Alternaria Invasive Infection in Children with Hemato-Oncological Disease: A National Multicenter Report

Invasive fungal diseases significantly impact hemato-oncology pediatric patients, with Aspergillus and Candida being the primary culprits. However, pediatric Alternaria infections remain understudied. This study aims to characterize Alternaria infections in pediatric hemato-oncology cases nationwide. This retrospective multicenter observational study reviewed medical records from Israel's 5 largest tertiary pediatric centers between 2011 and 2023. We identified 22 patients aged 4 to 18 years with invasive Alternaria infection. Predominant diagnoses were acute lymphoid leukemia (55%) and acute myeloid leukemia (23%), with 86% presenting neutropenic fever. Alternaria infections manifested as invasive rhinosinusitis (77%), skin lesions resembling ecthyma (14%), and pulmonary infection (9%). Notably, 76% of sinusitis cases exhibited suggestive symptoms. Voriconazole treatment led to a 90% recovery rate, irrespective of surgery. Two fatalities were unrelated to the infections. This study, the largest on Alternaria infections in children, emphasizes their occurrence in leukemia patients with neutropenic fever, showcasing common clinical presentations and a favorable prognosis despite underlying diseases.