Prävention von Pilzinfektionen bei Kindern und Jugendlichen mit neoplastischen Erkrankungen

Zusammenfassung.

Opportunistische Pilzinfektionen sind eine wichtige Ursache von Morbidität und Mortalität krebskranker Kinder und Jugendlicher. Betroffen sind vor allem Patienten mit intensiv zytostatisch behandelten hämatologischen Neoplasien, allogener hämatopoetischer Stammzelltransplantation und aplastischer Anämie. Die Inzidenz invasiver Pilzinfektionen in diesen Populationen beträgt 10 bis 25 % trotz empirischer antimykotischer Therapie, und die unbereinigte Mortalität liegt in Abhängigkeit vom Erreger zwischen 50 und 75 %. Präventive Interventionen einschließlich der Chemoprophylaxe mit antimykotischen Substanzen sind daher gerechtfertigt und auch grundsätzlich angezeigt. Eine wirksame Chemoprophylaxe invasiver Candida-Infektionen mit langanhaltendem Effekt auf die Überlebenswahrscheinlichkeit wurde bei Patienten mit allogener Knochenmarktransplantation nachgewiesen. Bei anderen Hochrisikopatienten ist ihr Nutzen weniger eindeutig, und eine effektive Chemoprophylaxe invasiver Aspergillus-Infektionen ist bislang nicht durch adäquate klinische Studien belegt. Die vorliegende Arbeit gibt eine Übersicht über die Epidemiologie opportunistischer invasiver Pilzinfektionen bei Kindern und Jugendlichen mit bösartigen Erkrankungen bzw. Stammzelltransplantation sowie die derzeitigen Ansätze der Chemoprophylaxe und enthält Empfehlungen zu Indikationen und Modalitäten der antimykotischen Chemoprophylaxe und allgemeinen Infektionskontrolle auf der Basis der publizierten Literatur.

Opportunistic mycoses have emerged as important causes for morbidity and mortality in pediatric cancer patients, particularly in those with intensively treated hematological malignancies, allogeneic hematopoetic stem cell transplantation, and aplastic anemia. The incidence of invasive fungal infections in these settings may range from 10 to 25 % despite empirical antifungal therapy with an overall case fatality rate of up to 50 and 75 % depending on the organism. Preventive interventions are thus warranted, including but not limited to chemoprophylaxis with antifungal agents. Effective chemoprophylaxis of invasive Candida infections with a long-term benefit for overall survival has been demonstrated in patients with allogeneic bone marrow transplantation. However, its benefit in other high-risk populations is less well established, and a clearly effective approach to chemoprophylaxis for invasive Aspergillus infections has not been documented in appropriately designed clinical trials. This article reviews epidemiology and current approaches to chemoprophylaxis of opportunistic invasive fungal infections in children and adolescents with cancer and/or stem cell transplantation, and provides evidence-based guidelines for indications and modalities of antifungal prophylaxis and antifungal infection control measures in this population.

Maligne Erkrankungen - Stammzelltransplantation - Mykosen - Candida - Aspergillus - Prophylaxe - Fluconazol - Itraconazol - Amphotericin - Kinder

Cancer - stem cell transplantation - mycoses - Candida - Aspergillus - prophylaxis - fluconazole - itraconazole - amphotericin - children

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