Background: Invasive fungal infections are common opportunistic diseases\nin patients with AIDS, other conditions related to immunodeficiency and\nhealthy infants. Most publications on this subject are related to industrialized\ncountries, and in adult population, with limited data in Latin America (except\nfor Brazil, Colombia, and Argentina), and especially in pediatric population.\nThese patients present a variety of clinical manifestations representing a diagnostic\nand therapeutic challenge for the health system. Objective: The objective\nof the study is to describe the epidemiological and laboratory characteristics\nof children with invasive fungal infections in Guatemala. Methods: A\nreview of the microbiology service database was carried out at Roosevelt\nHospital in Guatemala. Positive cultures were taken from children under 15\nyears of age, in a period of seven years, from 2007 to 2014, with its corresponding\nmedical history. Results: Finally, 23 isolates were documented but\nonly 15 patients were included in the study with complete information; 10\nHistoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp\ncase. The average age was 7 years old for Histoplasma and 9 years\nold for Criptococo, with an age range from 6 months to 14 years. Around\n60% of the patients were older than 5 years, of which, more than two-thirds\nwere HIV positive children without antiretroviral therapy, who presented an\ninvasive fungal infection at the time of HIV diagnosis. These infections are\nendemic in Guatemala, so the distribution was mostly uniform. Around 80%\nof the patients had some disease related to immunodeficiency and 70% were\ninfected with human immunodeficiency virus (HIV). The microbiological\nisolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and\nurine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly,\nrespiratory, gastrointestinal, neurological and weight loss.\nMortality rate was 53% (from them, 62% were HIV positive). From these patients,\nan87% did not receive antifungal treatment in time due to late diagnosis\nof the infection. Conclusions: These infections should be considered\nwhen treating pediatric patients from tropical regions, with nonspecific systemic\nsymptoms and signs, lymph node involvement and hematological alterations\nrelated to the mononuclear phagocytic system, mainly if they are patients\ninfected by HIV in an advanced stage, infants, or children with a disease\nthat weakens the immune system. When there is a high suspicion of a\nfungal infection, screening for HIV is mandatory; cultures should be taken\nearly and together with rapid diagnostic tests. An antifungal treatment should\nbe started immediately and then modified accordingly to laboratory results.
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