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Open AccessArticle

Invasive Mold Infection of the Central Nervous System in Immunocompromised Children

1
Department of Neuroradiology, University of Frankfurt, 60528 Frankfurt, Germany
2
Department of Pediatrics and Adolescent Medicine, St. Anna Children’s Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, 1090 Vienna, Austria
3
Department of Paediatrics, Pediatric Hematology and Oncology, Christian Albrechts University Kiel, 24118 Kiel, Germany
4
Department of Paediatric Haematology and Oncology, University Children’s Hospital Tübingen, 53424 Tübingen, Germany
5
Department of Paediatrics, University Hospital Aachen, 52056 Aachen, Germany
6
Department of Paediatric Haematology and Oncology, Hannover Medical School, 30625 Hannover, Germany
7
Department of Paediatric Haematology and Oncology, University Hospital Essen, 45147 Essen, Germany
8
Department of Paediatric Haematology and Oncology, University Hospital Charité Berlin, 10117 Berlin, Germany
9
Department of Infectious Disease Research, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 53424 Münster, Germany
10
Department of Paediatrics, Paediatric Haematology and Oncology, University of Lübeck, 23562 Lübeck, Germany
11
Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, 60528 Frankfurt, Germany
*
Author to whom correspondence should be addressed.
J. Fungi 2020, 6(4), 226; https://doi.org/10.3390/jof6040226
Received: 24 September 2020 / Revised: 12 October 2020 / Accepted: 14 October 2020 / Published: 16 October 2020
(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)
Background: Due to the difficulties in the definite diagnosis, data on brain imaging in pediatric patients with central nervous system (CNS)-invasive mold infection (IMD) are scarce. Our aim was to describe brain imaging abnormalities seen in immunocompromised children with CNS-IMD, and to analyze retrospectively whether specific imaging findings and sequences have a prognostic value. Methods: In a retrospective study of 19 pediatric patients with proven or probable CNS-IMD, magnetic resonance imaging (MRI)-findings were described and analyzed. The results were correlated with outcome, namely death, severe sequelae, or no neurological sequelae. Results: 11 children and 8 adolescents (11/8 with proven/probable CNS-IMD) were included. Seven of the patients died and 12/19 children survived (63%): seven without major neurological sequelae and five with major neurological sequelae. Multifocal ring enhancement and diffusion restriction were the most common brain MRI changes. Diffusion restriction was mostly seen at the core of the lesion. No patient with disease limited to one lobe died. Perivascular microbleeding seen on susceptibility weighted imaging (SWI) and/or gradient-echo/T2* images, as well as infarction, were associated with poor prognosis. Conclusions: The presence of infarction was related to poor outcome. As early microbleeding seems to be associated with poor prognosis, we suggest including SWI in routine diagnostic evaluation of immunocompromised children with suspected CNS-IMD. View Full-Text
Keywords: child; invasive mold infection; central nervous system; magnetic resonance imaging of the brain; outcome child; invasive mold infection; central nervous system; magnetic resonance imaging of the brain; outcome
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MDPI and ACS Style

Porto, L.; You, S.-J.; Attarbaschi, A.; Cario, G.; Döring, M.; Moser, O.; Mücke, U.; Poyer, F.; Temme, C.; Voigt, S.; Groll, A.H.; Lauten, M.; Hattingen, E.; Lehrnbecher, T. Invasive Mold Infection of the Central Nervous System in Immunocompromised Children. J. Fungi 2020, 6, 226.

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