i>p</i> &lt; 0.001) were higher in the mold group. Mold infections showed higher rates of nodules, cavitation, and air-crescent sign on thoracic CT (<i>p</i> &lt; 0.05) and greater pulmonary progression (23.8% vs. 2.3%; <i>p</i> = 0.011). The overall pediatric intensive care unit (PICU) admission rate was 40.0%; mechanical ventilation was more frequent in the mold group (47.6% vs. 15.9%; <i>p</i> = 0.007) and was identified as the sole independent predictor of IFI-attributable mortality (OR 14.5; 95% CI 3.47–60.41; <i>p</i> &lt; 0.001).Overall mortality was 36.9% with no between-group difference (<i>p</i> = 0.892); IFI-attributable mortality was higher in the mold group (28.6% vs. 18.2%; <i>p</i> = 0.081).</p> Conclusions <p>Mold and yeast infections show distinct clinical, radiological, and therapeutic profiles in immunocompromised children, with mold infections showing greater treatment burden and higher IFI-attributable mortality.</p>

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Epidemiology, Clinical Features, and Outcomes of Proven Invasive Fungal Infections in Pediatric Patients

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Selin Yıldız Sametoğlu,
  • Seval Ozen,
  • Gül Hatice Erkol Tuncer,
  • Belgin Gülhan,
  • Neriman Sarı,
  • Saliha Kanık Yüksek,
  • Derya Özyörük,
  • Gülsüm İclal Bayhan,
  • Neşe Yaralı,
  • Fatih Üçkardeş,
  • Turan Bayhan,
  • Aslınur Özkaya Parlakay,
  • Namık Yaşar Özbek

摘要

Background

Invasive fungal infections (IFIs) cause significant morbidity and mortality in immunocompromised pediatric patients; systematic data comparing mold- and yeast-related infections remain limited.

Objectives

To evaluate epidemiology, clinical features, antifungal treatment, and outcomes of proven infectious fungal infections (IFIs) in immunocompromised children, comparing mold and yeast infections.

Patients/Methods

This single-center retrospective study included 65 immunocompromised patients aged ≤ 18 years with proven IFIs diagnosed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) criteria.

Results

Of 65 patients (75.4% male; median age 62 months), mold infections occurred in 21 (32.3%) and yeast infections in 44 (67.7%). Aspergillus spp. (n = 6) and Mucor spp. (n = 3) were common molds; Candida parapsilosis (n = 15) predominated among yeasts. ALL was more prevalent in the mold group (38.1% vs. 11.4%; p = 0.019), while other oncological malignancies predominated in the yeast group (50.0% vs. 19.0%; p = 0.017). Combination therapy (66.7% vs. 9.1%; p < 0.001), salvage therapy (52.4% vs. 27.3%; p = 0.048), and treatment duration (median 56 vs. 21 days; p < 0.001) were higher in the mold group. Mold infections showed higher rates of nodules, cavitation, and air-crescent sign on thoracic CT (p < 0.05) and greater pulmonary progression (23.8% vs. 2.3%; p = 0.011). The overall pediatric intensive care unit (PICU) admission rate was 40.0%; mechanical ventilation was more frequent in the mold group (47.6% vs. 15.9%; p = 0.007) and was identified as the sole independent predictor of IFI-attributable mortality (OR 14.5; 95% CI 3.47–60.41; p < 0.001).Overall mortality was 36.9% with no between-group difference (p = 0.892); IFI-attributable mortality was higher in the mold group (28.6% vs. 18.2%; p = 0.081).

Conclusions

Mold and yeast infections show distinct clinical, radiological, and therapeutic profiles in immunocompromised children, with mold infections showing greater treatment burden and higher IFI-attributable mortality.