2018, Number 4
Invasive fungal disease by filamentous fungi: clinical-epidemiological profile and pharmacological response in a third level hospital in Mexico
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ABSTRACTIntroduction: The invasive fungi disease (IFD) are cause of morbidity and mortality in immunodeficient patients. Among the filament fungi, the most frequent is Aspergillus spp, follow by Hyalohyphomycosis y Zygomycetes that causes mucormycosis. Its microbiological determination could be difficult; therefore, it is important de diagnosis suspicion according to risk factors and if so, start specific treatment and increase the disease prognosis. Objectives: To describe the epidemiological and clinic features, and the pharmacological response among pediatric patients with IFD by filament fungi between January 1st, 2011 to December 31st, 2017 from Instituto Nacional de Pediatría. Material y methods: It was made a patient list, who had an IFD, took from hospital discharge data, and data from Pathology and Mycology Services. It was taken information from the clinical records corresponding to the statistical variables that included patient with IFI according to ECORTC/MSG diagnosis criteria. The information was included in an Excel program database and analyzed by SPSS 21.0 descript statistic. Results: 31 patients were identified: 18 (58%) had Aspergillosis, 9 (30%) Fusariosis, and 4 (12) Mucormycosis. The age range was from 16 days-old to 16 years old. The most important comorbidities for immunosuppression were oncohematological causes: acute lymphoblastic leukemia, and Primary Immunodeficiencies: chronic granulomatosis disease. In Aspergillosis the most frequent clinical presentation was pulmonary 61% (11), follow by brain 17% (3), skin 11% (2), rhinosinual and otomastoid 6% (1) each one. Of the cases fusariosis that in total were 9 cases 3 (33%) ecthyma gangrenosum, 2 (22%) with bacteremia and other presentations that included only one patient was neurological impairment. For Mucormycosis, four patients were reported. 75% rhinoorbital and one case representing 25% as necrotizing enterocolitis. The 80% received monotherapy, 60% with voriconazole and 20% with amphotericin duration of the average treatment was 116 days (14-540 days). Conclusions: The study replicated similar results in other clinical studies. According to the clinical characteristics referred to keep high suspected of these infections due to the fatal outcome with which they usually attend.
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