Fungal pneumonia: the predominant lung infection causing death in children undergoing bone marrow transplantation

The study included 6 children (aged 4–14 years) receiving a conditioning regimen for bone marrow transplantation (BMT) and 14 children (aged 2-14 years) with bone marrow transplants (13 allo-geneic, 1 autologous). The children underwent flexible fibre-optic bronchoscopy (FFB) with broncho-alveolar lavage during 6 and 17 episodes of pneumonia, respectively. The aim was to compare the results of the two groups with respect to bronchoscopy findings, pneumonia-causing agents and outcome. During the conditioning regimen, the aetiological agents were recovered by bronchoscopy in 1/6 (17%) episodes and revealed by autopsy in another episode. In three episodes where the aetiology was uncertain, bacterial pneumonia was suspected in two, and Candida pneumonia in one. In episodes after transplantation the aetiological agents were recovered from bronchoscopy material in 14/17 (82%) patients. Autopsy confirmed the premortal diagnosis in the four children who died. In three episodes, bacterial pneumonia was clinically suspected. Based on clinical manifestations, FFB and autopsy findings, bacterial and fungal pneumonia were the most common diagnoses both during conditioning and after BMT. Fungal pneumonia was the most common cause of death in both groups.