Invasive Fusarium Infections in Immunocompromised Children

BACKGROUND: Invasive fusariosis is a rare but severe fungal infection associated with high morbidity and mortality in immunocompromised children, and pediatric‑specific standardized management strategies remain limited. METHODS: We conducted a 10‑year multicenter retrospective cohort study across 28 pediatric hematology centers of the French Society for the Fight Against Cancer and Leukemia in Children and Adolescents, combined with a structured literature review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Children ≤18 years with proven or probable invasive fusariosis between 2012 and 2022 were included. Primary outcomes were infection response and mortality; secondary outcomes included dissemination patterns and impact on hematologic treatment. RESULTS: A total of 55 children were included (19 from the French cohort and 36 from the literature). The median age was 9 years, and 87% had underlying hematologic malignancies. Disseminated fusariosis occurred in 73% of patients. Skin involvement was the most frequent manifestation (82%). Voriconazole (91%) and liposomal amphotericin B (64%) were the most used antifungals; 75% of patients received combination therapy. Infection control at the end of antifungal therapy was achieved in 67% of patients. Overall mortality was 55%, with fusariosis contributing directly or indirectly to 45% of deaths. Disseminated disease was associated with a higher risk of fusariosis‑related mortality (odds ratio 4.7, 95% confidence interval [1.1-19.2], P = 0.03). CONCLUSIONS: Invasive fusariosis remains a highly lethal infection in immunocompromised children, particularly in disseminated forms, and significantly interferes with oncologic treatment. Early diagnosis and aggressive antifungal treatment, combined with continued management of the underlying condition, are critical to improving outcomes.