Viral infections in children undergoing hematopoietic stem cell transplantation: report 2016 of Polish Pediatric Infectious Working Group of Polish Society of Pediatric Oncology and Hematology

BackgroundPolish Pediatric Infectious Working Group of Polish Society of Pediatric Oncology and Hematology continues from 2012 the infections monitoring program in pediatric hematopoietic stem cell transplant (HSCT) and onco-hematology centers.ObjectiveEpidemiological analysis of viral infections in children and adolescents undergoing HSCT in pediatric centers in 2012–2013 and 2014–2015.MethodsRetrospective analysis of viral infections after 650 HSCT in children and adolescents.ResultsAn increase in incidence in 2014–2015 was observed (60.6% vs 51.3%; OR=1.5; p=0.035) after allo-HSCT. Cumulative incidence after allo-HSCT (2012–2013 vs. 2014–2015) was: CMV – 28.0% vs. 29.2%, BKV – 18.5% vs. 22.8%, EBV – 15.5% vs. 24.3%, ADV – 9.5% vs. 5.2%, rotavirus – 9.1% vs. 5.6%, VZV – 2.6% vs. 1.1%, influenza – 0.9% vs. 3.4%, HHV6 – 0.9% vs. 1.5%, norovirus – 0% vs. 2.2%, RSV – 0% vs. 1.5%, parainfluenza – 0% vs. 0.7%, and MPV – 0% vs 0.4%. Infections after auto-HSCT occurred in 8 (10.5%) patients between 2012 and 2013 vs. 2 (2.6%) between 2014 and 2015. Cure rate after viral infections has increased (2012–2013 vs. 2014–2015) for: EBV – 90.7% vs. 100%, ADV – 93.8% vs. 100%, BKV – 94.2% vs. 96.8%, CMV – 94.6% vs. 98%, and remained 100% in infections with influenza, VZV, HHV6, rotavirus as well as in parainfluenza, RSV, and MPV. Decrease of deaths rate attributed to viral infections from 6.5% (2012–2013) to 0.7% (2014–2015) was observed after allo-HSCT.ConclusionsWe found epidemiological trends in viral infections after HSCT in children: increase in incidence after allo-HSCT (increase EBV, appearance of CARV) and decrease after auto-HSCT. Decrease of deaths attributed to viral infections was observed in the last period of time

Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation : lesson from the nationwide study

Incidence and outcome of microbiologically documented bacterial/viral infections and invasive fungal disease (IFD) in children and adults after hematopoietic cell transplantation (HCT) were compared in 650 children and 3200 adults in multicenter cross-sectional nationwide study. Infections were diagnosed in 60.8% children and 35.0% adults, including respectively 69.1% and 63.5% allo-HCT, and 33.1% and 20.8% auto-HCT patients. The incidence of bacterial infections was higher in children (36.0% vs 27.6%; p  21 days were risk factors for death from infection. In conclusion, pediatric patients have 2.9-fold higher incidence and 2.5-fold better outcome of infections than adults after HCT

Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019

No epidemiological data exist so far on invasive mucormycosis (IM) in Polish hematopoietic cell transplantation (HCT) and pediatric hemato-oncology (PHO) centers. The objective of this study was to analyze the incidence, clinical course, therapy, and outcome of IM in pediatric and adult patients undergoing HCT and children with hemato-oncological diseases in Poland. A total number of 12425 at-risk patients were retrospectively analyzed, and the period between 2010 and 2019 was included. Patients were analyzed in three groups: nontransplant children with malignancies, children undergoing HCT, and adults after HCT. Twenty-one patients were diagnosed with IM, including 15 children (10 non-HCT, 5 HCT) and 6 HCT adults. Proven IM was confirmed in 18 patients, probable in 2 patients, and possible in 1 patient. Proven IM was diagnosed in 7.1% of all patients with invasive fungal diseases (IFDs), including 8.1% among PHO patients, 5.4% among pediatric HCT patients, and 7.0% among adult HCT patients. Clinically, pneumonia was diagnosed in 10 (47.6%) patients, involvement of the paranasal sinuses was found in 3 (14.3%) patients, gastrointestinal disease was noted in 2 (9.5%) patients, and disseminated mucormycosis was found in 6 (28.6%) patients. The probability of overall survival in IM patients was 0.50 ± 0.11. Infection-related mortality (IRM) was 10% for pediatric nontransplant IM patients and 82% for transplant IM (pediatric + adult) patients ( = 0.004). Among the transplant patients, all adults died within 120 days. IRM for pediatric HCT patients was 60% ( = 0.038). The only prognostic factor was HCT, which adversely influenced survival in IM patients

Hemophagocytic lymphohistiocytosis: what's new in old diagnostic and clinical criteria?

Hemophagocytic lymphohistiocytosis (HLH) is a condition of overexpressed inflammatory response resulting in hypercytokinemia, macrophages infiltration and subsequent multiple organ failure. Without treatment, it leads to death. The main etiological factors include: viral, bacterial and parasitic infections, malignancies and autoinflammatory diseases. The main clinical manifestations are: high fever ≥38°C, lymphadenopathy, splenomegaly, hepatomegaly. Central nervous system involvement occurs in 30–70% of cases. Less common symptoms include: dyspnea, cough, arrhythmias, jaundice, peripheral edema, rashes, albinism and diarrhea. The picture of the disease seen in laboratory tests consists of: duopenia, hypofibrinogenemia ( < 150 mg/dL) high D-dimers level, hyperferritinemia. Other abnormalities include hypertiglyceridemia, elevated liver enzymes, hyperbilirubinemia, hypoalbuminemia and hyponatremia. Diagnostics include: laboratory tests, histopathological examination, lumbar puncture, radiological imaging, functional test and genetic checking. It is important to rule out factors mimicking HLH. Some of the old, well known criteria are no more relevant nowadays. The aim of the therapy is immunosuppressive, immunomodulatory and anti-cytokine treatment, using HLH-2004 protocol. In secondary HLH, elimination of the causative agent is critical. In case of primary HLH, or relapse of secondary forms allogenic transplantation is the only curative treatment. The prognosis is uncertain