title: Benefit of surgical resection of invasive pulmonary aspergillosis in pediatric patients undergoing treatment for malignancies and immunodeficiency syndromes.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcome of children undergoing treatment for malignancy and immunodeficiency syndromes in whom invasive pulmonary aspergillosis (IPA) developed.
  
  
  METHODS
  The authors reviewed the medical records of all patients treated at their institution from January 1990 to August 1999 for culture-proven pulmonary aspergillus infection.
  
  
  RESULTS
  Among the 43 patients studied, the median age at the time of diagnosis of IPA was 13.1 years. The most common primary diagnoses were acute myelogenous leukemia (n = 18) and acute lymphoblastic leukemia (n = 14); 27 patients (63%) had received a bone marrow transplant (BMT). Of the 18 patients who underwent surgical intervention for IPA, 14 (78%) had one operation, whereas the remaining 4 patients had 2. The 4 patients alive at the time this report was written had undergone surgical intervention 2, 10, 23, and 44 months previously respectively. Surgical resection of the involved lung parenchyma was significantly prognostic for survival (P <.001). Other factors that influenced outcome were the extent of pulmonary invasion, steroid use, and the timing of bone marrow transplantation (BMT) in regard to the diagnosis of IPA.
  
  
  CONCLUSIONS
  The overall mortality rate of children treated for malignancies and immunodeficiency syndromes in who IPA develops remains high, and antifungal therapy alone may not be curative. Surgical resection may provide a small but possibly the only chance for survival. Therefore, we would advocate for resection of all involved tissue, even if it requires reoperation.
authors.affiliation: Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Hayes-Jordan
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Billups
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Shenep
authors.forename: Frederic A
authors.initials: FA
authors.lastname: Hoffer
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Schropp
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Shochat
mesh_terms: D000293:Adolescent; D001228:Aspergillosis / Q000150:complications / Q000601:surgery*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes / Q000150:complications; D007223:Infant; D007938:Leukemia / Q000150:complications / Q000628:therapy; D008172:Lung Diseases, Fungal / Q000150:complications / Q000601:surgery*; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome